Community-acquired and clindamycin-susceptible methicillin-resistant Staphylococcus aureus in children

Pediatr Infect Dis J. 1999 Nov;18(11):993-1000. doi: 10.1097/00006454-199911000-00012.

Abstract

Background: Recognition of children with community-acquired (CA) infections caused by clindamycin-susceptible, methicillin-resistant Staphylococcus aureus (MRSA) prompted a retrospective study in two Chicago hospitals conducted from 1987 through 1997.

Methods: Laboratory records of MRSA isolates, antibiotic susceptibilities and information from patient medical records were reviewed.

Results: One hundred eleven MRSA isolates from 103 children were studied with 51 isolates CA and 77 susceptible to clindamycin. The CA infections were less frequently associated with prior surgery (P = 0.0039) or a foreign body (P = 0.0001), and clindamycin-susceptible MRSA infections were less frequently associated with a foreign body (P = 0.001) compared with nosocomially acquired or clindamycin-resistant MRSA infections. Clindamycin-susceptible MRSA sources were mostly skin, wound or abscess (69%). Soft tissue diagnoses predominated (70%), but 16% were serious invasive infections. Ninety percent of clindamycin-susceptible MRSA were susceptible to erythromycin and/or trimethoprim-sulfamethoxazole. Antibiotic undertreatment (45%) or overtreatment (17%) of children with the clindamycin-susceptible MRSA occurred, but clindamycin appeared to be effective when used.

Conclusion: The impact of these organisms could be substantial if they become more frequent or widespread. S. aureus is a potential pathogen in large numbers of pediatric patients; microbiologic evaluation and both presumptive and definitive treatment of all these children may need to be changed.

MeSH terms

  • Abscess / microbiology
  • Adolescent
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Clindamycin / pharmacology*
  • Clindamycin / therapeutic use
  • Community-Acquired Infections / microbiology*
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Methicillin Resistance*
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / epidemiology
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / pathogenicity*
  • Wounds and Injuries / complications

Substances

  • Anti-Bacterial Agents
  • Clindamycin