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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report
Background:
Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant.
Clinical Findings:
A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage.
Primary Diagnosis:
The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis.
Interventions:
Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions.
Outcomes:
Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits.
Practice Recommendations:
Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.
Insights
Methicillin-susceptible Staphylococcus aureus (MSSA) can cause severe infections in premature infants, leading to complications like osteomyelitis and epidural abscesses. Early diagnosis and comprehensive treatment are crucial for improving outcomes in these vulnerable neonates.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Infectious disease in neonates
- Pediatric critical care
Background:
- Methicillin-susceptible Staphylococcus aureus (MSSA) is more prevalent than MRSA in NICUs, causing significant neonatal morbidity and mortality.
- MSSA infections can manifest as skin lesions and progress to severe systemic conditions like bacteremia, pneumonia, and osteomyelitis.
- Limited literature exists on the treatment and long-term outcomes of MSSA infections in premature infants.
Observation:
- A 32-week premature infant presented with MSSA sepsis, characterized by pain, reduced upper extremity movement, and hypotonia.
- Blood cultures remained positive despite initial antibiotic treatment, indicating a persistent infection.
- The infant was diagnosed with MSSA bacteremia, with concerns for disseminated disease and osteomyelitis.
Findings:
- Diagnostic workup revealed extensive cellulitis, osteomyelitis, multiple liver abscesses, and spinal epidural abscesses (SEA).
- Surgical debridement and irrigation were performed on affected limbs.
- The infant received 8 weeks of intravenous antibiotic therapy; immunologic and hematologic tests were normal.
Implications:
- Prompt recognition of sepsis signs in premature infants is critical for timely intervention.
- Consultation with pediatric subspecialists is essential for comprehensive diagnostic and treatment strategies.
- Long-term follow-up is necessary for premature infants diagnosed with spinal epidural abscesses (SEA).
