Reviewed by Sanchi Malhotra MD, University of California Los Angeles
This study used the Pediatric Health Information System (PHIS) database to identify patients hospitalized with MRSA infections to understand the epidemiologic trends of MRSA burden and severity over time in the United States. The authors identified pediatric patients using ICD-10 codes associated with MRSA in hospitalized patients across 40 children’s hospitals from 2016-2024. MRSA cases per 1000 hospitalizations and those requiring ICU care per 1000 hospitalizations were calculated. Authors also aimed to describe changes in anti-MRSA antibiotic prescribing, with a particular focus on ceftaroline.
Overall, 29,458 encounters were identified using ICD-10 codes. MRSA hospitalization rate declined from ~ 9/1000 in 2016 to ~5/1000 in 2024. The rate of ICU admissions stayed the same during this time period (~ 2/1000).
More detailed analysis was done on the 9288 encounters with invasive MRSA infection. Patients with cystic fibrosis, in the NICU, and those exclusively treated with TMP/SMX were excluded. Vancomycin remained the predominant agent, used in >50% of all MRSA days of therapy in every study year. Decline in IV clindamycin use, and increase in ceftaroline use was observed over time. High interhospital variability with regard to antibiotic selection was seen. Ceftaroline use was associated with ICU admission, osteomyelitis, CVC infection, endocarditis, and pneumonia and less likely in SSTI. The authors discuss that high inter-hospital heterogeneity may reflect difference in stewardship practices or ID/provider preferences. The authors could also consider that differences in local clindamycin resistance could influence heterogeneity and may contribute to decrease in use. They do acknowledge lack of resistance data as a limitation to their data set. They also acknowledge the data is limited by risk of misclassification due to reliance on ICD-10 codes.
This study is encouraging that MRSA rates have declined overall in pediatrics and may help institutions look at their local data to reconsider need for empiric anti-MRSA coverage in non-ICU settings.
Reference:
Zhang S, Hersh AL, Mehra S, Fino N, Olson J. Trends in Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Hospitalized Children. J Pediatric Infect Dis Soc. 2026 Aug 4;15(8):piag065. doi: 10.1093/jpids/piag065. PMID: 42550477.