Severe sepsis attributable to community-associated methicillin-resistant Staphylococcus aureus: an emerging fatal problem.
We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extracorporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Eric T
ET
Castaldo
Edmund Y
EY
Yang
D000293:Adolescent; D021821:Communicable Diseases, Emerging; D017714:Community-Acquired Infections / Q000382:microbiology* / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology* / Q000401:mortality*; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000401:mortality*; D013211:Staphylococcus aureus; D013714:Tennessee / Q000453:epidemiology