1785 Experience with Mrsa (methicillin Resistant Staphylococcus Aureus) in a Central London Tertiary Paediatric Hospital

Background MRSA sepsis contributes to significant morbidity and mortality. National guidelines (2018) have been adopted by individual NHS trusts to minimise the incidence of MRSA. Currently it is not known whether adherence to MRSA guidelines impacts outcomes in paediatric surgical patients. The aim of the study is to audit the MRSA incidence and adherence to guidelines in paediatric surgical patients. Methods A single-centre retrospective audit was conducted from January 2019 to October 2020 in a tertiary paediatric hospital in London, UK. Case notes of in-patients with MRSA colonisation were reviewed. MRSA sepsis incidence, paediatric intensive care unit (PICU) stay, surgery during admission and MRSA guideline adherence were noted. The results were analysed using SPSS statistical package. Results Of 47,904 hospital admissions, 161 were MRSA colonised, incidence 0.3%. All underwent topical decontamination. Twelve patients had MRSA sepsis (7.45%). Four of the 12 patients had elective surgery. There was significant increase in incidence of MRSA sepsis in PICU compared to ward admissions, χ2(1, N=161)=6.091, (P < 0.05). There was no significant difference in MRSA sepsis incidence between medical and surgical patients. MRSA pre-surgical antibiotic administration guideline was adhered in 80% and isolation guideline in 11.6%. Median duration stay for MRSA sepsis patients was 9 days and 3 for colonised patients. Conclusions MRSA sepsis contributed significantly to longer hospital length-of stay and PICU stay. This underlies importance of quality improvement interventions as this worsens outcomes for patients and incurs greater hospital costs. Changes need to be made to ensure improved compliance with local MRSA guidelines such as adequate isolation measures to reduce spread and appropriate antibiotic therapy.