MRSA Is More Prevalent In Paediatric Healthcare Than Previously Thought - Birmingham Children's Hospital, UK

Main Category: MRSA / Drug Resistance
Also Included In: Pediatrics / Children's Health;  Infectious Diseases / Bacteria / Viruses
Article Date: 27 Oct 2008 - 5:00 PST

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Birmingham Children's Hospital has introduced a new way of detecting the MRSA superbug amongst its most critically ill young patients. The test, developed by molecular diagnostics company Cepheid, has so far proven to be 100% accurate and is allowing doctors at the hospital to identify if a patient to be admitted to the ICU has MRSA within an hour. The only other testing method that offers the same level of accuracy as the GeneXpert(R) test is the traditional culture-based test, where the bacteria is grown in a petri dish in a micro-biology lab. However, it takes up to three days to verify if the MRSA culture can be grown from the patient's sample.

At the moment the project is focusing on screening all patients being admitted to the Intensive Care Unit. Every result obtained using the Cepheid GeneXpert(R) System has so far been verified as accurate by a further culture test and the hospital has already identified two cases of MRSA that they wouldn't normally have picked up on.

"Something else that is becoming apparent as we roll out a wider screening programme of our patients is that levels of MRSA amongst children are actually higher than is commonly believed," says Dr Jim Gray, Consultant Microbiologist at Birmingham Children's Hospital. "It is a generally accepted belief in the medical profession that children are not really carriers of the MRSA bacterium, however we are increasingly finding that this is not the case."

Obtaining an accurate and rapid result for MRSA is absolutely key at the emergency admission point in hospitals. For example, if a patient is critically ill and needs to be admitted to the ICU (Intensive Care Unit) without delay, clinicians simply cannot afford to wait two to three days for a culture result to see whether the patient has MRSA. By then the patient will certainly have undergone several medical procedures that carry a risk of introducing MRSA into sites of the body where it can cause serious harm, such as the lungs and the bloodstream. Also, if the child is carrying the superbug, by the time the results of MRSA cultures arrive back from the lab it may have spread to other children on the unit.

"It made sense to start the screening with ICU patients as they are the most susceptible to contracting the MRSA infection due to the bacteria most commonly gaining access to the body through open wounds, injections, catheters and IV sites," says Dr Gray. "It is vital to prevent MRSA from entering the ICU as it is extremely serious and potentially fatal for children who are already critically ill."

Paediatric hospitals are not currently required to comply with the Department of Health guidelines issued to UK hospitals regarding the introduction of MRSA screening for all elective admissions to hospitals by March 2009. Although Birmingham Children's Hospital has comparatively low levels of the superbug, it was concerned to realise that approximately half of the MRSA cases at the hospital were going undetected until the child had actually developed symptoms and fallen ill with the infection. They are therefore rolling out a policy of screening all patients who fall into one of the deemed 'high risk' categories at admittance stage, starting with the ICU. The hospital will then expand the screening programme to include all elective surgical patients who require overnight admission, as well as elective and emergency admissions to the liver and renal units, and haematology and oncology ward.

Dr Gray believes that the surveillance work the hospital is carrying out on MRSA is very important in building a better picture of the levels of MRSA colonisation within children. "We are learning a lot and asking ourselves a great many questions. For example, because of the nature of their condition, some of our haematology patients may be admitted as often as three or four times per month. Is it necessary and helpful to screen them every time they come back? Hopefully the answers that we obtain will assist other UK health trusts in developing a best practice policy regarding MRSA in child patients."

About Birmingham Children's Hospital

Birmingham Children's Hospital is the foremost specialist Children's Hospital for Birmingham and the Midlands, offering a wide range of paediatric services for children and young people throughout the Midlands and beyond. Some of its services cater for children and young people on a national or supra-regional basis, for example our Burn Centre and Liver Unit. But it also offers many local services for children and young people, including one of the country's largest Child and Mental Health Services (CAMHS).

About the GeneXpert(R) System Molecular Diagnostic Platform

Cepheid's GeneXpert System is a closed, self-contained, fully-integrated and automated platform that represents a paradigm shift in the automation of molecular analysis, producing accurate results in a timely manner with minimal risk of contamination. The GeneXpert System is the only system to combine on-board sample preparation with real-time PCR (polymerase chain reaction) amplification and detection functions for fully integrated and automated nucleic acid analysis. The system is designed to purify, concentrate, detect and identify targeted nucleic acid sequences thereby delivering answers directly from unprocessed samples. Modular in design, the GeneXpert System has a variety of configurations to meet the broad range of testing demands of any clinical environment. http://www.cepheid.com

Source
Nigel Smith/Laura Warner/Victoria Harvey
Schwartz Communications
Cepheid