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Hospital-Acquired Staphylococcus aureus Infections at Texas Children's Hospital, 2001–2007

Published online by Cambridge University Press:  02 January 2015

Kristina G. Hultén ,
Sheldon L. Kaplan ,
Linda B. Lamberth ,
Katherine Slimp ,
Wendy A. Hammerman ,
Maria Carrillo-Marquez ,
Jeffrey R. Starke ,
James Versalovic  and
Edward O. Mason Jr
Kristina G. Hultén*
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
Sheldon L. Kaplan
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
Linda B. Lamberth
Affiliation:
Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
Katherine Slimp
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas
Wendy A. Hammerman
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
Maria Carrillo-Marquez
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
Jeffrey R. Starke
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
James Versalovic
Affiliation:
Pathology, Texas Children's Hospital, Houston, Texas Department of Pathology, Texas Children's Hospital, Houston, Texas
Edward O. Mason Jr
Affiliation:
Departments of Pediatrics, Texas Children's Hospital, Houston, Texas Baylor College of Medicine, and the Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Houston, Texas
*
Texas Children's Hospital, 6621 Fannin Street, MC 3-2371, Houston, TX 77030, (khulten@ bcm.tmc.edu)
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Extract

Objective.

To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure.

Design.

Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston.

Methods.

Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl).

Results.

Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P < .001), onset of infection less than 10 days after admission (P = .007), and lack of comorbidities (P < .001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P < .01).

Conclusions.

In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 2 , February 2010 , pp. 183 - 190
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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