I’m the director of a hospital-based emergency clinic. Recently, we’ve had a bunch of children come through with skin infections that turned out to be community-acquired MRSA (CA-MRSA). Our docs have asked me to research best practice recommendations for this problem. I am checking several other sources. What do you suggest?

A recent study from the University of Kentucky College of Medicine may have some information to help you. They reviewed their records for 10 years (2001-2010) and pulled the medical charts of any patient 0 to 14 years old who presented with hand infections at their hospital. They were able to see some patterns that might be helpful in better understanding CA-MRSA in children.

Overall incidence of CA-MRSA in the group was 25 per cent. That means one in every four children admitted to the hospital for a skin infection already had CA-MRSA before even coming to the hospital. This is much higher than the recommended rate of no higher than 10 to 15 per cent set by the Centers for Disease Control and Prevention (CDC).

Data collected from hospital charts included patient age, medical problems, treatment for the hand infection, and number of days in the hospital. Of course the infection was cultured (sent to the lab) to identify the specific type of bacteria present. The lab tests are able to test the microorganisms and determine which antibiotics will work.

By analyzing the children’s charts, they were able to identify risk factors — variables that put the children at increased risk for developing CA-MRSA. Instead of the typical risk factors reported for adults (e.g., older age, poor health, abscess drainage in a surgical setting, history of trauma, previous history or MRSA), they found children had a different set of risk factors.

For the children in this study, low income living conditions, poor personal hygiene, and crowded settings with close personal contact were the main risk factors. The presence of an abscess that needed surgical draining was an additional risk factor. The deeper the abscess, the greater the chances the child had a positive case of CA-MRSA.

Of course, the question comes up: what can be done about this alarming rise in CA-MRSA among children and young teens? The authors outline their recommendations. These may be helpful to your staff:

  • Whenever possible, all skin and soft tissue infections should be cultured for identification of microorganisms present and type of antibiotic most likely to work.
  • When cultures are not available, antibiotics should be given for infections with signs of cellulitis (red streaks) up the arm.
  • Oral (by mouth) antibiotics are acceptable for infections with cellulitis but no symptoms of systemic disease (e.g., fever, sweats, nausea, fatigue).
  • Intravenous (IV) antibiotics are advised for widespread cellulitis or systemic illness.
  • Abscesses should be drained and cultured to assist in choosing the best antibiotic to combat the microorganism present.
  • Certain antibiotics (e.g., vancomycin, sulfamethoxazole) can be started until lab results come back. After receiving the lab results, the patient can be switched to a more specific/effective antibiotic if needed.

    With the rise in number of cases of community-acquired methicillin resistant staphylococcus aureus (CA-MRSA), new treatment techniques are needed to prevent serious effects from this bacteria. Children with CA-MRSA (especially anyone with an abscess) who come to the hospital for treatment should be tested for MRSA and treated appropriately. Efforts should be made at the community level to reduce risk factors through education (hand washing) and improving living conditions for children in crowded, low-income, housing projects.