Differences among MRSA Pneumonia between High Risk and Non High Risk Pediatric Patients

Characterization of MRSA Infections and Outcomes between High Risk (HR) and Non High Risk (NHR) Pediatric Patients

Background: There is a paucity of data on treatment regimens, health outcomes and resource utilization in pediatric patients with MRSA infections.

Objective: The objective of this study is to compare the clinical characteristics, treatment differences and outcomes between HR and NHR pediatric patients with MRSA infections.

Methods: Clinical characteristics and treatment regimens were collected from patients hospitalized with confirmed MRSA cultures at the Children’s Hospital at St. Francis Medical Center in Tulsa, OK between 1/1/04 and 5/1/09. HR patients (patients with chronic diabetes, renal failure, cardiovascular disease, immunosuppression and previous MRSA infection), who also had a MRSA positive culture were compared to NHR (no chronic medical conditions and no previous MRSA admissions).

Results: Of the 225 patients with MRSA infections during the study timeframe, there were 57 (25%) with pneumonia, 155 (69%) with skin and skin structure infections (SSSI) and 39 (17%) with other sites. 22 (10%) of patients had multiple sites of MRSA infection. There were 94 patients considered HR, 37 (39%) had pneumonia and 43 (46%) had SSSI. There were 131 patients considered NHR, 20 (15%) had pneumonia and 112 (86%) had SSSI. In the pneumonia cohort, HR patients were significantly older (5.2 v. 2.3 years, p = 0.05) had a numerically longer length of stay (18.3 v. 12.4 days) and a lower platelet count on admission (369 v. 523, p<0.05). 83% of the HR group received vancomycin compared to 10% in the NHR group (p <0.01) and 19% of the HR group and 10% of the NHR group were discharged on IV vancomycin. NHR were more likely to receive bactrim then HR (45% v. 19%, p <0.05). 6 patients expired in the HR group compared to none in NHR.

In the SSSI cohort, there were no differences in age (4.1 years vs. 3.4), but significant difference in race (61% vs. 37% Caucasian, p <0.01). HR patients had a significantly longer length of stay (8.4 v. 3.6 days, p <0.01), had almost double the number of consults (1.86 v. 1.03, p <0.01) and more home health referrals (18% v. 4%, p =0.01) than NHR patients. 82% of the HR patients received vancomycin compared to 5% in the NHR patients (p <0.01). HR patients were more likely to receive cefepime then NHR 16% v. 5%, (p = 0.03). There were no inpatient deaths in either the SSSI HR or NHR groups.

Conclusions: MRSA is a frequent cause of infection in the pediatric population and causes excess morbidity and mortality, especially in patients with chronic conditions. High vancomycin use in the HR group may reflect more intense therapy associated with these patients or more hospital acquired MRSA infections. In this small cohort, there appears to be differences in clinical characteristics, treatment regimens and outcomes between HR and NHR patients that may be important for clinicians to consider when treating children with MRSA infection.