[Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children in Argentina].
BACKGROUND
Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA).


OBJECTIVE
To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same community.


METHODS
Prospective, multicentric and comparative study. Children with clinically and microbiologically documented CA-MRSA were included.


RESULTS
Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68%) were community-acquired. Among these 356 (61%) were CA-MRSA. In this group, 75 (21%) were HCA-MRSA and 281 (79%) CA-MRSA. The median age was 36 months (range: 1-201). Chronic skin disease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSA had more frequency of previous antibiotic treatment (63 vs 34%) and previous medical consult (76 vs 52%), invasive procedures (31 vs 8%), surgery (15 vs 0.3%) and fever (94 vs 74%) (p = < 05). Children with CA-MRSA had subcutaneous abscesses (34 vs 15%) (p = < .05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18%) and 17 vs 11%) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1%), trimethoprim-sulphametoxazole (7 vs 1%) and clindamycin (25 vs 9%) (p = < .05). Four children (5%) with HCA-MRSA infections died and 3 (1%) mCA-MRSA group (p = .05).


CONCLUSIONS
Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our area.
Paganini
Hugo
H
Ciudad Autónoma de Buenos Aires, Hospital Juan P Garrahan, República Argentina. hpaganini@intramed.net.ar
Della
M Paula
MP
Muller
Beatriz
B
Ezcurra
Gustavo
G
Uranga
Macarena
M
Aguirre
Clarisa
C
Kamiya
Marys
M
Ensinck
Gabriela
G
Miranda
M Rosa
MR
Ciriaci
Cristina
C
Hernández
Claudia
C
Casimir
Lidia
L
Rial
M José
MJ
Schenonne
Norma
N
Ronchi
Estela
E
Rodríguez
M del Carmen
Mdel C
Aprile
Fabiana
F
De Ricco
Catalina
C
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
M del Pilar
Mdel P
Maninno
Leonardo
L
Sarkis
Claudia
C
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents