Prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) in Pediatric Patients with State-Mandated Surveillance

Background: Although prevalence of nasal colonization with MRSA has increased in the United States ⁽¹⁾, studies have focused primarily on adults with limited data on pediatric patients.  One study found prevalence among pediatric patients to represent only a small fraction of total patients colonized with MRSA ⁽²⁾.  At Rady Children’s Hospital San Diego, MRSA represent 35% of S. aureus bacteria isolated. With the enactment of Senate Bill No.1058 in the State of California mandatory MRSA surveillance for all California hospitals was established into law.  

Objective: Assess prevalence of MRSA nasal colonization in a Pediatric Hospital over the initial 22-month period of state-mandated surveillance screening.

Methods: The study was performed at Rady Children’s Hospital, a 240 bed pediatric facility.  The surveillance period reported started on January 1, 2009 to October 31, 2010.  Patients involved in the surveillance included: surgical patients, patients recently discharged from an acute care hospital, patients transferred from a skilled nursing facility, patients admitted to an intensive care unit, dialysis patients, and patients deemed at high risk for MRSA colonization. The testing method used was CHROMagar^TM MRSA media, with an estimated cost of $5.00 per test not including clinician time of obtaining specimen.  Initial program resources were geared towards leadership involvement, microbiology lab collaboration, electronic medical record support and staff education.  Direct care nurses were responsible for obtaining screening specimens as well as ensuring MRSA education was given when positive culture results were found. 

Results: After the initial 22-month period of MRSA screening there were 356 positive screens out of a total 16,472 screens performed (2%).  Over the same 22-month period in the Neonatal Intensive Care Unit population there have been six positive MRSA screens out 1,619 total screens performed (0.4%).  As mandated by the bill, costs of screening and processing cannot be charged to patients but thus far during the 22-month period are estimated at $83,710 (not including additional costs associated with clinician time).

Conclusions: Based on surveillance using NP swab cultures on CHROMagar, the prevalence of nasal colonization in hospitalized pediatric patients is low. Based on these results, the benefit of screening patients in this population may not justify costs. 

References: 

1.  Gorwitz RJ, Kruszon-Moran D, McAllister SK, McQuillan G, Mc-Dougal LK, Fosheim GE, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis. 2008;197:1226–34.

2.  Milstone AM, Carroll KC, Ross T, Shangraw KA, Peri TM.  Community-associated methicillin-resistant Staphylococcus aureus Strains in Pediatric Intensive Care Unit. Emerg Infect Dis. 2010;16:647–655.