Prevention of Hospital-Acquired Methicillin-Resistant Staphylococcus Aureus in U.S. Pediatric Inpatients: A Systematic Review
Creators: name: See, Rachel
Publisher: name: Georgia State University
Year: 2016

description: Background: Pediatric inpatients in United States healthcare settings may be particularly vulnerable with respect to methicillin-resistant Staphylococcus aureus (MRSA) infection and transmission.  Although infection prevention and control protocols have well been established for MRSA and for adult inpatients, there are few current guidelines available on how to address MRSA prevention and control in pediatric inpatients.  
Objectives: To systematically identify, describe, and evaluate the quality of the current literature on infection prevention and control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in United States pediatric inpatient settings.  
Search methods: In June-August 2015, Campbell Collaboration Library, Cochrane Library, PubMed, MEDLINE, Biological Abstracts, CINAHL Plus, and Web of Science was searched for studies published between January of 2005 and December 2015 by using relevant key terms for pediatric patients (ex, children, infant, newborn, neonate) and prevention and control of MRSA.  
Selection criteria: All primary data studies on infection prevention and control interventions for healthcare associated MRSA in United States pediatric inpatient settings were eligible for inclusion. 
Data collection and analysis: Two authors independently reviewed the results of the searches. Another author was consulted for any discrepancies between categorization of articles. Data extraction was conducted by one author and was checked by a second author.
Main results: 1,619 studies were initially identified, of which 21 studies met the criteria for inclusion.  Of the studies that met inclusion criteria, one was a randomized control trial, thirteen were retrospective cohort studies, four were before and after studies, two were prospective cohort studies and one was a retrospective case finding.  Three studies (Song (2010), Robicsek (2009), and Gregory (2009)) found that Mupirocin or antibiotic treatment did not eradicate MRSA colonization consistently and were unsuccessful in eliminating continuing transmission of MRSA.  However, the study by Delaney found that there was a significant reduction in rates of S. aureus infection when comparing Mupirocin prophylactic period with the control period.  Another two studies (Constantini and Kjonegaard) found that screening was not identifying all of the MRSA cases, and that HA-MRSA infection rates did not decline after implementation of ICU screening, thus proving that this method was ineffective in regards to decreasing transmission and incidence of MRSA infections.
Conclusion: There is a lack of research evaluating the effects on MRSA transmission of infection prevention and control strategies in pediatric inpatient settings. More resources should be devoted to understand the epidemiology of MRSA amongst the pediatric inpatient population as well as continued research interventions to establish prevention and control protocols for this vulnerable population.