Methicillin-Resistant Staphylococcus aureus in Patients With Congenital Heart Disease in the Pediatric Intensive Care Unit

Abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been recognized as a significant problem among hospitalized patients. Available data about prevalence of MRSA among children with congenital heart disease (CHD) are minimal. The aim of the study was to determine the prevalence of MRSA colonization and to identify risk factors for MRSA colonization among children <19 years old with CHD admitted to a pediatric intensive care unit (PICU). Methods Admission and weekly MRSA nasal surveillance testing was performed, and patients were stratified into six risk groups based on the Risk Adjustment for Congenital Heart Surgery-1 Method. The MRSA-colonized children were compared to the MRSA noncolonized children. Results During the 3-year study period, there were 372 admissions of children with CHD to the PICU. Of the 372, 72 (19.4%) had no surveillance cultures performed or had no prior history of MRSA and were excluded from further analysis. Of the remaining 300 admissions, 29 (9.7%) (263 individual children) were found to be colonized. The mean age of the 263 children when first admitted to the PICU was 3.29 years (range 0.03–18.30, median 0.66). Age distribution was not significantly different between the colonized and noncolonized groups (P = .236). Gender (P = .667), race (P = .837), and CHD complexity (P = .395) were not significantly associated with colonization. The odds of being colonized if previously hospitalized were 4.42 times greater than if not previously hospitalized (95% confidence interval 1.89, 10.34). Conclusion Routine MRSA surveillance should be performed in patients with CHD to identify colonized patients.

Epidemiology and outcomes of pretransplant methicillin‐resistant Staphylococcus Aureus screening in pediatric solid organ transplant candidates

“…Following the initiation of a systematic process to screen pediatric solid organ transplant candidates for S. aureus , we found that 13% of all patients screened were colonized with MRSA. This is a considerably higher MRSA colonization rate than documented in other pediatric patient populations, ranging from 1.15% in all patients admitted to a children's hospital in Rome up to 9.7% in pediatric intensive care unit patients with a history of congenital heart disease . Locally, in 2015, 2.5% of all staphylococcus aureus screening tests were positive for MRSA (JEM, Joel Mortensen, unpublished data).…”

“…The majority of the available literature involving MRSA in SOT has focused on the epidemiology and risk factors in adult SOT recipients. Within the pediatric population, there are no published reports of pretransplant MRSA colonization rates, while rates in other non‐transplant populations range from 1.15% in hospitalized children in Italy to 9.7% in pediatric intensive care unit patients with a history of congenital heart disease …”

Effects of Stepwise Application of Active Surveillance Culture, Preemptive Isolation, and Chlorhexidine Bed Bath on the Acquisition of Methicillin-resistant Staphylococcus aureus in Children Undergoing Cardiac Surgery in the Paediatric Intensive Care Unit

“…또한 선천성 심장병 환자들에서 황 색포도알균 감염 중 MRSA가 53.6% 분리되었고, MRSA 감염 중 수술부위 감염이 28.2% 발생하였으며 [6] 소아 심 장수술 후 수술부위 감염이 136,950달러의 병원 비용을 발생시키고 재원기간을 9.5일 증가시킨다고 하였다 [5]. 성인을 대상으로 한 일부 연구 [7,8]에서는 MRSA 감시 배양이 MRSA 감염 발생 감소에 효과적이지 않다고 하였 지만, 국외 소아중환자실 환아를 대상으로 한 선행연구 [9,10]에서는 감시배양이 MRSA 집락 환자를 확인함으로써 MRSA 전파를 감소시켜 효과적이라고 하였다. MRSA 관리 를 위해 클로르헥시딘 침상목욕의 중요성이 강조 [11][12][13] 되기는 하였지만 최근 체계적 고찰 연구 [14]에서는 클로르 헥시딘 침상목욕이 의료관련감염을 감소시키는지 불분명 하다는 결과가 제시되어 논란이 되고 있다.…”