Space Time Trends of Community Onset Staphylococcus Aureus Infections in Children Living in Southeastern United States: 2002-2010

Abstract Background Staphylococcus aureus (S. aureus) remains a serious cause of infections in the U.S. and worldwide. Non antibiotic resistant Staphylococcus aureus (methicillin susceptible or MSSA) is the cause of half of all health care–associated staphylococcal infections, and methicillin resistant Staphylococcus aureus (MRSA) still is the leading cause of community onset skin and soft tissue infections in the U.S. This is the first study to spatially look at trends of both community onset MRSA and MSSA infections over nine years and determine ‘best’ to ‘worst’ infection trends over a nine year period (2002-2010),which spanned when community onset MRSA infections were occurring in epidemic proportions across the U.S. MethodsRetrospective study from 2002-2010, using electronic health records of children living in the southeastern U.S. (Atlanta, Georgia) with S. aureus infections and relevant U.S. census data (at the census tract level). The Proc Traj for SAS was applied to generate community onset MRSA and MSSA trajectory infection groups (low, high, very high, or deviant trends), and then, mapping of these trajectory groups using census tract boundaries.ResultsFrom community onset MRSA infection trend patterns (low, high, very high), only 0.8% of the census tracts showed a dramatic increase from 2002-2007 and then a gradual decline from 2008 to 2010. From community onset MSSA infection trend patterns (low and high), 85.7% of ‘high infection’ group persisted throughout the nine year period, compared to 14.3% of ‘low infection’ group over this same period. Low community onset MRSA and MSSA trend patterns were seen throughout the 20 counties of Atlanta, Georgia’s metropolitan statistical area, but more often seen in those counties less densley populated. Census tracts reflecting Atlanta’s ‘innercity’ had the highest proportion of the worst infection trend pattern (community onset MRSA-Very High-CO-MSSA-High or community onset MRSA-High-CO-MSSA-High). The deviant trend of community onset MRSA Very High- CO-MSSA Low infection were in census tracts east of downtown Atlanta. Conclusions ‘Trends’ of S. aureus infection patterns, stratified by antibiotic resistance, over geographic areas and time identify communities with higher risks for community onset MRSA infection compared to community onset MSSA infection.