MRSA Infection

French find MRSA in child skin infections

Link: HighWire Press -- Medline Abstract.

BACKGROUND: A dramatic increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in community-onset skin infections has been reported over the last 10 years in the USA. The emergence of MRSA has been recently described in France. The aims of this study were to assess the incidence of MRSA in community-onset skin infections and to analyse the characteristics of MRSA skin infections in a French paediatric population. PATIENTS AND METHODS: This is a retrospective study covering the period January 2000 to December 2005. Patients aged under 15 years with S. aureus isolated from skin and a clinical diagnosis of skin infection were included. RESULTS: One hundred and thirty-four children were included with a median age of 3.4 years. There were no significant differences in MRSA prevalence between the different years of the study. The overall prevalence of MRSA was 8.2% (n=11/134). None of the isolated strains presented an antimicrobial susceptibility profile suggestive of the ST80-type community-acquired MRSA described in France. Three MRSA strains were isolated from serious superantigen-mediated skin infections. The antimicrobial susceptibility and genetic profile (tst-positive agr2 MSRA) for one strain of S. aureus militated strongly in favour of an MRSA ST5 clone skin infection. CONCLUSION: In this study we found no evidence of epidemic spread of MRSA in community-onset childhood skin infections between 2000-2005. Nevertheless, we report three cases of serious MRSA-induced superantigen-associated skin infection. This argues in favour of the presence of virulent community MRSA clones in France. PMID: 18457721

MRSA Spread threatens vulnerable children

Link: Arch Otolaryngol Head Neck Surg -- Abstract: Pediatric Mediastinitis as a Complication of Methicillin-Resistant Staphylococcus aureus Retropharyngeal Abscess, April 2008, Wright et al. 134 (4): 408.

Results  The number of RPI cases doubled from 36 to 72 in the final 4 years. In the first 4 years, no isolates of methicillin-resistant Staphylococcus aureus (MRSA) were found, and 1 patient developed mediastinitis. In the last 4 years, 8 of 25 patients (32%) with positive cultures had MRSA isolated, and 7 cases of mediastinitis occurred. Of the 8 children with cultures positive for MRSA, 6 developed mediastinitis. The median age for all children with RPI was 32.5 months (n = 108). The median age for children with MRSA and mediastinitis was 6.5 months (n = 8) and 5.5 months (n = 8), respectively. Conclusions  An alarming increase in the number of RPI cases occurred over the final 4 years. Methicillin-resistant S aureus is now a significant pathogen in patients with RPI at our institution. Documented local increases in community-associated MRSA infections and universal sensitivity to clindamycin suggest that community-associated MRSA is responsible for the change in bacteriology. A high correlation exists between MRSA infection and mediastinitis. Patients with MRSA infections are younger and may be vulnerable to developing mediastinitis because of immature immune systems. A higher index of suspicion is needed for MRSA, especially in patients younger than 1 year.

Doctors warned about MRSA that attacks children after flu

Link: FOXNews.com - CDC: Wide-Reaching Flu Outbreaks Hit 11 States - Health News | Current Health News | Medical News.

Children are at particular risk, and the CDC this week sent an alert to doctors to watch for young flu victims who might also have such bacterial infections as the notorious drug-resistant staph known as MRSA. Last year, the CDC learned of 73 children who died from flu, and 44 percent of them had a bacterial co-infection — mostly staph. Compared to earlier years, that's a five-fold increase in staph piggybacking on kids' flu. While the CDC's newest flu report lists one child death so far this year, Gerberding wanted to be sure that doctors test for staph in any child with a suspicious illness "because these bacteria need special treatment, and we want to make sure they get the right therapy."

Treatment Patterns Vary for MRSA Babies

Link: Evaluation and Treatment of Community-Acquired Staphylococcus aureus Infections in Term and Late-Preterm Previously Healthy Neonates -- Fortunov et al. 120 (5): 937 -- Pediatrics.

S aureus infections included 43 pustulosis, 68 cellulitis/abscess, and 15 invasive infections. We found 84 methicillin-resistant and 42 methicillin-susceptible S aureus isolates. Twenty-one patients received outpatient antibiotics before hospital presentation. Systemic infection evaluation included urine, blood, and cerebrospinal fluid cultures in 79, 102, and 84 neonates, respectively. Culture revealed S aureus urinary tract infections in 1, S aureus bacteremias in 6, and aseptic cerebrospinal fluid pleocytosis of unclear cause in 11 neonates. Physicians admitted 106, transferred 5 to other hospitals, and discharged 15 afebrile patients with topical or oral antibiotics. Clindamycin was the predominant antistaphylococcal intravenous and oral antibiotic for pustulosis and cellulitis/abscess infections. One patient with systemic S aureus and herpes simplex virus infection died. At discharge after inpatient treatment, physicians prescribed no antibiotics for 43 patients and oral or topical antibiotics for 62 patients. Outpatient treatment failed for 1 patient who was discharged after intravenous therapy and was readmitted. Eighty percent (16 of 20) of patients with mastitis alone completed treatment with outpatient oral antibiotics.

Julia’nna headed home after weeks of care for MRSA

Link: Julia’nna headed home after weeks of care for MRSA on The Murfreesboro Post.

