Vidyya Medical News Service
Volume 6 Issue 82 Published - 14:00 UTC 08:00 EST 22-Mar-2004 Next Update - 14:00 UTC 08:00 EST 23-Mar-2004
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Levels of MRSA infection among children risen rapidly in 10 years

Levels of MRSA (methicillin resistant Staphylococcus aureus) infection among children have risen rapidly in 10 years, reveals a study in Archives of Disease in Childhood.

Rates among adults have risen steadily over the same period, but were always thought to be very much lower among children.

This is largely because fewer of them spend time as hospital inpatients, the most important risk factor for acquiring MRSA, but also because even when children do require hospital treatment, their units tend to be separate from adult services, so minimising the spread of the infection.

Although first identified in 1961, MRSA only really became a problem during the 1980s and 1990s, when epidemic strains started to appear. In 1991, 5% of all blood samples positive for the bacterial infection S aureus in adults and children were resistant to the antibiotic methicillin. By 2000 this proportion had reached 42%.

The authors base their findings on an analysis of communicable disease reports filed by microbiology laboratories in England and Wales to the Health Protection Agency Communicable Disease Surveillance Centre between 1990 and 2001 as part of its voluntary reporting scheme.

No information was supplied on whether the infections were acquired in hospital or in the community; similarly, the methicillin sensitivity of 17% of samples was not known.

But between 1990 and 2001 there were 376 reports of MRSA among children up to the age of 15 years. Infants less than a year old accounted for over half the cases (53%).

Overall, the numbers of MRSA positive samples as a proportion of all S aureus infections among children rose from 4 (0.9%) in 1990 to 77 (13.1%) in 2001.

The authors suggest that the rise may be attributable to infections among premature babies on neonatal units.

"The increasing proportion of MRSA bacteraemia among children is a cause for concern for both patients and clinicians," they say. "MRSA bacteraemia is associated with a higher mortality rate, longer hospital stay, and is a significant independent risk factor for death."

One of the other problems with MRSA infections is that they are usually resistant to other classes of antibiotics as well. S aureus infections that are resistant to vancomycin are becoming more common, warn the authors.

Although the rates among children are not as high as those among adults, action must be taken now to ensure that they do not escalate to those levels, urge the authors. They call for an immediate national review of the risk factors and the preventive measures in place.

An accompanying editorial by microbiologist Dr Jim Gray of the Birmingham Children's Hospital, reports that in the USA, MRSA accounts for up to 60% of childhood S aureus infections acquired outside hospital. Worryingly, many of these cases were not associated with any known risk factors, suggesting that MRSA is circulating in the community at large, he says.

This could mean that common childhood skin infections, such as impetigo, would become extremely difficult to treat with the battery of drugs currently available, he warns.

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