Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses.
OBJECTIVE
To determine the microbiology, particularly the prevalence of MRSA, in pediatric patients with community-acquired bacterial lymphadenitis. Long considered a nosocomial organism, methicillin-resistant Staphylococcus aureus (MRSA) has recently emerged as a cause of community-acquired infections. Resistance to other classes of antibiotics, including clindamycin, is prevalent amongst S. aureus, as well.


METHODS
A retrospective review of the medical records and culture results of patients under the age of 18 who underwent trans-cervical surgical drainage of abscessed lymph nodes between the years 2000 and 2006.


RESULTS
Sixty-two patients were identified for whom microbiology data were available. Six infections were classified as parapharyngeal on imaging; the remainder involved cervical chain lymph nodes. Forty-nine patients grew microorganisms on culture while 13 collections had no growth. The most common organism was S. aureus (63% of positive cultures); followed by beta-hemolytic group A Streptococcus (22%). Of S. aureus isolates, 27% were oxacillin-resistant (MRSA). All MRSA isolates were sensitive to clindamycin and trimethoprim/sulfamethoxazole; 63% were sensitive to ciprofloxacin, and 25% sensitive to erythromycin. Of methicillin-sensitive S. aureus isolates, 100, 86, and 82% were sensitive to trimethoprim/sulfamethoxazole, clindamycin, and ciprofloxacin, respectively. All MRSA isolates were identified during the latter half of the study period (2003-2006); none grew prior to 2003.


CONCLUSIONS
MRSA is a common pathogen in community-acquired lymphadenitis, and its incidence is rising. Resistance to clindamycin, a drug commonly used to treat MRSA, is prevalent amongst methicillin-sensitive S. aureus. This has important implications regarding the empiric treatment of lymphadenitis in children.
Guss
Joel
J
Department of Otorhinolaryngology-Head & Neck Surgery, The University of Pennsylvania, 5 Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, United States. xxxjoel.guss@uphs.upenn.edu
Kazahaya
Ken
K
D000038:Abscess / Q000382:microbiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis*; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000382:microbiology*; D008297:Male; D016106:Methicillin Resistance; D009333:Neck / Q000382:microbiology*; D010068:Oxacillin / Q000627:therapeutic use; D010403:Penicillin Resistance; D010608:Pharyngeal Diseases / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D013290:Streptococcal Infections / Q000175:diagnosis; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002939:Ciprofloxacin; D004917:Erythromycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D010068:Oxacillin