Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007

Kristina G. Hultén, Sheldon L. Kaplan, Linda B. Lamberth, Katherine Slimp, Wendy A. Hammerman, Maria Carrillo-Marquez, Jeffrey R. Starke, James Versalovic, Edward O. Mason

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure. DESIGN. Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston. METHODS. Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl). RESULTS. Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P<.001), onset of infection less than 10 days after admission (P=7), and lack of comorbidities ( P <.001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P<.01). CONCLUSIONS. In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.

Original languageEnglish (US)
Pages (from-to)183-190
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

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Staphylococcus aureus
Methicillin-Resistant Staphylococcus aureus
Infection
Soft Tissue Infections
Genes
Clone Cells
Hospital Information Systems
Skin
Methicillin
Diamines
Molecular Epidemiology
Clindamycin
Electronic Health Records
Pulsed Field Gel Electrophoresis
Sulfamethoxazole Drug Combination Trimethoprim
Cross Infection
Transferases
Anti-Infective Agents
Gentamicins
Comorbidity

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007. / Hultén, Kristina G.; Kaplan, Sheldon L.; Lamberth, Linda B.; Slimp, Katherine; Hammerman, Wendy A.; Carrillo-Marquez, Maria; Starke, Jeffrey R.; Versalovic, James; Mason, Edward O.

In: Infection Control and Hospital Epidemiology, Vol. 31, No. 2, 01.02.2010, p. 183-190.

Research output: Contribution to journalArticle

Hultén, KG, Kaplan, SL, Lamberth, LB, Slimp, K, Hammerman, WA, Carrillo-Marquez, M, Starke, JR, Versalovic, J & Mason, EO 2010, 'Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007', Infection Control and Hospital Epidemiology, vol. 31, no. 2, pp. 183-190. https://doi.org/10.1086/649793
Hultén, Kristina G. ; Kaplan, Sheldon L. ; Lamberth, Linda B. ; Slimp, Katherine ; Hammerman, Wendy A. ; Carrillo-Marquez, Maria ; Starke, Jeffrey R. ; Versalovic, James ; Mason, Edward O. / Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007. In: Infection Control and Hospital Epidemiology. 2010 ; Vol. 31, No. 2. pp. 183-190.
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title = "Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007",
abstract = "OBJECTIVE. To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure. DESIGN. Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston. METHODS. Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl). RESULTS. Of 242 patients with hospital-acquired S. aureus infection, 147 (61{\%}) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73{\%}) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P<.001), onset of infection less than 10 days after admission (P=7), and lack of comorbidities ( P <.001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P<.01). CONCLUSIONS. In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.",
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T1 - Hospital-acquired staphylococcus aureus infections at Texas children's hospital, 2001-2007

AU - Hultén, Kristina G.

AU - Kaplan, Sheldon L.

AU - Lamberth, Linda B.

AU - Slimp, Katherine

AU - Hammerman, Wendy A.

AU - Carrillo-Marquez, Maria

AU - Starke, Jeffrey R.

AU - Versalovic, James

AU - Mason, Edward O.

PY - 2010/2/1

Y1 - 2010/2/1

N2 - OBJECTIVE. To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure. DESIGN. Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston. METHODS. Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl). RESULTS. Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P<.001), onset of infection less than 10 days after admission (P=7), and lack of comorbidities ( P <.001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P<.01). CONCLUSIONS. In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.

AB - OBJECTIVE. To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure. DESIGN. Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston. METHODS. Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl). RESULTS. Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P<.001), onset of infection less than 10 days after admission (P=7), and lack of comorbidities ( P <.001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P<.01). CONCLUSIONS. In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.

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