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Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children


The Pediatric Infectious Disease Journal: October 2002 - Volume 21 - Issue 10 - p 910-916
Original Studies

Context. Community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children are increasing in frequency for unknown reasons.

Objectives. To compare the presence of risk factors for methicillin resistance between patients with CA-MRSA and community-acquired methicillin-susceptible S. aureus (CA-MSSA) infection and to compare the presence of risk factors among household contacts of the patients from both groups. To compare the demographic and clinical characteristics between children with CA-MRSA and CA-MSSA infection.

Design. Prospective observational study conducted between February 2, 2000 and November 14, 2000, excluding the month of May and the period between September 2 and October 15.

Setting and patients. Texas Children’s Hospital, Houston, TX; inpatients and outpatients with community-acquired S. aureus infection.

Main outcome measures. Proportion of MRSA among all community-acquired S. aureus infections. The presence of risk factors associated with methicillin resistance among patients, and their household contacts, with CA-MRSA and CA-MSSA.

Results. The monthly rates of methicillin resistance of S. aureus varied between 35 and 51%. CA-MSSA isolates were associated with deep-seated infections significantly more often (30%) than CA-MRSA isolates (11%;P = 0.01). CA-MRSA isolates were generally susceptible to clindamycin and trimethoprim-sulfamethoxazole and resistant to erythromycin. There were no significant differences in the exposure to risk factors between children with CA-MRSA and CA-MSSA infection. No significant risk factors for CA-MRSA were identified among household contacts.

Conclusions. MRSA is an established, community-acquired pathogen in our area. This necessitates a change in empiric therapy of infections suspected to be caused by S. aureus.

From the Department of Pediatrics, Baylor College of Medicine, and the Infectious Disease Laboratory, Texas Children’s Hospital, Houston, TX.

Accepted for publication May 29, 2002.

*Current address: Merck Research Laboratories, West Point, PA 19486.

Address for reprints: Sheldon L. Kaplan, M.D., Texas Children’s Hospital, Mail Code 3-2371, 6621 Fannin St., Houston, TX 77030. Fax 832-825-4347; E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.