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J Pediatric Infect Dis Soc. 2012 Sep;1(3):200-11. doi: 10.1093/jpids/pis061. Epub 2012 Jul 13.

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area.

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Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, San Francisco.
San Francisco Department of Health.
California Emerging Infections Program, Oakland.
School of Public Health, University of California, Berkeley.
Children's Hospital & Research Center Oakland, California.
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, San Francisco San Francisco Department of Health.



Risk factors differentiating methicillin-resistant Staphylococcus aureus (MRSA) from methicillin-sensitive S aureus (MSSA) infections in the pediatric community have been unclear.


We performed a prospective case-comparison investigation of clinical, epidemiological, and molecular factors in pediatric community-associated (CA) MRSA and MSSA cases in the San Francisco Bay Area. Chart reviews were conducted in 270 CA-MRSA and 313 CA-MSSA cases. Fifty-eight CA-MRSA (21.4%) and 95 CA-MSSA (30.4%) cases were interviewed. Molecular typing was performed on 111 isolates.


MSSA represented 53.7% of CA cases and was more likely to cause invasive disease (6.2% vs 1.1%, P = .004). Few potential epidemiologic risk factors distinguished CA-MRSA from CA-MSSA. No differences were found in factors related to crowding, cleanliness, or prior antibiotic use. Compromised skin integrity due to eczema (24.3% vs 13.5%, P = .001) was associated with CA-MSSA. Many exposures to potentially infected or colonized contacts or contaminated objects were assessed; only three were associated with CA-MSSA: having a household contact who had surgery in the past year (18.9% vs 6.0%, P = .02), and regular visits to a public shower (9.1% vs 2.0%, P = .01) or gym (12.6% vs 3.3%, P = .04). Molecular typing identified clonal complex 8 as the predominant genetic lineage among CA-MRSA (96.4%) and CA-MSSA (39.3%) isolates.


In the context of recent heightened focus on CA-MRSA, the burden of serious disease caused by CA-MSSA among children should not be overlooked. MRSA and MSSA may be growing epidemiologically similar; thus, research, clinical, and public health efforts should focus on S aureus as a single entity.


Epidemiology; MRSA; MSSA; Pediatrics; S aureus

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