title: [Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children in Argentina].
abstract: 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.
authors.affiliation: Ciudad Autónoma de Buenos Aires, Hospital Juan P Garrahan, República Argentina. hpaganini@intramed.net.ar
authors.forename: Hugo
authors.initials: H
authors.lastname: Paganini
authors.forename: M Paula
authors.initials: MP
authors.lastname: Della
authors.forename: Beatriz
authors.initials: B
authors.lastname: Muller
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: Marys
authors.initials: M
authors.lastname: Kamiya
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ensinck
authors.forename: M Rosa
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: M José
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: M del Carmen
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: 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: M del Pilar
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; 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*
chemical_list: D000900:Anti-Bacterial Agents