• Lilly Cheng Immergluck, Shabnam Jain, Susan M Ray, Robert Mayberry, Sarah Satola, Trisha Chan Parker, Keming Yuan, Anaam Mohammed, and Robert C Jerris.
• Morehouse School of Medicine, Clinical Research Center, Departments of Microbiology, Biochemistry, Immunology and Pediatrics, Atlanta, Georgia; Emory University, Department of Pediatrics, Atlanta, Georgia.
• West J Emerg Med. 2017 Feb 1; 18 (2): 201-212.

IntroductionThe purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300.MethodsWe conducted a case control study in a pediatric emergency department. Nasal and axillary swabs were collected, and participants were interviewed for risk factors. The primary outcome was the proportion of S. aureus carriers among those presenting with and without a skin and soft tissue infection (SSTI). We further categorized S. aureus carriers into MRSA USA300 carriers or non-MRSA USA300 carriers.ResultsWe found the MRSA USA300 carriage rate was higher in children less than two years of age, those with an SSTI, children with recent antibiotic use, and those with a family history of SSTI. MRSA USA300 carriers were also more likely to have lower income compared to non-MRSA USA300 carriers and no S. aureus carriers. Rates of Panton-Valentine leukocidin (PVL) genes were higher in MRSA carriage isolates with an SSTI, compared to MRSA carriage isolates of patients without an SSTI. There was an association between MRSA USA300 carriage and presence of PVL in those diagnosed with an abscess.ConclusionChildren younger than two years were at highest risk for MRSA USA300 carriage. Lower income, recent antibiotic use, and previous or family history of SSTI were risk factors for MRSA USA300 carriage. There is a high association between MRSA USA300 nasal/axillary carriage and presence of PVL in those with abscesses.

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