Role and Risk Factors for Community-associated Methicillin Resistant Staphylococcus aureus USA300 Carriage in Children Presenting with and without Skin and Soft Tissue Infections in a Pediatric Emergency Department - Abstract
The purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated with specific S. aureus strains, specifically MRSA USA300. A case control study was conducted in a pediatric emergency department. Nasal and axillary swabs were collected, and participants were interviewed for risk factors for MRSA infections. The primary outcome was the proportion of S. aureus carriers among those presenting with and without a skin and soft tissue infection (SSTI). S. aureus carriers were further categorized into MRSA USA300 carriers or non MRSA USA300 carriers. MRSA USA300 carriage rate was higher in children less than 2 years of age, those with an SSTI, children with recent antibiotic use, and those with a family history of SSTI compared to non MRSA USA300 carriers. MRSA USA300 carriers were also more likely to have lower income compared to non MRSA USA300 carriers and no S. aureus carriers. Rates of presence of Panton-Valentine leukocidin (PVL) genes were higher in MRSA carriage isolates with an SSTI, with all 39 being USA300, compared to MRSA carriage isolates of patients without an SSTI. Our results indicate risk factors associated with MRSA USA300 carriage were age younger than two years, low income, recent antibiotic use, and previous or family history of SSTI. There is also an association between MRSA USA300 carriage and presence of PVL in those diagnosed with an abscess.