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541 Methicillin-resistant Staphylococcus aureus among hospitalized pediatric patients in Canadian acute care facilities 1995-2007

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Anne G. Matlow, MD, MSc , Hospital for Sick Children, Toronto, ON, Canada
Linda Pelude, MSc , Public Health Agency of Canada, Ottawa, ON, Canada
Sarah E. Forgie, MD , Stollery Childrens Hospital, Edmonton, AB, Canada
Dorothy L. Moore, MD, PhD , Montreal Children's Hospital, Montreal, QC, Canada
Denise Gravel, MSc , Public Health Agency of Canada, Ottawa, ON, Canada
Michael Mulvey, PhD , National Microbiology Lab Public Health Agency of Canada, Winnipeg, MB, Canada
Joseph Vayalumkal, MD , Alberta Children's Hospital, Calgary, AB, CANADA
Joanne Embree, MD , Winnipeg Children's Hospital, Winnipeg, MB, Canada
Joanne M. Langley, MD , Dalhousie University, Halifax, NS, Canada
Nicole Le Saux, MD , Children's Hospital of Eastern Ontario, Ottawa, Ontario, ON, CANADA
Karen Olekson, RN, CIC , Winnipeg Children's Hospital, Winnipeg, MB, Canada
Susan J. Gilbride, RN, CIC , Stollery Childrens Hospital, Edmonton, AB, Canada
Sally Strople, RN, CIC , Alberta Children's Hospital, Calgary, AB, CANADA
Yasmine Chagla, MSc , London Health Services Center, London, ON, Canada
Andrew E. Simor, MD , Sunnybrook Health Science Center, Toronto, ON, Canada

Methicillin-resistant Staphylococcus aureus among hospitalized pediatric patients in Canadian acute care facilities 1995-2007

Background: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) has been steadily increasing in hospitals worldwide.  There are limited Canadian pedatric data describing MRSA at a national level

Objective: 1) To describe the results of Canadian national surveillance among hospitalized pediatric patients (<18 years of age) from January 1995 to December 2007.

2) To identify pediatric risk factors for hospital associated (HA) MRSA and community associated (CA) MRSA.

Methods:   Fifty three Canadian hospitals with pediatric inpatients participated in surveillance, including 8 `stand alone' pediatric facilities.  Surveillance for new cases of MRSA in hospitalized children was laboratory based.  Standardized case definitions were used to classify each case as colonized/infected and HA or CA.  Incidence rates of pediatric CA-MRSA and HA-MRSA were collected and analysed from ‘stand-alone' pediatric facilities while demographic and descriptive data were collected from all participating hospitals with pediatric patients. Fifty three percent of MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE).

Results: There were a total of 1263 MRSA cases.  The median age was 1.3 years, 55% were male, First Nations children were overrepresented (25% of all positive MRSA cultures), and 90% of children had a length of hospital stay of less then 30 days.  Infections accounted for 51% of cases. Bacteremia accounted for 5% and while skin/soft tissue infections accounted for the largest proportion (29%).  Cases were more likely to be classified as HA if they were <1 month of age and more likely to be CA if First Nations or living in western Canada.  Additionally, those with HA-MRSA were significantly less likely to be infected and more likely to be colonized.  The proportion of CA-MRSA increased from 0 in 1995 to 76% in 2007.  Overall MRSA rates increased from 0.04 to 2.51 per 1000 patient admissions and from 0.08 to 3.88 per 10,000 patient days. Infection rates rose from 0 (1995) to 2.69 (2007) per 10,000 patient days.  The major types were CMRSA2 (USA100/800; p = <0.001), CMRSA 7 (USA400) or CMRSA10 (USA300) (p = <0.001) and these types changed over time. CMRSA2 decreased from 41% to 23% (p<0.05), CMRSA 7 increased from 3% to 25% (p<0.05) and CMRSA10 increased from 0 to 36% (p<0.05).

Conclusions: MRSA among hospitalized pediatric patients continues to increase. These results suggest that the rates are being driven by CA-MRSA. Further studies are required to better understand the changing epidemiology of MRSA in pediatric patients.