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15 June 2005

Volume 40, Number 12
Clinical Infectious Diseases 2005;40:1785–1791
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4012-0012$15.00
DOI: 10.1086/430312
MAJOR ARTICLE

Three‐Year Surveillance of Community‐Acquired Staphylococcus aureus Infections in Children

Sheldon L. Kaplan,1,3

Kristina G. Hulten,1,3

Blanca E. Gonzalez,1,3

Wendy A. Hammerman,1,3

Linda Lamberth,3

James Versalovic,2,3 and

Edward O. Mason, Jr.1,3

Departments of 1Pediatrics and 2Pathology, Baylor College of Medicine, and 3Texas Children’s Hospital, Houston, Texas

Background.Methicillin‐resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft‐tissue infections or invasive infections in many communities.

Methods.Prospective surveillance for community‐acquired S. aureus infections at Texas Children’s Hospital was initiated on 1 August 2001. Infections meeting the definition of community‐acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities, including inducible resistance to macrolide, lincosamide, and streptogramin B (MLSB), were determined in the clinical microbiology laboratory with the methodology of the NCCLS. All data were entered into a computer database. Data were analyzed by χ2 tests.

Results.From 1 August 2001 to 31 July 2004, the percentage of community‐acquired S. aureus isolates that were methicillin resistant increased from 71.5% (551 of 771 isolates) in year 1 to 76.4% (1193 of 1562 isolates) in year 3 ( ). The number of both community‐acquired MRSA (CA‐MSRA) isolates and community‐acquired methicillin‐susceptible S. aureus (CA‐MSSA) isolates increased yearly, but the rate of increase was greater for the CA‐MRSA isolates. Among the CA‐MRSA isolates, 2542 (95.6%) were obtained from children with skin and soft‐tissue infections, and 117 (4.4%) were obtained from children with invasive infections. Overall, 62% of children with CA‐MRSA isolates and 53% of children with CA‐MSSA isolates were admitted to the hospital ( ). The rate of clindamycin resistance increased significantly for both CA‐MRSA isolates ( ) and CA‐MSSA isolates ( ) over the 3 years. MLSB inducible resistance was found in 27 (44%) of 62 clindamycin‐resistant CA‐MSSA isolates, compared with 6 (4.5%) of 132 clindamycin‐resistant CA‐MRSA isolates ( ).

Conclusions.CA‐MRSA isolates account for an increasing percentage and number of infections at Texas Children's Hospital. Clindamycin resistance increased among community‐acquired S. aureus isolates. Community surveillance of community‐acquired S. aureus infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections.

Received 3 December 2004; accepted 26 January 2005; electronically published 6 May 2005.

Reprints or correspondence: Dr. Sheldon L. Kaplan, Texas Children’s Hospital, Feigin Center, Ste. 1150, MC 3‐2371, 6621 Fannin, Houston, TX 77030 ().

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