Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus

Pediatr Infect Dis J. 2004 Feb;23(2):123-7. doi: 10.1097/01.inf.0000109288.06912.21.


Background: Although the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been explored in many investigations, management of this emerging infection has not been well-studied. For non-methicillin-resistant Staphylococcus aureus skin and soft tissue abscesses, incision and drainage is generally adequate therapy without the use of antibiotics, but this has not been established for CA-MRSA.

Methods: Children presenting to Children's Medical Center of Dallas for management of skin and soft tissue abscesses caused by culture-proved CA-MRSA were prospectively followed. We analyzed data from the initial evaluation and from two follow-up visits that focused on the management and outcome of CA-MRSA infection. Retrospective chart review was performed 2 to 6 months after the initial visit.

Results: Sixty-nine children were identified with culture-proved CA-MRSA skin and soft tissue abscess. Treatment consisted of drainage in 96% of patients and wound packing in 65%. All children were treated with antibiotics. Five patients (7%) were prescribed an antibiotic to which their CA-MRSA isolate was susceptible before culture results were known. Four patients (6%) required hospital admission on the first follow-up; none of these patients had received an antibiotic effective against CA-MRSA. A significant predictor of hospitalization was having a lesion initially >5 cm (P = 0.004). Initial ineffective antibiotic therapy was not a significant predictor of hospitalization (P = 1.0). Of the 58 patients initially given an ineffective antibiotic and managed as outpatients, an antibiotic active against CA-MRSA was given to 21 (36%) patients after results of cultures were known. No significant differences in response were observed in those who never received an effective antibiotic than in those who did.

Conclusions: Incision and drainage without adjunctive antibiotic therapy was effective management of CA-MRSA skin and soft tissue abscesses with a diameter of <5 cm in immunocompetent children.

Publication types

  • Comparative Study

MeSH terms

  • Abscess / microbiology
  • Abscess / therapy*
  • Adolescent
  • Anti-Bacterial Agents
  • Child
  • Child, Preschool
  • Cohort Studies
  • Combined Modality Therapy
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Community-Acquired Infections / therapy
  • Drainage / methods
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Methicillin Resistance*
  • Microbial Sensitivity Tests
  • Probability
  • Prospective Studies
  • Risk Assessment
  • Soft Tissue Infections / epidemiology
  • Soft Tissue Infections / microbiology
  • Soft Tissue Infections / therapy*
  • Staphylococcal Skin Infections / diagnosis
  • Staphylococcal Skin Infections / epidemiology
  • Staphylococcal Skin Infections / therapy*
  • Staphylococcus aureus / isolation & purification*
  • Treatment Outcome


  • Anti-Bacterial Agents