Risk of Skin and Soft Tissue Infections among Children Found to be Staphylococcus aureus MRSA USA300 Carriers.

• Type of Material: Article
• Authors: Lilly Immergluck, Emory University; Shabnam Jain, Emory University; Susan Ray, Emory University; Robert Mayberry, Morehouse School of Medicine; Sarah Satola, Emory University; Trisha Chan Parker, Anglia Ruskin University Clinical Trials Unit; Keming Yuan, Morehouse School of Medicine; Anaam Mohammed, Pediatric Emergency Medicine Associates; Robert Jerris, Emory University
• Language: English
• Date: 2017-02
• Publisher: UC Irvine Health School of Medicine.
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Immergluck et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.5811/westjem.2016.10.30483
• Title of Journal or Parent Work: Western Journal of Emergency Medicine
• ISSN: 1936-900X
• Volume: 18
• Issue: 2
• Start Page: 201
• End Page: 212
• Grant/Funding Information: This project was supported in part by funds received from the PHS Grant UL1 RR025008 from the Clinical and Translational Science Award program, National Institute of Health, Grant Number 2R25RR017694-06A1; and Grant Number G12-RR03034, a component of the National Institutes of Health; and Children’s Healthcare of Atlanta Friends Fund.
• Keywords: community associated; risk factors; CA-MRSA; Panton- valentine leukocidin
• Research Categories: Biology, Microbiology; Health Sciences, Public Health

Abstract

INTRODUCTION: The purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300. METHODS: We conducted a case control study in a pediatric emergency department. Nasal and axillary swabs were collected, and participants were interviewed for risk factors. The primary outcome was the proportion of S. aureus carriers among those presenting with and without a skin and soft tissue infection (SSTI). We further categorized S. aureus carriers into MRSA USA300 carriers or non-MRSA USA300 carriers. RESULTS: We found the MRSA USA300 carriage rate was higher in children less than two years of age, those with an SSTI, children with recent antibiotic use, and those with a family history of SSTI. MRSA USA300 carriers were also more likely to have lower income compared to non-MRSA USA300 carriers and no S. aureus carriers. Rates of Panton-Valentine leukocidin (PVL) genes were higher in MRSA carriage isolates with an SSTI, compared to MRSA carriage isolates of patients without an SSTI. There was an association between MRSA USA300 carriage and presence of PVL in those diagnosed with an abscess. CONCLUSION: Children younger than two years were at highest risk for MRSA USA300 carriage. Lower income, recent antibiotic use, and previous or family history of SSTI were risk factors for MRSA USA300 carriage. There is a high association between MRSA USA300 nasal/axillary carriage and presence of PVL in those with abscesses.