COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS IN CHILDREN WITH NO IDENTIFIED PREDISPOSING RISK

Context.-Community-acquired methicillin-resistant Staphylococcus aureu s (MRSA) infections in children have occurred primarily in individuals with recognized predisposing risks. Community-acquired MRSA infection s in the absence of identified risk factors have been reported infrequ ently. Objectives.-To determine whether community-acquired MRSA infect ions in children with no identified predisposing risks are increasing and to define the spectrum of disease associated with MRSA isolation. Design.-Retrospective review of medical records. Patients.-Hospitalize d children with S aureus isolated between August 1988 and July 1990 (1 988-1990) and between August 1993 and July 1995 (1993-1995). Setting.- The University of Chicago Children's Hospital. Main Outcome Measures.- Prevalence of community-acquired MRSA over time, infecting vs colonizi ng isolates, and risk factors for disease. Results.-The number of chil dren hospitalized with community-acquired MRSA disease increased from 8 in 1988-1990 to 35 in 1993-1995. Moreover, the prevalence of communi ty-acquired MRSA without identified risk increased from 10 per 100 000 admissions in 1988-1990 to 259 per 100 000 admissions in 1993-1995 (P <.001), and a greater proportion of isolates produced clinical infecti on. The clinical syndromes associated with MRSA in children without id entified risk were similar to those associated with community-acquired methicillin-susceptible S aureus. Notably, 7 (70%) of 10 community-ac quired MRSA isolates obtained from children with an identified risk we re nonsusceptible to at least 2 drugs, compared with only 6 (24%) of 2 5 isolates obtained from children without an identified risk (P=.02). Conclusions.-These findings demonstrate that the prevalence of communi ty-acquired MRSA among children without identified risk factors is inc reasing.