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Updated: Feb 9, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in
Adrienne G Randolph1,2,3, Ruifei Xu1, Tanya Novak1
1Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Background:
Coinfection with influenza virus and methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening necrotizing pneumonia in children. Sporadic incidence precludes evaluation of antimicrobial efficacy. We assessed the clinical characteristics and outcomes of critically ill children with influenza-MRSA pneumonia and evaluated antibiotic use.
Methods:
We enrolled children (<18 years) with influenza infection and respiratory failure across 34 pediatric intensive care units 11/2008-5/2016. We compared baseline characteristics, clinical courses, and therapies in children with MRSA coinfection, non-MRSA bacterial coinfection, and no bacterial coinfection.
Results:
We enrolled 170 children (127 influenza A, 43 influenza B). Children with influenza-MRSA pneumonia (N = 30, 87% previously healthy) were older than those with non-MRSA (N = 61) or no (N = 79) bacterial coinfections. Influenza-MRSA was associated with increased leukopenia, acute lung injury, vasopressor use, extracorporeal life support, and mortality than either group (P ≤ .0001). Influenza-related mortality was 40% with MRSA compared to 4.3% without (relative risk [RR], 9.3; 95% confidence interval [CI], 3.8-22.9). Of 29/30 children with MRSA who received vancomycin within the first 24 hours of hospitalization, mortality was 12.5% (N = 2/16) if treatment also included a second anti-MRSA antibiotic compared to 69.2% (N = 9/13) with vancomycin monotherapy (RR, 5.5; 95% CI, 1.4, 21.3; P = .003). Vancomycin dosing did not influence initial trough levels; 78% were <10 µg/mL.
Conclusions:
Influenza-MRSA coinfection is associated with high fatality in critically ill children. These data support early addition of a second anti-MRSA antibiotic to vancomycin in suspected severe cases.
Insights
Coinfection with influenza and methicillin-resistant Staphylococcus aureus (MRSA) leads to severe pneumonia in children. Early combination therapy with vancomycin and a second anti-MRSA antibiotic significantly reduces mortality in these critical cases.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Respiratory medicine
Background:
- Coinfection with influenza and methicillin-resistant Staphylococcus aureus (MRSA) causes severe, life-threatening necrotizing pneumonia in children.
- The rarity of this coinfection makes evaluating antimicrobial effectiveness challenging.
- This study assesses clinical characteristics, outcomes, and antibiotic use in critically ill children with influenza-MRSA pneumonia.
Purpose of the Study:
- To characterize critically ill children with influenza and bacterial coinfection.
- To compare outcomes between children with MRSA coinfection, other bacterial coinfections, and no bacterial coinfection.
- To evaluate the efficacy of antibiotic regimens in children with influenza-MRSA pneumonia.
Main Methods:
- A multicenter study enrolled children (<18 years) with influenza and respiratory failure from November 2008 to May 2016.
- Children were categorized into three groups: MRSA coinfection, non-MRSA bacterial coinfection, and no bacterial coinfection.
- Clinical data, including baseline characteristics, disease course, and therapies, were compared across groups.
Main Results:
- Influenza-MRSA pneumonia (30 children) was associated with increased severity, including acute lung injury, vasopressor use, extracorporeal life support, and higher mortality compared to other groups.
- Mortality was significantly higher in children with MRSA coinfection (40%) versus those without (4.3%).
- Among MRSA cases receiving vancomycin, mortality was lower with combination anti-MRSA therapy (12.5%) compared to vancomycin monotherapy (69.2%).
Conclusions:
- Influenza-MRSA coinfection presents a high fatality risk in critically ill children.
- Early administration of vancomycin combined with a second anti-MRSA agent is recommended for suspected severe cases.
- This strategy may improve survival rates in pediatric patients with severe influenza-MRSA pneumonia.
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