title: Epidemiology of community-onset Staphylococcus aureus infections in pediatric patients: an experience at a Children's Hospital in central Illinois.
abstract: BACKGROUND
  The nation-wide concern over methicillin-resistant Staphylococcus aureus (MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset S. aureus infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy.
  
  
  METHODS
  From January 2005-June 2008, children (0-18 years old) admitted to the Children's Hospital of Illinois with community-onset S. aureus infections were identified by a computer-assisted laboratory-based surveillance and medical record review.
  
  
  RESULTS
  Of 199 patients, 67 (34%) had invasive infections, and 132 (66%) had skin and soft tissue infections (SSTIs). Among patients with invasive infections, S. aureus isolates were more likely to be susceptible to methicillin (MSSA 63% vs. MRSA 37%), whereas patients with SSTIs, S. aureus isolates were more likely to be resistant to methicillin (MRSA 64% vs. MSSA 36%). Bacteremia and musculoskeletal infections were the most common invasive infections in both groups of S. aureus. Pneumonia with empyema was more likely to be caused by MRSA (P = 0.02). The majority (approximately 90%) of MRSA isolates were non-multidrug resistant, even in the presence of healthcare-associated risk factors.
  
  
  CONCLUSIONS
  Epidemiological data at the local level is important for antimicrobial decision-making. MSSA remains an important pathogen causing invasive community-onset S. aureus infections among hospitalized children. In our hospital, nafcillin in combination with vancomycin is recommended empiric therapy in critically ill patients with suspected invasive staphylococcal infections. Because up to 25% of MSSA circulating in our area are clindamycin-resistant, clindamycin should be used cautiously as empiric monotherapy in patients with suspected invasive staphylococcal infections.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Illinois College of Medicine at Peoria and Children's Hospital of Illinois at OSF Saint Francis Medical Center, Illinois, USA. kmongkol@uic.edu
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Mongkolrattanothai
authors.forename: Jean C
authors.initials: JC
authors.lastname: Aldag
authors.forename: Peggy
authors.initials: P
authors.lastname: Mankin
authors.forename: Barry M
authors.initials: BM
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009254:Nafcillin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000453:epidemiology*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D009254:Nafcillin; D014640:Vancomycin