[Community-acquired methicillin-resistant Staphylococcus aureus infections in children: multicenter trial].
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.
Paganini
Hugo
H
Hospital Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires. hpaganini@intramed.net.ar
Della Latta
María P
MP
Muller Opet
Beatriz
B
Ezcurra
Gustavo
G
Uranga
Macarena
M
Aguirre
Clarisa
C
Ensinck
Gabriela
G
Kamiya de Macarrein
Marys
M
Miranda
María R
MR
Ciriaci
Cristina
C
Hernández
Claudia
C
Casimir
Lidia
L
Rial
María J
MJ
Schenonne
Norma
N
Ronchi
Estela
E
Rodríguez
María del C
Mdel C
Aprile
Fabiana
F
De Ricco
Catalina
C
García Saito
Viviana
V
Vrátnica
Claudia
C
Pons
Laura
L
Ernst
Adriana
A
Morinigo
Sandra
S
Toffoli
Marcelo
M
Bosque
Celia
C
Monzani
Victoria
V
Mónaco
Andrea
A
Pinheiro
José L
JL
López
María del P
Mdel P
Maninno
Leonardo
L
Sarkis
Claudia
C
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