Emerging dilemmas with methicillin-resistant Staphylococcus aureus infections in children

There has been an increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in recent years. This article reviews the literature on three manifestations of MRSA infections in the head and neck of children: sinonasal infections, otologic infections, and neck abscesses.

Historically nosocomial in origin, MRSA infections more recently are found to occur in otherwise healthy patients with no obvious risk factors. This community-acquired MRSA is known to be responsible for cutaneous abscesses in various regions of the body. Nasal carriage in healthy children is thought to account for increasing incidence of infections involving the respiratory tract as well as deep-space neck infections. Although these community-acquired strains of MRSA often retain susceptibility to nonbeta lactam antibiotics, there are reports of clindamycin resistance.

There is an increase in incidence of MRSA among infections involving the head and neck in children. Vigilant monitoring of antibiotic susceptibilities is warranted as well as judicious use of culture-directed antibiotic agents in their treatment. Topical therapy may play an important role in treatment of infections involving the sinonasal tract and ear.