Introduction: Staphylococcus aureus (SA) is a major cause of sepsis, osteoarticular and skin infections in children. Infections with MRSA are more difficult to treat. Risk factors for MRSA infections include, among others, prior antibiotic use and hospitalization. Data on local epidemiology of MRSA in children in southern Israel are scarce.
Objective: To assess MRSA infections prevalence, clinical manifestations and risk factors in children in southern Israel.
Methods: Our medical center is the sole hospital in southern-Israel. The medical files of all SA in-hospital infections recorded between 2005 and 2015 were reviewed retrospectively.
Results: Overall, 1,062 SA infections were identified; 65% cellulitis, 23% bacteremia/invasive infections (16% non-osteoarticular and 7% osteoarticular) and 12% non-bacteremic osteoarticular infections.
Of all SA infections, 164 (15%) were MRSA. Young age, Bedouin ethnicity, burns and congenital insensitivity to pain with anhidrosis (CIPA) were risk factors for MRSA infections.
Higher rate of hospital-associated infections was found in MRSA vs. MSSA osteoarticular bacteremic cases (64% vs. 23%, p=0.01) and cellulitis cases (21% vs. 14%, p=0.07). Temperature, C-reactive protein, hemoglobin, platelets, leukocytes and neutrophils counts were similar comparing the two groups. Trends for higher intensive-care hospitalization (11% vs. 8%, p=0.2) and mortality rates (2.4% vs. 0.9%, p=0.09) were found in MRSA cases.
MRSA isolates exhibited higher resistance rates (than MSSA) to clindamycin (30% vs. 14%, p<0.001), erythromycin (34% vs. 15%, p<0.001), co-trimoxazole, tetracycline, rifampin, ciprofloxacin and gentamicin (all 4% vs. 0.5%, p<0.001). All isolates were susceptible to vancomycin.
Conclusions: SA resistance is worrisome, emphasizing the need to better identify MRSA infections and allow optimization of treatment.
