Brief Report
Methicillin-resistant Staphylococcus aureus colonization is not associated with higher rate of admission to pediatric intensive care unit

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Abstract

Purposes

Methicillin-resistant Staphylococcus aureus (MRSA) colonization is consistently rising. The question whether the MRSA colonization places the patients at higher risk, requiring higher levels of care when being admitted, has never been studied. We conducted this study to determine the impact of MRSA colonization status on the required level of care upon admission to hospital.

Basic procedures

We conducted a retrospective chart review in 1000 plus–bed tertiary care academic institute. Our study population composed of all the patients who were admitted from January 2011 to March 2011. We found 7413 pediatric admissions that were identified as the study subjects. We assessed and divided study subjects into 2 groups, MRSA colonized and MRSA noncolonized. Methicillin-resistant Staphylococcus aureus–colonized patients were further grouped into those admitted to either pediatric intensive care unit (PICU) or ward, and these 2 groups were analyzed using P value, Fisher exact test, relative risks, and odds ratios.

Main findings

We found a total of 7413 admissions, 753 were admitted in PICU (average pediatric risk of mortality score 18), and 6660 were admitted in pediatric wards (average pediatric risk of mortality score, 5). We found that MRSA colonization was 20 (2.66%) of 753 in PICU admissions and 155 (2.33%) of 6660 in ward admissions. We found that rate of admissions difference between MRSA colonized and MRSA noncolonized groups was clinically insignificant (P > .05).

Principal conclusions

We conclude that MRSA colonization does not increase the need of care in PICU upon admission to hospital from emergency department. However, these preliminary results need to be confirmed through larger, multicenter, and multicountry data analysis.

Introduction

Staphylococcus aureus is an important virulent gram-positive coccus organism implicated in a wide spectrum of diseases including life-threatening infections. Its virulence multiplies when it develops resistance to antimicrobial agents. When the resistance is developed against antimicrobials called β-lactams such as methicillin and other penicillins, it is called methicillin-resistant Staphylococcus aureus (MRSA).

Increasing number of studies show that MRSA colonization is a significant risk factor in health care resulting in higher morbidity and mortality as well as increased health care costs [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Methicillin-resistant S aureus colonization has been implicated in the rising MRSA prevalence [11], higher rates of community-associated and nosocomial MRSA infections [6], [12], [13], and a greater risk of morbidity and mortality [14] of hospitalized patients. Overall, at our own hospital, there are increasing numbers of MRSA-colonized patients presenting to emergency departments (EDs) nowadays. The question whether the MRSA colonization puts patients at a risk for requiring higher levels of care at the time of admission has not so far been addressed. The answer to this question will add to our existing knowledge of MRSA epidemiology and provide rational basis for allocating resources and organizing more rigorous MRSA control programs [15], [16], [17]. Here, we present the data showing that MRSA colonization does not cause a significant risk for higher levels of care by requiring pediatric intensive care unit (PICU) admission.

Section snippets

Study setting

This study was conducted at King Abdulaziz Medical City hospital, a 1000 plus–bed tertiary care academic institute in Riyadh, Saudi Arabia. The pediatric ED at this hospital tends to an average of 25 000 patients per year. In-patient services include a 20-bed PICU admitting around 700 medical/surgical pediatric patients per year and a 100-bed pediatric ward admitting around 7500 patients annually. The study was approved by the Institutional Review Board of King Abdullah International Medical

Results

During the period from January 1, 2010, to March 31, 2011, a total of 26 656 visits were made to the department of pediatric emergency. A total of 7413 pediatric patients were admitted during this period, and 175 (2.36%) were found to be colonized with MRSA as tested by PCR and confirmed by routine culture assay for MRSA. In group 1 (ie, PICU admissions), there were 753 admissions including 20 subjects colonized with MRSA. In group 2 (ie, ward admissions), there were 6660 admissions including

Discussion

To our knowledge, no previous study has assessed the relationship between MRSA colonization and degree of severity of disease process upon admission from ED. The issue of MRSA colonization in hospitalized patients is important in many respects. First, MRSA colonization may act as a hidden reservoir for clinical infections [18], [19]. Second, a colonized individual may spread MRSA to other individuals [20], [21]. Third, being a highly resistant organism, it increases morbidity and health care

Conclusion

In summary, our data suggest that MRSA colonization does not present a greater risk for admission to PICU. This study not only indicates a requirement of PICU care for MRSA-colonized patients with pulmonary and renal disorders but also shows a higher prevalence of skin and soft tissue infections in these patients. Last but not least, these results need to be considered with caution because of the limitations heretofore mentioned. We, therefore, suggest that large scale multicenter studies,

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