S. T. Papastefan1,3, C. T. Buonpane1,2, G. Ares1,2,3, B. Benyamen1, I. Helenowski1,2, C. J. Hunter1,2 1Ann & Robert H. Lurie Children’s Hospital of Chicago,Pediatric Surgery,Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University,Surgery,Chicago, IL, USA 3University Of Illinois At Chicago,Surgery,Chicago, IL, USA
Introduction: Methicillin-resistant staphylococcus aureus (MRSA) nasal colonization is associated with the development of future skin and soft tissue infection in children. While MRSA decolonization protocols are effective in eradicating MRSA colonization, they have not been shown to prevent recurrent MRSA infections. This study analyzed the prescription of decolonization protocols, rates of MRSA abscess recurrence, and factors associated with recurrence. We hypothesized that decolonization would decrease MRSA abscess recurrences after incision and drainage.
Methods: This study is a single institution retrospective review of patients ≤ 18 years of age diagnosed with MRSA culture-positive abscesses who underwent incision and drainage from January 2007 to December 2017 at a tertiary care children’s hospital. The primary outcome was MRSA abscess recurrence. MRSA decolonization protocols (for the patient and all family members) included daily mupirocin nasal ointment and sodium hypochlorite baths or chlorhexidine towel washes two to three times per week for two weeks.
Results: Three hundred ninety-nine patients with MRSA culture-positive abscesses who underwent incision and drainage were identified. Mean age was 3.44 ± 4.45 years, 45% were male and 94.5% had community acquired MRSA infections. 119 (29.8%) patients were prescribed the MRSA decolonization protocol. Patients with prior history of abscesses or cellulitis (32% vs 17%, p=0.002), prior MRSA infection (17.6% vs 4.6%, p<0.0001), groin/genital region abscesses (30% vs 18%, p=0.01), and incision and drainage by a pediatric surgeon (34.0% vs. 10.0%, p<0.0001) were more likely to be prescribed decolonization. Additionally, patients with a higher number of family members with a history of abscess/cellulitis (0.45 vs. 0.20, p<0.0001) or MRSA infection (0.27 vs 0.05, p<0.0001) were more likely to be prescribed decolonization. 62 patients (15.6%) had a MRSA abscess recurrence. Decolonized patients did not have lower rates of recurrence (18.5% vs 14.3%, p=0.29). Recurrence was more likely to occur in patients with prior abscesses (p=0.004), prior MRSA infection (p=0.04), family history of abscesses (p=0.002), family history of MRSA infection (p=0.0003), Hispanic ethnicity (p=0.018), and those with fever on admission (p=0.047). In a subgroup analysis of patients with these significant risk factors, decolonization did not decrease the rate of recurrence.
Conclusion: Contrary to our hypothesis, MRSA decolonization did not decrease the rate of recurrence of MRSA abscesses in our patient cohort. We found significant variability in decolonization prescription between practitioners. Patients at high risk for MRSA recurrence such as personal or family history of abscess or MRSA infection, Hispanic ethnicity, or fever on admission did not benefit from decolonization. Future study of methods to reduce recurrence in patients at high risk are indicated.