Elif BÖNCÜOĞLU, Elif KIYMET, İlknur ÇAĞLAR, Yeliz ORUÇ, Nevbahar DEMİRAY, Aybüke Akaslan KARA, Tülin ERDEM, Gamze GÜLFİDAN, İlker DEVRİM, Nuri BAYRAM

Upward trend in the frequency of community-acquired methicillin-resistant Staphylococcus aureus as a cause of pediatric skin and soft tissue infections over five years: a cross-sectional study

Background. The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its resistance to multiple antibiotics has become a serious challenge since the early 2000s. Especially, community-acquired MRSA (CA-MRSA) infections that appear mainly as skin and soft tissue infections (SSTIs) tend to increase worldwide. The objective of this cross-sectional study was to evaluate the trends in the frequency of SSTIs due to community-acquired S. aureus among children. Methods. All children with SSTIs caused by culture positive community-acquired S. aureus during the period from 2013 to 2018 were included in this study. Data of the outpatients were collected from medical records. Annual alteration in frequencies of CA-MRSA and community-acquired methicillin-sensitive S. aureus (CA- MSSA) were evaluated. Results. A total of 112 cases was evaluated. Of these, 35 (31.25%) were CA-MRSA. The rates of CA-MRSA had emerged from an increasing annual frequency of 9.5 cases per 10,000 SSTIs as of 2014 to 96.8 cases per 10,000 SSTIs in 2018. The ratio of cases with CA-MRSA to cases with CA-MSSA was 0 – 0.09 in two years of the study period and increased to a maximum ratio of 0.6 – 0.72 in the last two years. Consequently, the frequency of S. aureus in cases with SSTIs was significantly higher in 2016 – 2018 compared to the initial study period within the years of 2013-2015 [p

PDF

___

1. Shanson DC. Staphylococcal infections in hospital. Br J Hosp Med 1986; 35: 312-320.

2. Chambers HF. The changing epidemiology of Staphylococcus aureus. Emerg Infect Dis 2001; 7: 178-182.

3. Purcell K, Fergie J. Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children’s Hospital. Arch Pediatr Adolesc Med 2005; 159: 980- 985.

4. Fortunov RM, Hulten KG, Hammerman WA, Mason EO Jr, Kaplan SL. Community-acquired Staphylococcus aureus infections in term and near- term previously healthy neonates. Pediatrics 2006; 118: 874-881.

5. Kaplan SL, Hulten KG, Gonzalez BE, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40: 1785-1791.

6. Fortunov RM, Hulten KG, Hammerman WA, Mason EO Jr, Kaplan SL. Evaluation and treatment of community-acquired Staphylococcus aureus infections in term and late-preterm previously healthy neonates. Pediatrics 2007; 120: 937-945.

7. Grundmann H, Aires-de-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006; 368: 874- 885.

8. Peltola H, Pääkkönen M, Kallio P, Kallio MJ; Osteomyelitis-Septic Arthritis (OM-SA) Study Group. Prospective, randomized trials of 10 days versus 30 days of antimicrobial treatment, including a short-term course of parenteral therapy, for childhood septic arthritis. Clin Infect Dis 2009; 48: 1201-1210.

9. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23: 616-687.

10. Maree C, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG. Community-associated methicillin- resistant Staphylococcus aureus isolates and healthcare-associated infections. Emerg Infect Dis 2007; 13: 236-242.

11. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. (28th ed) CLSI Supplement M100 (ISBN 1-56238-838-X [Print]; ISBN 1-56238- 839-8 [Electronic]). Pennsylvania: Clinical and Laboratory Standards Institute, 2018. Available at: http://file.qums.ac.ir/repository/mmrc/CLSI-2018- M100-S28.pdf (Accessed on April 14, 2020).

12. EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. Available at: https://pdfs.semanticscholar. org/8fa9/0d4e48d77c9fb0e33a4e700d45cdde09b232. pdf (Accessed on April 14, 2020).

13. Hota B, Ellenbogen C, Hayden MK, Aroutcheva A, Rice TW, Weinstein RA. Community–associated methicillin–resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 2007; 167: 1026-1033.

14. McMullen KM, Warren DK, Woeltje KF. The changing susceptibilities of methicillin-resistant Staphylococcus aureus at a Midwestern hospital: the emergence of “community-associated” MRSA. Am J Infect Control 2009; 37: 454-457.

15. Bukharie HA. Increasing threat of community- acquired methicillin-resistant Stapylococcus aureus. Am J Med Sci 2010; 340: 378-381

16. Ensinck G, Ernst A, Lazarte G, et al. Community- acquired methicillin-resistant Staphylococcus aureus infections: 10-years’ experience in a children’s hospital in the city of Rosario, Argentina. Arch Argent Pediatr 2018; 116: 119-125.

17. World Health Organization. Central Asian and Eastern European Surveillance of Antimicrobial Resistance. Annual report 2017. (Available at: https://www.euro.who.int/__data/assets/ p d f _ f i l e / 0 0 0 5 / 3 5 4 4 3 4 / W H O _ C A E S A R _ AnnualReport_2017.pdf) (Accessed on April 14, 2020).

18. Montravers P, Snauwaert A, Welsch C. Current guidelines and recommendations for the management of skin and soft tissue infections. Curr Opin Infect Dis 2016; 29: 131-138.

19. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59: 147-159.

20. Frank AL, Marcinak JF, Mangat PD, et al. Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children. Pediatr Infect Dis J 2002; 21: 530-534.