Community-acquired methicillin-resistant Staphylococcus aureus in outpatient children assisted at a university hospital in Saudi Arabia: A 3-year study (2005–2008)

Abstract

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a serious problem in the community setting, primarily as a cause of skin and soft tissue infections. The incidence of CA-MRSA infections in children has increased dramatically over the past decade. The objectives of this retrospective study were to report the frequency of CA-MRSA isolates, to describe the spectrum of disease observed in children infected with CA-MRSA and to compare the type of infections and antibiotic susceptibility patterns of CA-MRSA and community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA). A retrospective review was conducted of the medical records of children 0 to 18 years old with S. aureus infection including CA-MRSA isolated by the microbiology laboratory at King Khalid University Hospital between 2005 and 2008. Between January 2005 to December 2008, S. aureus was isolated from 285 children. Of these children 85 (29.8%) had CA-MRSA. The percentage of community-acquired S. aureus isolates that were methicillin-resistant increased from 18.8% (15 of 80 isolates) in year 2005 to 40.5% (34 of 84 isolates) in year 2008 (P = 0.0253). Among the CA-MRSA isolates, 75 (88.2%) were obtained from children with skin and soft-tissue infections, and eight (9.4%) were obtained from children with invasive infections. Overall, 45.9% of children with CA-MRSA isolates and 17.5% of children with CA-MSSA were admitted to the hospital (P = 0.0001). Patients without identifiable risk factors comprised 55 CA-MRSA infections (64.7%). Risk factors for acquisition of MRSA including allergic skin disease (eczema), chronic diseases, previous health care contact, antibiotic treatment and intrafamilial spread were identified in 30 of the 85 (35.3%) CA-MRSA patients. CA-MRSA infections tended to occur at younger ages (infant < 1-year, P = 0.0001). Compared to CA-MSSA isolates, CA-MRSA isolates were more resistant to erythromycin, clindamycin, tetracycline, gentamicin and rifampin (P < 0.05). CA-MRSA isolates account for an increasing percentage and number of infections among children seen and managed at our hospital. More surveillance and epidemiologic studies to evaluate the magnitude of infection caused by CA-MRSA infection in our community is warranted.

Keywords

CA-MRSA - Saudi Arabia - children