Increasing prevalence of nasal and rectal colonization with methicillin-resistant Staphylococcus aureus in children with cancer

Authors

  • Ashok Srinivasan MD,

    Corresponding author
    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
    3. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
    • Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105-3678.
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  • Steven E. Seifried PhD,

    1. Department of Cell and Molecular Microbiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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  • Liang Zhu PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Deo K. Srivastava PhD,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Rosalie Perkins BS,

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Jerry L. Shenep MD,

    1. Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Matthew J. Bankowski PhD,

    1. Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
    2. Diagnostic Laboratory Services, Inc., Honolulu, Hawaii
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  • Randall T. Hayden MD

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Conflict of interest: Nothing to declare.

  • This work was presented in part at the 51st annual meeting of the American Society of Hematology, December 2009, New Orleans, LA.

Abstract

Background

Infections with methicillin-resistant Staphylococcus aureus (MRSA), in community-settings, especially with strains carrying the Panton-Valentine Leukocidin (PVL) genes, have increased markedly in recent years. Colonization with S. aureus is a risk factor for infection. However, there are few studies that examine colonization and infection with PVL-positive strains of MRSA in cancer patients.

Procedure

The epidemiology of colonization and infection with MRSA was studied in children with cancer during two time periods: 2000/2001 and 2006/2007. PVL genes were screened and spa typing performed on the isolates.

Results

The prevalence of colonization with MRSA increased from 0.6% in 2000/2001 to 2.9% in 2006/2007 (P = 0.0003). MRSA colonization at admission was associated with infection (P < 0.0001; RR 38.32; 95% CI: 23.36–62.84). The prevalence of infection increased from 0.99% in 2000/2001 to 3.78% in 2006–2007 (P = 0.0002). Of the 32 colonized patients, 18 (56%) had infection. None of the 14 colonized but non-infected patients had dual colonization of nares and rectum, while 8 of the 18 infected patients had colonization of both of these sites (P = 0.004). Ten patients (31%) were colonized with PVL-positive strains. Patients colonized with PVL-positive strains were more likely to be colonized both in the nares and rectum (P = 0.005), and more likely to have infection (P = 0.001). Recurrent MRSA infections were seen in 22% of patients.

Conclusion

An increasing prevalence of colonization with MRSA was observed in children with cancer at our institution. Colonization with MRSA especially with PVL-positive strains was associated with infection. Pediatr Blood Cancer. 2010;55:1317–1322. © 2010 Wiley-Liss, Inc.

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