Abstract

Aims: To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital.

Methods: Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children’s hospital.

Results: There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric & neonatal surgery accounted for 59.6% of cases. Dermatology and A&E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%.

Conclusions: Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.