Spatiotemporal surveillance of pediatric community-onset MRSA infections in Metro Atlanta using electronic health record data Open Access

Wood, Anna (Spring 2019)

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While other types of Staphylococcus aureus infections decreased in the United States in recent years, community-onset methicillin resistant Staphylococcus aureus (CO-MRSA) and community-onset methicillin sensitive Staphylococcus aureus (CO-MSSA) infection rates have been stagnant. CO-MRSA and CO-MSSA commonly affect children and are a massive economic burden. This study sought to understand how the epidemiology of these infections compared to one another across time and space in the Atlanta Metropolitan Statistical Area (MSA). We assessed socioeconomic risk factors for infection at the individual level using electronic health records (EHR) from two pediatric hospitals in the MSA from 2002 through 2010. We geocoded patients’ addresses and linked each to a census tract. Infection counts were aggregated for each census tract in the MSA. Incidence ratios were calculated and mapped for each census tract. Population level data was also collected using the 2000 American Community Survey (ACS) (2002-2004) and the 2010 ACS (2005-2010). Census tract level socioeconomic risk factors were then identified. CO-MRSA incidence was highest in 2008 (63.17 infections per 100,000 children), while CO-MSSA incidence was highest in 2009 (51.62 infections per 100,000). Cumulatively, census tract incidence ratios ranged from 0 infections per 100,000 children to 6,250 infections per 100,000 over the nine-year study. Increased CO-MRSA incidence was associated with increased nursery school and preschool enrollment (IDR: 0.9993, 95% CI: 0.9989-0.9997, p < 0.0001) while increased CO-MSSA incidence was associated with increased nursery school and preschool enrollment as well as proportion of the population that was black (aIDR: 1.0008, 95% CI: 1.00-1.00, p < 0.0001). Statistically significant hot spots of CO-MRSA moved from the northeast region of the MSA toward the center in 2005 and remained centrally located for the remainder of the study. CO-MSSA statistically significant hot spots appeared more sporadic from year to year, but also became centrally located from 2008 through 2010. Further research is essential to identifying and implementing interventions in individual census tracts at highest risk for CO-MRSA and CO-MSSA. This study shows the importance of integrating population level demographics with EHR to inform diagnoses and treatments for CO-MRSA and CO-MSSA and decrease the burden of these infections in DeKalb and Fulton counties.

Table of Contents

Background, 1

Methods, 3

Results, 6

Discussion, 10

Conclusion, 13

References, 14


Table 1. Data sources, 17

Table 2. MRSA and MSSA Infections and Rates (2002-2010), 17

Table 3. Patient Level Characteristics, 18

Table 4a. Census Tract Level Characteristics Medians – MRSA, 19

Table 4b. Census Tract Level Characteristics – MRSA, 20

Table 5. Patient Level Characteristics – MSSA, 21

Table 6a. Census Tract Level Characteristics Medians – MSSA, 22

Table 6b. Census Tract Level Characteristics – MSSA, 23

Table 7. Census Tract Level Factors – MRSA, 24

Table 8. Census Tract Level Factors – MSSA, 24


Figure 1. Atlanta MSA, 25

Figure 2. Study Enrollment Schema, 26

Figure 3. CO-MRSA and CO-MSSA Incidence Rates, 27

Figure 4. CO-MRSA and CO-MSSA Census Tract Transference, 28

Figure 5. CO-MRSA and CO-MSSA Incidence Rates by Year and Census Tract, 29


Children’s Healthcare of Atlanta Institutional Review Board Approval, 30

Table 9. Patient Level Characteristics – MRSA v. MSSA (n = 10,642), 32

Figure 6. MRSA Infections Incidence Rates (2002-2010), 33

Figure 7. MSSA Infections Incidence Rates (2002-2010), 34

Figure 8. Cluster Maps for Pediatric MRSA Infections by Year, 35

Figure 9. Cluster Maps for Pediatric MRSA Infections by Year, 36

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