Abstract :
Introduction: Community acquired MRSA (CA MRSA) can cause invasive diseases posing a challenge to treating physicians. The knowledge about the disease load, clinical pattern, risk factors, outcome and susceptibility pattern in a given geo demographic context contribute crucially to the treatment outcome of MRSA infections in children.
Aim: To study the profile, clinical pattern, factors affecting the immediate outcome and antimicrobial susceptibility of MRSA infections in children
Materials and Methods: A prospective observational study was conducted in children between 2 months and 12 years admitted with MRSA infections, from January 2016 to December 2017 in the Institute of Maternal and Child Health, Government Medical College Kozhikode, Kerala state, India.
Results: Out of 431 children evaluated 83(19.3%) had MRSA infections with 44(53%) CA MRSA and 39(47%) hospital associated MRSA (HA MRSA). Twenty one (53.8%) of HA MRSA infections were hospital onset MRSA (HAHO MRSA) and 18(46.2%) community onset MRSA (HACO MRSA). There were 37 infants, 16 toddlers, 12 preschool children, 18 school children, 48 males and 35 females in the study population. Blood (50.6%), pus (33.7%), and body fluids (15.7%) were the sites of isolation. Skin and soft tissue infections (SSTI)(30.10%), pneumonia (28.90%), empyema (9.64%), meningitis (7.23%), septicaemia (12.05%), bone and joint infections (9.64%), peritonitis (2.41%) and septic shock (18.1%) were the clinical presentation. Mortality occurred in 9.9% and paediatric intensive care requirement in 45.8% patients. Anaemia and thrombocytopenia were identified as the risk factors for PICU admissions (corrected OR; 95% C I, 3.38; 1.02–11.18 and 8.35; 1.35–45.03 respectively). Thrombocytopenia was associated with mortality (corrected OR 43.74, 95% C I 3.86–495.9). Susceptibility to clindamycin, co-trimoxazole, amikacin and rifampicin were 79.5%, 73.5%, 68.7% and 90.4% respectively.
Conclusion: MRSA constituted a significant proportion of bacterial infections in children, the majority being community onset. Pneumonia and empyema predominate over SSTI. Thrombocytopenia was associated with mortality and PICU admission. Clindamycin, co-trimoxazole and amikacin can be utilised in the treatment of less severe MRSA infections
Keyword :
Children, MRSA, Hospital associated, Community associated, Antimicrobial susceptibility, Community onset