Study shows jump in pediatric MRSA; doctors advised to culture suspected cases

In January 2001, the rate of MRSA infections in the head and neck area was almost 12%. That figure jumped to 28% by the end of 2006, according to researchers from Emory University and Egleston Hospital in Atlanta, Georgia. Their evaluation of pediatric MRSA infections of the head and neck region is based on data from more than 300 hospitals nationwide and appears in the January 2009 issue of Archives of Otolaryngology – Head and Neck Surgery.

The study also suggests that the majority of children become infected in the community rather than in hospitals. The researchers noted that almost 60% of all MRSA pediatric head and neck infections in their study were from outpatient sources.

“There is a nationwide increase in the prevalence of MRSA in children with head and neck infections that is alarming,” said lead researcher Steven E. Sobol, MD, MSc, primary investigator of the study and director of Pediatric Otolaryngology in the Department of Otolaryngology - Head and Neck Surgery at Emory. Citing concern about antimicrobial drug resistance, he called upon doctors to prescribe antibiotics more carefully.

Public health departments across the nation have advised primary care doctors to suspect MRSA when examining S. aureus skin or soft tissue infections, but to hold off treating them until they get results from a culture of the sample taken from the infected area. Laboratory professionals take the sample and place it onto a thin layer of nutrient gel or into a nutrient broth and examine the sample for growth of characteristic S. aureus colonies. If present, the lab professional does another test to determine whether the staphylococci are MRSA. Usually the process takes at least one to two days.

Infections caused by MRSA do not respond to usual treatment for S. aureus and are notoriously difficult and expensive to treat. Many studies have shown that rates of MRSA infection have been rising for several years, but research has mostly focused on skin infections. The study by the Atlanta researchers is the first to show skyrocketing national rates of infection in deeper head and neck tissues. These include certain ear and sinus infections and abscesses in the tonsils and throat.

Many hospitals are now taking more aggressive action to combat MRSA. In addition to testing patients with suspected MRSA infections, these institutions routinely test all patients entering departments with higher infection rates, like the intensive care unit. A very few hospitals are now using much faster molecular tests that screen for genes present in MRSA, but these tests are far more expensive than culture.

Several states have passed or are considering legislation that would mandate reporting rates of MRSA and other hospital-acquired infections. Meanwhile, the federal government’s Medicare program has stopped reimbursing institutions for treatment related to MRSA and other infections that are acquired while the patient is in the hospital.

Sources

Naseri, Iman. et al. Nationwide Trends in Pediatric Staphylococcus aureus Head and Neck Infections. Arch Otolaryngol Head Neck Surg. 2009; 135: 14-16.

Press release. Study Shows Rise in Antibiotic Resistant Pediatric Head and Neck Infections. Emory University School of Medicine. Available online at http://whsc.emory.edu/home/news/releases/2009/01/rise-in-antibiotic-resistant-pediatric-infections.html through http://whsc.emory.edu. Accessed February 11, 2009.

Associated Press. Doctors report 'alarming' rise of MRSA in kids. Available online at http://www.msnbc.msn.com/id/28736696/ through http://www.msnbc.msn.com. Accessed February 11, 2009.

Staph Wound Infections and Methicillin Resistant Staphylococcus aureus. Lab Tests Online. Available online. Accessed February 11, 2009.

Levenson, Deborah. The Path to Better MRSA Control. Clinical Laboratory News. Available online at http://www.aacc.org/publications/cln/2007/august/Pages/cover1_0807.aspx through http://www.aacc.org. Accessed February 11, 2009.