title: [Community-acquired methicillin-resistant Staphylococcus aureus infections in children: multicenter trial].
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities. Local data are scarce.
  
  
  OBJECTIVE
  To determine the frequency, clinical features and outcome of infections caused by MRSA.
  
  
  METHODS
  Prospective and multicentric study of surveillance for community-acquired S. aureus infections in children from Argentina. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities were determined in the clinical microbiology laboratory with the methodology of the NCCLS.
  
  
  RESULTS
  From November 2006 to November 2007, 840 S. aureus infections were diagnosed, 447 of them were community-acquired. One hundred and thirty-five children with underlying disease or previous hospital admission were excluded. Two hundred and eighty one (62%) infections were community-acquired MRSA (CA-MRSA). The median age of children was 36 months (r:1-201), 60% were male. Among the CA-MRSA isolates, 62% were obtained from children with skin and soft-tissue infections, and 38% from children with invasive infections. Of them, osteomyelitis, arthritis, empyema and pneumonia were prevalent. Eigthteen percent of children had bacteremia and 11% sepsis. The rate of clindamycin resistance of CA-MRSA isolates was 10% and 1% for trimethoprim-sulfamethoxazole. Only 31% of children had appropriate treatment at admission. The median time of treatment delayed was 72 h. The median time of parenteral treatment was 6 days (r:1-70). In 72% of patients surgical treatment was required. Three children died (1%).
  
  
  CONCLUSIONS
  CA-MRSA isolates account for a high percentage and number of infections in children of Argentina. Community surveillance of CA-MRSA infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections. Clindamycin resistance was under 15% in the strains tested. Clindamycin should be use when CA-MRSA infection is suspected in children.
authors.affiliation: Hospital Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires. hpaganini@intramed.net.ar
authors.forename: Hugo
authors.initials: H
authors.lastname: Paganini
authors.forename: María P
authors.initials: MP
authors.lastname: Della Latta
authors.forename: Beatriz
authors.initials: B
authors.lastname: Muller Opet
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ezcurra
authors.forename: Macarena
authors.initials: M
authors.lastname: Uranga
authors.forename: Clarisa
authors.initials: C
authors.lastname: Aguirre
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ensinck
authors.forename: Marys
authors.initials: M
authors.lastname: Kamiya de Macarrein
authors.forename: María R
authors.initials: MR
authors.lastname: Miranda
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciriaci
authors.forename: Claudia
authors.initials: C
authors.lastname: Hernández
authors.forename: Lidia
authors.initials: L
authors.lastname: Casimir
authors.forename: María J
authors.initials: MJ
authors.lastname: Rial
authors.forename: Norma
authors.initials: N
authors.lastname: Schenonne
authors.forename: Estela
authors.initials: E
authors.lastname: Ronchi
authors.forename: María del C
authors.initials: Mdel C
authors.lastname: Rodríguez
authors.forename: Fabiana
authors.initials: F
authors.lastname: Aprile
authors.forename: Catalina
authors.initials: C
authors.lastname: De Ricco
authors.forename: Viviana
authors.initials: V
authors.lastname: García Saito
authors.forename: Claudia
authors.initials: C
authors.lastname: Vrátnica
authors.forename: Laura
authors.initials: L
authors.lastname: Pons
authors.forename: Adriana
authors.initials: A
authors.lastname: Ernst
authors.forename: Sandra
authors.initials: S
authors.lastname: Morinigo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Toffoli
authors.forename: Celia
authors.initials: C
authors.lastname: Bosque
authors.forename: Victoria
authors.initials: V
authors.lastname: Monzani
authors.forename: Andrea
authors.initials: A
authors.lastname: Mónaco
authors.forename: José L
authors.initials: JL
authors.lastname: Pinheiro
authors.forename: María del P
authors.initials: Mdel P
authors.lastname: López
authors.forename: Leonardo
authors.initials: L
authors.lastname: Maninno
authors.forename: Claudia
authors.initials: C
authors.lastname: Sarkis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy