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Methicillin-resistant Staphylococcus aureus empyema in children
Abstract:
Over a 14 year period, there were 20 patients who presented with staphylococcal empyema from whom methicillin-resistant Staphylococcus aureus (MRSA) was isolated. Twelve cases were community-acquired and 8 were hospital-acquired infections. Patients were treated with penicillinase-resistant penicillin, cephalosporin or carbapenem in combination with or without aminoglycoside. They were also treated with drainage or thoracentesis. However, they were refractory to treatment and 7 patients, 6 of whom were suffering from bacteremia, died. One bacteremic patient was treated with vancomycin and was cured. In an area of endemic MRSA, vancomycin may be the first choice in the initial treatment of staphylococcal empyema until antimicrobial susceptibility can be determined.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) caused severe staphylococcal empyema in 20 patients. Vancomycin showed promise for treating MRSA empyema, especially in endemic areas, potentially improving outcomes for bacteremic patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Staphylococcal empyema presents a significant treatment challenge.
- Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common pathogen in empyema.
- Outcomes for MRSA empyema are often poor with standard therapies.
Purpose of the Study:
- To evaluate treatment outcomes for staphylococcal empyema caused by MRSA.
- To identify effective antimicrobial strategies for MRSA empyema.
- To inform initial treatment choices in MRSA-endemic regions.
Main Methods:
- Retrospective review of 20 patients with MRSA empyema over 14 years.
- Analysis of treatment regimens including antibiotics (penicillinase-resistant penicillin, cephalosporin, carbapenem, aminoglycoside) and drainage procedures.
- Comparison of outcomes between community-acquired and hospital-acquired infections.
Main Results:
- Seven of 20 patients died, with 6 deaths in bacteremic cases.
- Standard antibiotic and drainage treatments were often refractory.
- One patient with bacteremic MRSA empyema achieved cure with vancomycin.
Conclusions:
- Staphylococcal empyema due to MRSA has high mortality.
- Vancomycin may be a crucial first-line agent for MRSA empyema in endemic areas.
- Prompt administration of appropriate antibiotics, like vancomycin, is critical pending susceptibility results.