Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report

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).