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43 Methicillin-resistant Staphylococcus aureus (MRSA) colonization and risk of subsequent infection in children hospitalized in the pediatric intensive care unit (PICU)

Saturday, April 2, 2011: 10:45 AM
Coronado A (Hilton Anatole)
Aaron M. Milstone, MD, MHS , Johns Hopkins Medical Institutions, Baltimore, MD
Brian W. Goldner, BA , Johns Hopkins Medical Institutions, Baltimore, MD
John Shepard, BA, MBA , Johns Hopkins Medical Institutions, Baltimore, MD
Trish M. Perl, MD, MSc , Johns Hopkins Medical Institutions, Baltimore, MD
Background: MRSA colonization is a known risk factor for hospital-acquired MRSA (HA-MRSA) infections.  Up to 25% of adults colonized with MRSA on hospital admission developing a HA-MRSA infection. However, little is known about the risk of subsequent MRSA infections in hospitalized children colonized with MRSA.

Objective: To determine the risk of MRSA infection in children admitted to a pediatric intensive care unit.

Methods: We followed a prospective cohort of children admitted to The Johns Hopkins Hospital PICU between March 1, 2007 and March 1, 2010 with a hospital length of stay greater than two days. Admission nasal swabs, obtained per institutional policy, were cultured to identify MRSA colonization. Medical records and laboratory databases were reviewed to identify patients that developed MRSA infections (using National Healthcare Safety Network definitions) either during their hospitalization or within the study period.

Results: Of 3,620 patients, 55.5% were male and the median age was 6 years. Nasal swabs were collected on admission for 3,147 patients (87%). The MRSA admission prevalence of screened children was 6.4%. During their hospitalization, 11 screened children (0.3%) developed an HA-MRSA infection over 31,214 patient days (IR 0.35 per 1,000 patient days; 95%CI 0.18, 0.63), including 3 of 204 children (1.5%) colonized on admission and 8 of 2,943 children (0.3%) not colonized on admission [RR 5.4; 95% CI 1.7,17.6, p<0.01].  During the entire follow-up period, 46 screened children (1.5%) developed an MRSA infection, including 10 children (4.9%) colonized on admission and 36 children (1.2%) not colonized on admission [RR 3.7; 95% CI 1.9, 7.0, p<.001].  During the study period, 17 of 1387 children who were in the PICU for >48 hours acquired MRSA colonization.  Six of these children (35%) developed a subsequent HA-MRSA infection and 8 (47%) developed a MRSA infection over the follow-up period.

Conclusions: Our data suggest that MRSA colonization is a risk factor for subsequent MRSA infection in children admitted to PICU. Although children may have lower overall risks of infection compared with adults, children who acquire MRSA in the hospital have similarly high rates of infection.  Preventing transmission of MRSA in hospitalized children should remain a priority.