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Staphylococcus aureus Central Nervous System Infections in Children
Jesus G Vallejo1, Alexandra N Cain, Edward O Mason
1From the *Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
The Pediatric Infectious Disease Journal
|April 12, 2017
Summary
Pediatric Staphylococcus aureus central nervous system (CNS) infections are uncommon but can be severe. Methicillin-sensitive S. aureus (MSSA) caused most cases, often linked to devices, while methicillin-resistant S. aureus (MRSA) emerged in community settings.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Microbiology
Background:
- Central nervous system (CNS) infections due to Staphylococcus aureus are rare in children.
- This study reviews the epidemiology, clinical presentation, and treatment of S. aureus CNS infections in pediatric patients.
Purpose of the Study:
- To analyze the characteristics and outcomes of Staphylococcus aureus CNS infections in a pediatric population.
- To understand the evolving epidemiology of S. aureus CNS infections, including the roles of MSSA and MRSA.
Main Methods:
- Retrospective review of pediatric cases with S. aureus CNS infection (positive CSF cultures or spinal epidural abscess) from 2001-2013.
- Analysis of infection sources (device-associated, postoperative, hematogenous), causative strains (MSSA vs. MRSA), treatments, and outcomes.
Main Results:
- Out of 68 patients, 70 S. aureus CNS infections were identified, with 70% secondary to CNS devices.
- Methicillin-sensitive S. aureus (MSSA) accounted for 67.2% of infections, while methicillin-resistant S. aureus (MRSA) caused 32.8%, often in community-acquired cases (USA300/pvl).
- Most patients received nafcillin (MSSA) or vancomycin (MRSA); MRSA infections showed a favorable response to vancomycin, though optimal trough levels and combination therapy effects were uncertain. Only one death occurred.
Conclusions:
- The epidemiology of invasive S. aureus CNS infections is dynamic, with MSSA remaining predominant, often associated with neurosurgical procedures.
- Community-acquired S. aureus meningitis and spinal epidural abscesses occurred in previously healthy children.
- Vancomycin appears effective for MRSA CNS infections, but further research is needed on optimal dosing strategies and the benefits of combination therapy.