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


CONCLUSIONS
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.
Frank
A L
AL
Department of Pediatrics, College of Medicine, University of Illinois at Chicago, USA.
Marcinak
J F
JF
Mangat
P D
PD
Schreckenberger
P C
PC
D000038:Abscess / Q000382:microbiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000494:pharmacology* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016106:Methicillin Resistance; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity*; D014947:Wounds and Injuries / Q000150:complications
D000900:Anti-Bacterial Agents; D002981:Clindamycin