Community-acquired methicillin-resistant Staphylococcus aureus in outpatient
children assisted at a university hospital in Saudi Arabia: A 3-year study (2005–2008)
Affiliations: Department of Pathology/Microbiology, College of
Medicine and King Saud University, Riyadh, Saudi Arabia | Department of Pediatric/Infectious Disease, College of
Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia
Note: [] Correspondence: Dr. Fawzia Eida Al-Otaibi, Department of
Pathology/Microbiology, College of Medicine and King Saud University, PO Box
2925, Riyadh 11461, Saudi Arabia. Tel.: +996 01 467 1088/467 1010; E-mail: ofawzia@ksu.edu.sa
Abstract: Community-acquired methicillin-resistant Staphylococcus aureus
(CA-MRSA) has emerged as a serious problem in the community setting, primarily
as a cause of skin and soft tissue infections. The incidence of CA-MRSA
infections in children has increased dramatically over the past decade. The
objectives of this retrospective study were to report the frequency of CA-MRSA
isolates, to describe the spectrum of disease observed in children infected
with CA-MRSA and to compare the type of infections and antibiotic
susceptibility patterns of CA-MRSA and community-acquired methicillin-sensitive
Staphylococcus aureus (CA-MSSA). A retrospective review was conducted of
the medical records of children 0 to 18 years old with S. aureus
infection including CA-MRSA isolated by the microbiology laboratory at King
Khalid University Hospital between 2005 and 2008. Between January 2005 to
December 2008, S. aureus was isolated from 285 children. Of these
children 85 (29.8%) had CA-MRSA. The percentage of community-acquired
S. aureus isolates that were methicillin-resistant increased from 18.8% (15
of 80 isolates) in year 2005 to 40.5% (34 of 84 isolates) in year 2008
(P =0.0253). Among the CA-MRSA isolates, 75 (88.2%) were
obtained from children with skin and soft-tissue infections, and eight
(9.4%) were obtained from children with invasive infections. Overall,
45.9% of children with CA-MRSA isolates and 17.5% of children with
CA-MSSA were admitted to the hospital (P = 0.0001). Patients
without identifiable risk factors comprised 55 CA-MRSA infections (64.7%).
Risk factors for acquisition of MRSA including allergic skin disease (eczema),
chronic diseases, previous health care contact, antibiotic treatment and
intrafamilial spread were identified in 30 of the 85 (35.3%) CA-MRSA
patients. CA-MRSA infections tended to occur at younger ages (infant
< 1-year, P =0.0001). Compared to
CA-MSSA isolates, CA-MRSA isolates were more resistant to erythromycin,
clindamycin, tetracycline, gentamicin and rifampin (P <
0.05). CA-MRSA isolates account for an increasing percentage and number of
infections among children seen and managed at our hospital. More surveillance
and epidemiologic studies to evaluate the magnitude of infection caused by
CA-MRSA infection in our community is warranted.
