DOI: 10.5061/dryad.bnzs7h4b5
title: Methicillin resistant Staphylococcus aureus infections in children – a prospective study

description: Background: Prevalence of Methicillin-resistant Staphylococcus aureus
 (MRSA) is increasing worldwide. Community acquired MRSA (CA MRSA) can
 cause invasive diseases causing a challenge to the treating physicians.
 MRSA need to be considered while choosing empirical antibiotics in
 invasive infections. Methods: An observational study was conducted in a
 Government Medical College in south India from Jan 2016 to Dec 2017 to
 study the pattern and antimicrobial sensitivity of MRSA infections in
 children. Two month to 12y children with suspected bacterial infections
 analysed and MRSA infections were studied and followed up prospectively.
description: This prospective observational
 study was undertaken from Jan 2016 to Dec 2017 in a Government Medical
 College in South India which is a tertiary hospital catering six
 districts. Institute Ethics Committee clearance was obtained (Reg. 
 No.ECR/395/Inst/KL/2013). Ref.NO. GMCKKD/RP 2016/IEC/20; dated 
 28.01.2016). Blood, pus, body fluids, urine or bone marrow from children
 between two mon to 12 y admitted with suspected bacterial infections were
 subjected to bacteriological study as per Clinical and Laboratory
 Standards Institute recommendations, in the microbiology department.
 Informed consent was taken from the parents. Staphylococcus aureus was
 identified using standard microbiological lab parameters. MRSA was defined
 when isolate demonstrated a minimum inhibitory concentration (MIC) of
 &gt;4 μg of oxacillin per mL. Antimicrobial susceptibility testing was
 performed for Gentamicin, Amikacin, Cotrimoxazole, Vancomycin, Linezolid,
 Clindamycin and Rifampicin with the disk diffusion method Methicillin
 resistance was tested using a cefoxitin disk on Mueller-Hinton agar.
 Patients were investigated and treated according to the institutional
 protocol. Demographic data were collected by using a structured Performa.
 Each patient’s period of hospitalization was recorded. Cases were defined as HA MRSA, when
 growth obtained was ≥ 48 h after admission or growth obtained &lt; 48
 h of admission and had any of the health care associated risk factors like
 i) a history of hospitalization, surgery, dialysis, or residence in a
 long-term healthcare facility within  12 months prior to the culture date,
 ii) past history of MRSA infection or colonization or iii) presence of an
 indwelling intravenous line, catheter, or any other percutaneous medical
 device at the time the culture was taken. HA MRSA was categorized into
 hospital onset type (HAHO MRSA) when growth was obtained ≥ 48 h of
 hospitalization, and community onset type (HACO MRSA), when culture was
 obtained  &lt;48 h of hospitalization and had a health care associated
 risk factor. Patients
 with growth obtained &lt; 48 h with no health care risk factor were
 classified as CA MRSA infections. MRSA pneumonia was defined as patients
 with clinical and radiologic evidence of pneumonia with isolates of MRSA
 from blood. Empyema was defined as i) MRSA isolated from pleural fluid or
 ii) MRSA isolated from blood having loculated effusion by radiology and/or
 histologic evidence of empyema by pleural fluid study. MRSA septicemia was
 patients showing features of systemic inflammatory response syndrome(SIRS)
 and MRSA growth from blood. Peritonitis was defined as a
 symptomatic child with ascitic fluid study showing&gt;100
 leukocytes/mmᶾ  with ≥ 50% neutrophils and/or positive culture for MRSA
 from peritoneal fluid. Anemia was defined as hemoglobin level below the
 range for age and sex, leukocytosis as white blood cell (WBC) count
 &gt;2 SD above the mean for age and thrombocytopenia as platelet count
 &lt;1,50,000/cu mm. Prolonged hospital stay was defined as
 hospitalization ≥ 14 days.
description: No missing files.