1170. Outcome of Invasive Methicillin-resistant Staphylococcus aureus Infections in Children: Mother-to-Infant Transmission
Session: Poster Abstract Session: Staphylococcus aureus Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
  • Cogen_Poster_IDSA2011_FINAL.pdf (248.5 kB)
  • Background: This study will characterize children with invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections, key risk factors that can predict death, and describe cases of mother-to-infant transmission.  

    Methods: Retrospective-observational study that included patients with invasive MRSA infections identified between 2006 and 2010 at Children’s National in Washington DC.  An invasive infection was defined as MRSA recovered from sterile sites including blood, cerebrospinal, pleural, pericardial, and peritoneal fluid, synovial fluid, bone, and surgical sites of clean procedures.  Genotyping using Rep-PCR was performed on viable isolates.  Statistical analyses were conducted to examine independent associations between outcome (death) and the following risk factors: age, gender, history of MRSA colonization, surgery within 1 year prior to admission, surgery during current admission, health associated (HA) versus community associated (CA) infection, and antimicrobial resistance pattern.

    Results: During the study period, 116 of 3,348 (3.5%) children were diagnosed with invasive MRSA infections.  The incidence decreased from 4.2% (28/659) in 2006 to 2.1% (12/580) in 2010.  The most common sites of infection were primary bacteremia (32%), musculoskeletal infection (22%), abscesses (20%), cerebrospinal fluid (4%), peritoneal fluid (3%), endocarditis (3%), and surgical site (2%).  All-cause mortality rate was 15% (N=17).  Attributable mortality rate to MRSA was 12% (N=14).  Unadjusted analysis revealed that mortality was associated with young age (<1 yr), isolates with clindamycin resistance, HA infection, and history of surgery during admission.  Rep-PCR of viable isolates (N=53, 46%) revealed the USA 300 strain as most prevalent (66%), followed by USA 500 (11%), USA 100 (9%), and others (14%).  Isolates of two young infants with bacteremia/multiple abscesses and empyema with USA 300 matched (98.6%) similarity with MRSA isolates of their mother’s placenta and labial abscess confirming mother-to-infant transmission. 

    Conclusion: Invasive MRSA infections in children are declining, but remain a significant life threatening disease to this vulnerable population.  Mother-to-infant transmission was seen in two patients.

    Subject Category: P. Pediatric and perinatal infections

    Jonathan Cogen, MD MPH1, Xiaoyan Song, PhD, MBBS2, Lauren Minor, MD3 and Nalini Singh, MD MPH1, (1)Children's National Medical Center, Washington, DC, (2)George Washington University School of Medicine, Washington, DC, (3)Emory University , Atlanta, GA


    J. Cogen, None

    X. Song, None

    L. Minor, None

    N. Singh, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.