title: Clinical features and genotyping analysis of community-acquired methicillin-resistant Staphylococcus aureus infections in Taiwanese children.
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children without health care-associated risk factors has emerged. To evaluate the clinical features and genotyping analysis of CA-MRSA in children in Taiwan, we conducted this study.
  
  
  METHODS
  Between July 2000 and June 2001, 198 episodes of S. aureus infection were identified in 191 children hospitalized at Chang-Gung Children's Hospital. The medical records of these children were retrospectively reviewed. The MRSA clinical isolates from each episode of infection, if available, were collected for pulsed-field gel electrophoresis (PFGE) typing and staphylococcal cassette chromosome mec (SCCmec) type determination.
  
  
  RESULTS
  Among the 198 episodes of S. aureus infection, MRSA accounted for 47% of 114 CA infections and 62% of 84 hospital-acquired (HA) infections, respectively. Among 54 CA-MRSA infections, 32 episodes (59%) occurred in children without risk factors. Similar to HA-MRSA isolates, these CA-MRSA isolates were also multiresistant, with a high rate of resistance to clindamycin (93%) and erythromycin (94%), but 91% of them were susceptible to trimethoprim/sulfamethoxazole. Superficial soft tissue infection was the most common presentation, accounting for 65% of CA-MRSA infections. All 54 children with CA-MRSA infection recovered without sequelae, though 63% of 35 children with superficial soft tissue infection were treated with in vitro nonsusceptible antibiotics. Of the 83 clinical isolates (40 CA, 22 with no identified risk) available for analysis, 6 genotypes with 30 subtypes were identified. Three major PFGE patterns were identified, accounting for 94% of the isolates (92.5% for CA isolates, 95% for HA isolates). Type IV SCCmec was carried by 25 and 40% of CA and HA isolates, respectively.
  
  
  CONCLUSIONS
  In Taiwan, MRSA was prevalent among pathogens of CA infections in children, and these CA isolates were multiresistant and genetically associated with HA isolates. In an area with a high prevalence of methicillin resistance, for children with putative S. aureus infection, even community-acquired, a glycopeptide-containing regimen should be considered for initial empirical therapy in the case of serious infection.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang-Gung Children's Hospital, 5 Fu-Shin Street, 333, Taoyuan, Taiwan.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Chen
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Lin-Hui
authors.initials: LH
authors.lastname: Su
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology*; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics*; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology*; D013211:Staphylococcus aureus / Q000145:classification* / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents