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Methicillin resistant Staphylococcus aureus infections in children – a prospective study

Citation

Krishnan, C.; Lineesh, T.; Ramesh Menon, P. (2021), Methicillin resistant Staphylococcus aureus infections in children – a prospective study , Dryad, Dataset, https://doi.org/10.5061/dryad.bnzs7h4b5

Abstract

Background: Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) is increasing worldwide. Community acquired MRSA (CA MRSA) can cause invasive diseases causing a challenge to the treating physicians. MRSA need to be considered while choosing empirical antibiotics in invasive infections.

Methods: An observational study was conducted in a Government Medical College in south India from Jan 2016 to Dec 2017 to study the pattern and antimicrobial sensitivity of MRSA infections in children. Two month to 12y children with suspected bacterial infections analysed and MRSA infections were studied and followed up prospectively.

Methods

This prospective observational study was undertaken from Jan 2016 to Dec 2017 in a Government Medical College in South India which is a tertiary hospital catering six districts. Institute Ethics Committee clearance was obtained (Reg.  No.ECR/395/Inst/KL/2013). Ref.NO. GMCKKD/RP 2016/IEC/20; dated  28.01.2016). Blood, pus, body fluids, urine or bone marrow from children between two mon to 12 y admitted with suspected bacterial infections were subjected to bacteriological study as per Clinical and Laboratory Standards Institute recommendations, in the microbiology department. Informed consent was taken from the parents. Staphylococcus aureus was identified using standard microbiological lab parameters. MRSA was defined when isolate demonstrated a minimum inhibitory concentration (MIC) of >4 μg of oxacillin per mL. Antimicrobial susceptibility testing was performed for Gentamicin, Amikacin, Cotrimoxazole, Vancomycin, Linezolid, Clindamycin and Rifampicin with the disk diffusion method Methicillin resistance was tested using a cefoxitin disk on Mueller-Hinton agar. Patients were investigated and treated according to the institutional protocol. Demographic data were collected by using a structured Performa. Each patient’s period of hospitalization was recorded.

Cases were defined as HA MRSA, when growth obtained was ≥ 48 h after admission or growth obtained < 48 h of admission and had any of the health care associated risk factors like i) a history of hospitalization, surgery, dialysis, or residence in a long-term healthcare facility within  12 months prior to the culture date, ii) past history of MRSA infection or colonization or iii) presence of an indwelling intravenous line, catheter, or any other percutaneous medical device at the time the culture was taken. HA MRSA was categorized into hospital onset type (HAHO MRSA) when growth was obtained ≥ 48 h of hospitalization, and community onset type (HACO MRSA), when culture was obtained  <48 h of hospitalization and had a health care associated risk factor.

Patients with growth obtained < 48 h with no health care risk factor were classified as CA MRSA infections. MRSA pneumonia was defined as patients with clinical and radiologic evidence of pneumonia with isolates of MRSA from blood. Empyema was defined as i) MRSA isolated from pleural fluid or ii) MRSA isolated from blood having loculated effusion by radiology and/or histologic evidence of empyema by pleural fluid study. MRSA septicemia was patients showing features of systemic inflammatory response syndrome(SIRS) and MRSA growth from blood. Peritonitis was defined as a symptomatic child with ascitic fluid study showing>100 leukocytes/mmᶾ  with ≥ 50% neutrophils and/or positive culture for MRSA from peritoneal fluid. Anemia was defined as hemoglobin level below the range for age and sex, leukocytosis as white blood cell (WBC) count >2 SD above the mean for age and thrombocytopenia as platelet count <1,50,000/cu mm. Prolonged hospital stay was defined as hospitalization ≥ 14 days.

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Funding

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