Community-acquired methicillin-resistant Staphylococcus aureus in pediatrics.
OBJECTIVE
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging problem in pediatrics, with clinical and microbiologic characteristics that differentiate it from hospital-acquired MRSA (HA-MRSA).


RESULTS
Relative to HA-MRSA, CA-MRSA tends to cause localized disease (although serious illness occurs), is susceptible to more antibiotics, and has the same risk factors for acquisition/disease as methicillin-susceptible S. aureus (MSSA). At the gene level, CA-MRSA is more similar to MSSA than HA-MRSA: its emergence is apparently due to acquisition by an MSSA of the Staphylococcal Cassette Chromosome that bears mecA: the gene that encodes the methicillin-resistant penicillin binding protein. Carriage of recognized staphylococcal virulence factors, particularly Panton-Valentine leukocidin, is common in CA-MRSA, emphasizing its potential for causing serious illness. CA-MRSA is usually susceptible to clindamycin, trimethoprim-sulfamethoxazole, and rifampin, but inducible macrolide-lincosamide-streptogramin resistance in a subset of CA-MRSA could be problematic when clindamycin is used.


CONCLUSIONS
The appearance and spread of CA-MRSA represents a new challenge in pediatric medicine. A high level of clinical suspicion and development of rapid methods for its identification are needs for the future.
Buescher
E Stephen
ES
Center for Pediatric Research, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA. sbuesche@chkd.com
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000235:genetics; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D016106:Methicillin Resistance / Q000235:genetics*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity
D000900:Anti-Bacterial Agents; D002981:Clindamycin