The health of 5-year-old Julia’nna Clemmons, the Rutherford County kindergartener who became gravely ill from methicillin-resistant Staphylococcus aureus (MRSA), has taken a dramatic turn for the better after weeks of treatment in the Critical Care Unit (PCCU) of the Monroe Carell Jr. Children’s Hospital at Vanderbilt. Today, her parents are working with doctors to ready Julia’nna for hospital discharge sometime this week. Her doctors give Julia’nna a good chance at full recovery. Those involved in Julia’nna’s care say she is extremely lucky.  The release of that news coincided with the most serious days of Julia’nna’s illness. Creech says media coverage of high-profile cases of healthy young athletes and children, like Julia’nna, who are stricken with community-associated MRSA and have had no prior hospitalizations, have parents asking if they should stop children from participating in team sports, or be alarmed about reported cases of MRSA at their children’s schools. “It can be frustrating for us as physicians to try to help the public make sense of reports in the media like those that surrounded Julia’nna’s case,” Creech said. “While the challenges involved with these cases are evident, we know cases like hers are still rare. We don’t want parents to be overly concerned and certainly don’t advise them to take kids out of sports. The trouble is deciding what to say about cases like this when the vast majority of MRSA infections in children and adults are simple skin infections that can heal with minimal treatment.”

Hospitals still finding their way with Child MRSA

Link: Evaluation and Treatment of Community-Acquired Staphylococcus aureus Infections in Term and Late-Preterm Previously Healthy Neonates -- Fortunov et al. 120 (5): 937 -- Pediatrics.

S aureus infections included 43 pustulosis, 68 cellulitis/abscess, and 15 invasive infections. We found 84 methicillin-resistant and 42 methicillin-susceptible S aureus isolates. Twenty-one patients received outpatient antibiotics before hospital presentation. Systemic infection evaluation included urine, blood, and cerebrospinal fluid cultures in 79, 102, and 84 neonates, respectively. Culture revealed S aureus urinary tract infections in 1, S aureus bacteremias in 6, and aseptic cerebrospinal fluid pleocytosis of unclear cause in 11 neonates. Physicians admitted 106, transferred 5 to other hospitals, and discharged 15 afebrile patients with topical or oral antibiotics. Clindamycin was the predominant antistaphylococcal intravenous and oral antibiotic for pustulosis and cellulitis/abscess infections. One patient with systemic S aureus and herpes simplex virus infection died. At discharge after inpatient treatment, physicians prescribed no antibiotics for 43 patients and oral or topical antibiotics for 62 patients. Outpatient treatment failed for 1 patient who was discharged after intravenous therapy and was readmitted. Eighty percent (16 of 20) of patients with mastitis alone completed treatment with outpatient oral antibiotics. CONCLUSIONS. Evaluation and treatment strategies for neonatal community-acquired S aureus disease are varied at our hospital. Prospective studies are needed to determine optimal management strategies.

CA MRSA causing severe illness in children

Link: HighWire Press -- Medline Abstract.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children is increasingly common and can be associated with dissemination and life-threatening complications. Empiric therapy for presumed severe Staphylococcus aureus infection should be reviewed. Four children with severe invasive CA-MRSA infection causing osteomyelitis and pneumonia complicated by pulmonary embolus and deep venous thrombosis are described. The literature is reviewed and recommendations for management are provided.

New Borns Vulnerable to CA MRSA

Link: HighWire Press -- Medline Abstract.

BACKGROUND: Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children. OBJECTIVE: Our goal is to describe the clinical presentation of neonatal community-acquired S aureus disease and provide molecular analyses of the infecting isolates. PATIENTS AND METHODS: We retrospectively reviewed the demographics and hospital course of term and near-term previously healthy neonates, < or = 30 days of age, with community-acquired S aureus infections presenting after nursery discharge between August 2001 and March 2005 at Texas Children's Hospital. Prospectively collected isolates were characterized by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type, and the presence of PVL genes. RESULTS: Of 89 S aureus infections, 61 were methicillin-resistant S aureus; S aureus infections increased each year. Methicillin-resistant S aureus infections increased from 10 of 20 to 30 of 36 infections from 2002 to 2004. Most subjects, 65 of 89, were male. Symptoms began at 7 to 12 days of age for 26 of 45 male infants with methicillin-resistant S aureus. Most infections, 77 of 89, involved skin and soft tissue; 28 of 61 methicillin-resistant S aureus versus 7 of 28 methicillin-susceptible S aureus infections required drainage. Invasive manifestations included shock, musculoskeletal and urinary tract infection, perinephric abscess, bacteremia, empyema/lung abscess, and a death. Maternal S aureus or skin-infection history occurred with 13 of 61 methicillin-resistant S aureus versus 1 of 28 methicillin-susceptible S aureus infections. The predominant community clone, USA300 (PVL genes  ), accounted for 55 of 57 methicillin-resistant S aureus and 3 of 25 methicillin-susceptible S aureus isolates. CONCLUSIONS: Community-acquired methicillin-resistant S aureus is a substantial and increasing proportion of S aureus infections in previously healthy neonates. Male infants 7 to 12 days of age are affected most often. Neonatal community-acquired S aureus infection may be associated with concurrent maternal infection. USA300 is the predominant clone among these neonatal isolates in our region.

CA MRSA in children - drug treatment

Link: Staphylococcal skin infections in children

Skin and soft tissue infections due to methicillin-resistant S. aureus (MRSA) are still relatively uncommon in children. Well children with community-acquired MRSA infections can be treated with clindamycin or trimethoprim-sulfamethoxazole (cotrimoxazole), but must be observed closely for potentially severe adverse effects. In severe infections, vancomycin remains the treatment of choice, while intravenous teicoplanin and clindamycin are suitable alternatives. Linezolid and quinupristin/dalfopristin are currently showing great promise for the treatment of multi-resistant Gram-positive infections. While the choice of antibacterial is important, supportive management, including removal of any infected foreign bodies, surgical drainage of walled-off lesions, and regular wound cleaning, play a vital role in ensuring cure.