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Methicillin-resistant Staphylococcus aureus infections in children: Epidemiology and clinical spectrum

Author
Sheldon L Kaplan, MD
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Shortly after the introduction of methicillin in 1959, outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infections were reported [1].

The epidemiology and clinical spectrum of MRSA infections in children will be reviewed here. The treatment and prevention of MRSA infections in children is discussed separately. (See "Suspected methicillin-resistant Staphylococcus aureus skin and soft tissue infections: Evaluation and management in children >28 days" and "Methicillin-resistant Staphylococcus aureus in children: Treatment of invasive infections" and "Methicillin-resistant Staphylococcus aureus in children: Prevention and control".)

The epidemiology, treatment, and prevention of MRSA infections in adults are also discussed separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of skin and soft tissue infections" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of bacteremia" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control".)

MRSA DEFINITION

Methicillin resistance in S. aureus is defined as an oxacillin minimum inhibitory concentration (MIC) ≥4 mcg/mL. Isolates resistant to oxacillin or methicillin also are resistant to all beta-lactam agents, including cephalosporins (with the exception of ceftobiprole and ceftaroline).

Methicillin resistance is mediated by the mecA gene, which encodes for an abnormal low-affinity binding protein, PBP-2a, that permits the organism to grow and divide in the presence of methicillin and other beta-lactam antibiotics. The mecA gene is located on a mobile genetic element called staphylococcal cassette chromosome (SCCmec). A single clone probably accounted for most methicillin-resistant S. aureus (MRSA) isolates recovered during the 1960s; by 2002, five major MRSA clones emerged worldwide [2-4]. Dissemination of resistance was mediated by horizontal transfer of the mecA gene and related regulatory sequences [5]. (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology".)

                        

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