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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
12:18

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)

Published on: February 9, 2011

Severe invasive community-associated methicillin-resistant Staphylococcus aureus infections in previously healthy

Amy M Creel1, Spencer H Durham, Kim W Benner

  • 1Louisiana State University Health Sciences Center, New Orleans, LA, USA. Acree1@lsuhsc.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 25, 2009
PubMed
Abstract

Insights

Severe community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are rising in healthy children. This trend, with high mortality, suggests current vancomycin treatment may be insufficient for invasive CA-MRSA cases.

Area of Science:

  • Infectious Diseases
  • Pediatric Critical Care
  • Microbiology

Background:

  • Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasing.
  • Severe CA-MRSA infections were previously linked to immunocompromised or frail individuals.
  • A rise in primary, severe invasive CA-MRSA infections in healthy children has been observed.

Purpose of the Study:

  • To investigate the incidence and outcomes of severe invasive CA-MRSA infections in previously healthy children admitted to a pediatric intensive care unit (PICU).
  • To evaluate the effectiveness of current empirical antibiotic therapy for these severe pediatric CA-MRSA cases.

Main Methods:

  • Retrospective chart review of previously healthy patients with culture-proven severe invasive CA-MRSA disease admitted to a medical-surgical PICU over six years.
  • Analysis of patient demographics, clinical course, treatment, and outcomes.

Main Results:

  • Eleven previously healthy children were diagnosed with severe invasive CA-MRSA infections between March 2006 and September 2007, compared to none in the prior five years.
  • The mortality rate for these patients was 27%, significantly higher than the overall PICU mortality rate (<7%).
  • Patients experienced prolonged PICU stays (mean 14.9 days), delayed blood culture conversion (mean 5.7 days), and a high incidence of bilateral necrotizing pneumonia requiring mechanical ventilation.

Conclusions:

  • Severe CA-MRSA infections in previously healthy children are increasing at an alarming rate within the institution.
  • The high mortality rate associated with these infections raises concerns about the adequacy of empirical vancomycin monotherapy.
  • Further investigation into optimal treatment strategies for severe invasive CA-MRSA infections in pediatric patients is warranted.

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