Experience with Methicillin-Resistant Staphylococcus aureus in a Central London Tertiary Pediatric Hospital

Abstract Objective  Methicillin-resistant Staphylococcus aureus (MRSA) infection is very serious, and thus, it is common practice, worldwide, to screen for MRSA colonization at admission and institute decolonization procedures. Our aim was to review adherence to local guidelines and sepsis risk in pediatric patients with a focus on surgical cases. Methods  A retrospective case note review was conducted from January 2019 to October 2020 in a tertiary pediatric hospital. Data collected included demographics, incidence of sepsis, pediatric intensive care unit (PICU) admissions, and adherence to guidelines. The results were analyzed with an SPSS statistical package. Results  MRSA screening was performed in all 47,904 admissions; 161/47,904 had MRSA colonization. All underwent topical decontamination; however, isolation guidelines were adhered in only 7.45%; 71/161 were surgical patients; 23/71 were admitted to the PICU. Irrespective of the class of wound, 4/71 surgical patients developed MRSA sepsis. Of these, 2/5 surgical patients did not receive MRSA appropriate preoperative antibiotics; 4/5 surgical patients who had sepsis were admitted to PICU. Standard preoperative World Health Organization (WHO) surgical checklists were completed in all surgical cases. There was no mention of MRSA status in these forms. Conclusion  MRSA remains a risk for sepsis and PICU admissions despite a 100% compliance with screening and decontamination. Adherence to WHO checklist did not result in the administration of correct antibiotics. High risk of postoperative sepsis (6.8%), with 80% needing PICU, irrespective of class of wound, mandates a more robust approach to prevention. Changes need to be made to WHO local surgical checklists.