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A nasal swab specimen was collected for culture within 48 hours of admission and a questionnaire was completed using a convenience sample of 350 patients admitted to Driscoll Children's Hospital between February 15 and March 15, 2005. Of the 350 patients enrolled, 125 (36%) patients were colonized with Staphylococcus. aureus and 76 (61%) of the 125 S. aureus isolates were methicillin-resistant.

Cellulitis and abscess accounted for increasing percentages of inpatient (4.6-11.1%), outpatient (0.6-1.2%) and total (1.7-3.3%) expenses from 2001 through 2004. The per member per month expenses attributed to cellulitis and abscess increased from $0.74 in 2001 to $1.19 in 2004. The epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections in children has had a significant economic impact on the Driscoll Children's Health Plan.

Background: Previously we reported the rapid emergence and exponential increase of community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections in South Texas children., Objective: To assess whether changes have occurred in the frequency, types, susceptibility, and treatment of CAMRSA infections at Driscoll Children's Hospital., Methods: Data from 1990 through 2001 were collected during 2 previous studies. Data from 2002 through 2003 were collected and compared with data from 1990 through 2001. All S aureus isolates were identified by a computer-assisted search of culture results, and the medical records were reviewed for all patients with MRSA infections., Results: A total of 1002 MRSA cases were identified from 1990 through 2003 of which 928 (93%) were community-acquired. The number of CAMRSA cases ranged from 0 to 9 per year from 1990 through 1999 and then increased exponentially from 36 in 2000 to 459 in 2003. The most common type of CAMRSA infection in children without (94%) and with (72%) risk factors was cellulitis and abscess. A higher percentage of children with risk factors had invasive CAMRSA infections (26% vs 3%; P<.001). From 2002 through 2003, there was a significant difference in clindamycin susceptibility between CAMRSA isolates from children without and with risk factors and nosocomial isolates (97% and 86% vs 62%; P<.005). A higher percentage of patients admitted for treatment of CAMRSA infections received an empirical intravenous antibiotic to which the organism was susceptible when comparing 2002-2003 with 1990-2000 (96% vs 15%; P<.001). During this 14-year study, all patients recovered, including those with life-threatening CAMRSA infections., Conclusion: The rapid emergence of CAMRSA as a cause of noninvasive and invasive infections in children, which started occurring in the 1990s, has reached epidemic proportions.

A retrospective study was conducted of all patients with complicated parapneumonic effusion discharged between January 1, 1994 and March 31, 2004. We identified 54 patients. The number of patients with complicated parapneumonic effusion per 10,000 admissions increased from 4.4 in 1994 to 18.4 in 2000 (P = 0.03) and then decreased to 13.9 in 2003 (not statistically significant). Community-acquired methicillin-resistant Staphylococcus aureus accounted for none of the 36 cases from 1994 through 2001 and 4 of the 18 cases from 2002 through 2004.

Background: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infections have increased dramatically from 1990 to 2000., Objectives: The objectives of this retrospective study were to report the frequency of CAMRSA isolates, to describe the spectrum of disease observed in children infected with CAMRSA and to compare the antibiotic susceptibility patterns of community-acquired and nosocomial methicillin-resistant S. aureus (MRSA) infections., Methods: All cases of S. aureus including MRSA infections were identified by a computer-assisted search of the Vitek system culture results from 1990 to 2000 and review of the minutes of Infection Control Committee meetings., Results: MRSA was isolated from 147 children (77 boys; 2 weeks to 17 years) from October 1, 1990, to December 31, 2000. Seven cases of CAMRSA were identified from 1990 to 1996, and 53 cases were identified from 1997 to 2000 with 35 cases occurring in 2000. Of the 128 children whose medical records were reviewed, 60 (47%) had CAMRSA infections. In 53 (88%) of these 60 children no risk factor for MRSA was identified. Soft tissue infections accounted for 48 (91%) of the 53 cases of the CAMRSA in children without known risk factors. CAMRSA isolates from children without known risk factors were more susceptible to trimethoprim-sulfamethoxazole (98% vs. 82%; P < 0.005) and clindamycin (92% vs. 57%; P < 0.001) and less susceptible to tetracycline (54% vs. 95%; P < 0.001) than were nosocomial MRSA isolates., Conclusions: The emergence of CAMRSA as a cause of common infections may require a change in the initial selection of antibiotics to assure appropriate coverage in critically ill children.

The article consists of abstracts for published medical research. Topics include psychiatry, pediatric and adolescent medicine, surgery, neurology, internal medicine, ophthalmology, and otolaryncology. The studies include "Association Between Smoking and Attention-Deficit/Hyperactivity Disorder Symptoms in a Population-Based Sample of Young Adults," "Obesity and Vascular Risk Factors at Midlife and the Risk of Dementia and Alzheimer Disease," "Reduced Melanoma-Related Mortality in Uveal Melanoma by Preenucleation Radiotherapy," "Epidemic of Community-Acquired Methicillin-Resistant Staphylococcus aureaus Infections: A 14-Year Study at Driscoll Children's Hospital," and "Choice of Urine Collection Methods for the Diagnosis of Urinary Tract Infection in Young, Febrile Infants."