Enhanced surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Ireland

Alan P Johnson^1,*, Mike Sharland², Catherine Goodall¹, Ruth Blackburn¹, Angela Kearns¹, Ruth Gilbert³, Theresa Lamagni¹, Andre Charlett¹, Mark Ganner¹, Robert Hill¹, Barry Cookson¹, David Livermore¹, Julie Wilson⁴, Robert Cunney⁵, Angela Rossney⁶, Georgia Duckworth¹

¹ Health Protection Agency, United Kingdom;
² St Georges Hospital, United Kingdom;
³ Institute for Child Health, United Kingdom;
⁴ Health Protection Scotland, United Kingdom;
⁵ National Disease Surveillance Centre, United Kingdom;
⁶ National MRSA Reference Laboratory, United Kingdom

Correspondence to: Alan Johnson, HPA, /, /, /, United Kingdom; alan.johnson{at}hpa.org.uk

Accepted 15 September 2009

Objective: To determine the incidence and demographic features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in children in the UK and Republic of Ireland, and to characterise MRSA isolated from cases.

Design: Prospective surveillance study.

Setting: Children aged <16 years hospitalized with bacteraemia due to MRSA.

Methods: Cases were ascertained by active surveillance involving paediatricians reporting to the British Paediatric Surveillance Unit and by routine laboratory surveillance. Patient characteristics were obtained using questionnaires sent to reporting paediatricians. MRSA isolates were characterised using molecular and phenotypic techniques including antimicrobial susceptibility testing.

Results: 265 episodes of MRSA bacteraemia were ascertained, involving 252 children. The overall incidence rate was 1.1 per 100,000 child population per year (95%CI 0.9-1.2): 61% of the children were aged <1 year (a rate of 9.7 cases per 100,000 population per year [95% CI 95% CI 8.2 – 11.4]) and 35% were <1 month. Clinical data were obtained from 115 cases. The clinical presentation varied, with fever present in only 16% of neonates compared with 72% of older children. A history of invasive procedure was common, with 32% having had intravascular lines and 13% having undergone surgery. Sixty-two per cent of patients for whom data were available were receiving high-dependency care (46% in SCBU/NICU and 16% in PICU). Of 93 MRSA isolates studied, 73% belonged to epidemic strains widely associated with nosocomial infection in the UK and Ireland.

Conclusions: MRSA bacteraemia in children was relatively uncommon and was predominantly seen in very young children, often those receiving neonatal or paediatric intensive care. Bacteraemia predominantly involved well documented epidemic strains of MRSA associated with nosocomial infection.

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