[Community-associated methicillin-resistant Staphylococcus aureus infections among children in the western Galilee region: the beginning of an epidemic?]

Abstract

Background: Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections were reported in the United States in the 1990's among healthy children, without traditional risk factors for infection with MRSA. CA-MRSA is now epidemic in the United States causing superficial infections and severe invasive disease. There is a paucity of data about CA-MRSA disease in the pediatric Israeli population and the common belief is that CA-MRSA disease is rare.

Objective: Prospective surveillance for CA-MRSA strains among hospitalized children at the Western Galilee Hospital in Israel over a 1-year period.

Methods: Staphylococcus aureus isolates were collected prospectively in 2007-8. CA-MRSA strains were defined as MRSA isolated in the first 72 hours of hospitalization with non-multi-drug resistant profile (resistant to < 3 non-beta-lactam antimicrobials). Patients' clinical characteristics were collected from medical charts.

Results: Five of 103 (4.8%) children were identified with Staphylococcus aureus isolates that were infected with CA-MRSA strains. All five had MRSA isolated from skin abscesses; their median age was 2.5 years. Skin and soft tissue infections were evident among 59 children infected with Staphylococcus aureus, 5 of which were CA-MRSA strains (8.5%). The calculated prevalence of CA-MRSA infections among pediatric patients within the study period was 76 cases per 100,000 admissions. All isolates were susceptible to vancomycin, linezolid, rifampin, trimethoprim sulfamethoxazole, and clindamycin. Four of the 5 children presented with recurrent MRSA infections. Possible risk factors for CA-MRSA were noted among 3 patients: participation in contact sports, atopic dermatitis, and family history of MRSA infections.

Conclusions: A significant rate of CA-MRSA disease exists among children in the Western Galilee Region. CA-MRSA disease presents as recurrent skin and soft tissue infections. Awareness and recognition by culturing, mainly of skin lesions, is the first crucial step in investigating the magnitude of CA-MRSA disease. The old school thinking of MRSA being solely a hospital-based pathogen, in patients with frequent exposure to the healthcare system, is no longer valid in Israel.