Emergence of Community-Associated Methicillin-Resistant Staphylococcus aureus at a Memphis, Tennessee Children's Hospital.
Buckingham, Steven C. MD *+; McDougal, Linda K. MS ++; Cathey, Lorene D. RN, BSN, CIC +; Comeaux, Katha LPN +; Craig, Allen S. MD [S]; Fridkin, Scott K. MD ++; Tenover, Fred C. PhD, ABMM ++
Pediatric Infectious Disease Journal.
23(7):619-624, July 2004.
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Background: An epidemiologic investigation was performed because of a perceived increase in infections caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA) among children in the greater Memphis area.
Methods: We reviewed medical records of 289 children evaluated from January 2000 to June 2002 at a children's hospital. Clinical criteria were applied to classify MRSA isolates as community-associated (n=51) or health care-associated (n=138). The relatedness of 33 archived S. aureus isolates was evaluated using pulsed field gel electrophoresis (PFGE) of Sma I-digested genomic DNA; a common pulsed field type was defined as >=80% similarity based on Dice coefficients. PFGE profiles were compared with those in a national database of MRSA isolates.
Results: During the first 18 study months, 46 of 122 MRSA isolates (38%) were community-associated; this proportion increased to 106 of 167 isolates (63%) during the last 12 study months (P < .0001). Community-associated isolates were recovered from normally sterile sites as frequently as were health care-associated isolates (16% versus 13%). PFGE revealed that 15 of 16 community-associated isolates shared a common pulsed field type (USA300) observed in community-associated MRSA infections elsewhere in the United States and characterized by staphylococcal cassette chromosome mec type IV, clindamycin susceptibility and erythromycin resistance mediated by an msr A-encoded macrolide efflux pump.
Conclusions: Community-associated MRSA has emerged as a potentially invasive pathogen among children in the greater Memphis area, and this phenomenon is not explained by spread of nosocomial strains into the community.
(C) 2004 Lippincott Williams & Wilkins, Inc.