Purpose: Infection following pediatric solid organ transplantation (SOT) is a major cause of morbidity and mortality. Peri-operative antibiotic prophylaxis is commonly used to reduce the incidence of infectious complications in the immediate post-operative time frame, but infection within 90 days of transplantation remains an area of concern. There is a paucity of published evidence documenting the actual incidence and impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization in the pediatric population. We evaluated the incidence of MRSA colonization in pediatric patients undergoing evaluation for SOT and subsequent incidence of MRSA infection within 3 months of transplantation in screened patients.

Methods: We performed a retrospective cohort study of pediatric SOT < 20 years of age at pre-transplant evaluation, from May 2013 until July 2014. Demographics, MRSA screen results, progression to transplant and subsequent MRSA infection post-transplant were abstracted from the electronic medical record.

Results: 66 patients were screened. 30 (45%) were male and 36 (55%) were female. Mean age at screening was 9.3 years (range, 5 weeks – 20 years). Of those screened, 37/66 (56%) were liver, 13/66 (20%) heart, 8/66 (12%) multi-visceral, 5/66 (8%) renal, and 3/66 (5%) lung transplant evaluations. MRSA colonization was found in 7/66 (11%) of all evaluated patients. Of the 7 MRSA colonized patients, 28.6% were heart (2/7), 28.6% lung (2/7), 28.6% multi-visceral (2/7) and 14.3% liver (1/7) candidates. In the 28 patients that proceeded to transplant, 2 (7%) were MRSA positive on screening. There was 1 post-transplant MRSA infection, and that occurred in one of the two known MRSA colonized patients that received MRSA targeted perioperative antimicrobial prophylaxis. No documented MRSA infections occurred within 90 days of transplant in the remaining 26 patients that were MRSA negative.

Conclusion: In this cohort of retrospectively analyzed pediatric SOT candidates we found that 11% of all evaluated patients were MRSA colonized, with an equal distribution between heart, lung and multi-visceral transplant evaluations. MRSA colonization in the pediatric SOT population is prevalent and may have significant impact on post-transplant risk of MRSA infection, despite targeted antimicrobial prophylaxis.

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