Risk factors for pediatric community-acquired methicillin-resistant staphylococcus aureus (MRSA)

A chart review of children under 18 years of age with a positive Staphylococcus aureus culture within the first 72 hours after admission or as an outpatient was conducted at All Childrenʹs Hospital St. Petersburg, FL, from January 2002 to August 2003. A cross-sectional study was conducted to determine the demographic characteristics and risk factors associated with development of a methicillin-resistant S. aureus (MRSA) infection and provide physicians with a model to assess their patientsʹ risks. Methods The medical charts were reviewed and the pertinent data were entered into a Microsoft Access database. The outcome assessed was a positive S. aureus culture as an outpatient or within 72 hours of becoming an inpatient. The exposure data collected consisted of age, race or ethnicity, gender, preexisting medical conditions, previous antibiotic use, previous hospitalization, community worn device, home health care, immunotherapy, and previous MRSA infection. After data entry was completed, statistical analysis using SAS and Epi Info was conducted to calculate frequencies, crude odds ratios (OR), and 95% confidence intervals (CI). The presence of effect modification was assessed and adjustment for confounding was performed. Results A total of 672 charts were reviewed and the following results were found. Blacks were at a higher risk of developing MRSA infection (OR = 2.98, 95% CI = 2.51, 3.45). Race was found to be an effect modifier for MRSA infection and previous antibiotic use (P = 0.02). After stratification by race, the results were adjusted for confounding. In whites, previous MRSA infection (OR = 2.86, 95% CI = 1.16, 7.05), home health care (OR = 4.37, 95% CI = 1.55, 12.32), and previous hospitalization (OR = 2.00, 95% CI = 1.14, 3.50) were significant risk factors for the development of MRSA infection. In blacks, only previous antibiotic use (OR = 5.13, 95% CI = 1.75, 15.08) was significantly associated with the development of MRSA infection. Conclusion It is possible for a physician to identify the presence of their patientsʹ risk according to the risk factor profiles of pediatric patients, in order to determine the likelihood of resistant infection and treat that patient accordingly in order to prevent the progression of the infection.