The role of antimicrobial therapy for treatment of uncomplicated skin and soft tissue infections from community-acquired methicillin-resistant Staphylococcus aureus in children.
OBJECTIVE
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in skin and soft tissues are increasing in children in Taiwan. This study investigated the outcomes of therapy with or without appropriate antibiotics among children with CA-MRSA skin and soft tissue infections (SSTIs), and analyzed the outcomes of management among children with Panton-Valentine leukocidin (PVL)-positive strains and PVL-negative strains.


METHODS
In this retrospective study, data for CA-MRSA SSTIs from 107 children younger than 18 years were analyzed. Worsening infection or other surgical therapy were considered treatment failure. Antimicrobial therapy was considered appropriate if it included at least 1 agent to which the organisms showed in vitro susceptibility.


RESULTS
The rate of successful treatment was 90.7% (97 episodes). Eighty six children (80.4%) underwent incision and drainage as part of their initial therapy. Four of 5 children (80%) treated with an appropriate antibiotic initially were treated successfully, compared with 93 of 102 children (91.2%) who did not receive an appropriate antibiotic agent (p = 0.394; Fisher's exact test). Treatment failed for 5 of the 39 patients (12.8%) with PVL-positive SSTI CA-MRSA compared with only 1 treatment failure among 11 patients (9.1%) with PVL-negative SSTI CA-MRSA (p = 1.0; Fisher's exact test).


CONCLUSIONS
The high rate of successful treatment among children with uncomplicated CA-MRSA SSTIs, even when given inappropriate antibiotic therapy, suggests that treatment of these uncomplicated infections without appropriate antibiotic therapy is possible. Incision and drainage may play an important role in the treatment of uncomplicated SSTIs.
Teng
Ching Shen
CS
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Lo
Wen Tsung
WT
Wang
Sheng Ru
SR
Tseng
Min Hua
MH
Chu
Mong Ling
ML
Wang
Chih Chien
CC
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001427:Bacterial Toxins / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D005098:Exotoxins / Q000378:metabolism; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000378:metabolism; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology; D013624:Taiwan; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin