title: Community-acquired Staphylococcus aureus pneumonia among hospitalized children in Hawaii.
abstract: BACKGROUND
  Invasive community acquired (CA) Staphylococcus aureus (SA) disease has been endemically observed in Hawaiian children. We wanted to evaluate the clinical, laboratory findings, and outcomes of methicillin-resistant SA (MRSA) and methicillin-susceptible SA (MSSA) associated pneumonia admissions.
  
  
  METHODS
  We performed retrospective chart reviews of 38 culture proven SA pneumonia patients admitted to a pediatric tertiary medical center in Hawaii between January 1996 to December 2007.
  
  
  RESULTS
  Twenty-six patients (68%) had MRSA and 12 patients (32%) had MSSA infection. The mean age of MRSA patients was 2.8 and 6.7 years for MSSA patients (P < 0.05). Pacific Islander and Native Hawaiian patients were affected disproportionately compared to non-Pacific Islander and Hawaiian groups (P < 0.0001). Demographic data, days of fever, tachypnea, hypoxia, and length of stay (LOS) were not significantly different between MRSA and MSSA infected patients. The mean LOS was 26.2 days (range 6-138 days); mean length of fever was 12.4 days. Seventy five percent (15 of 20) of patients who required intubation had MRSA. Twenty-one of the 29 (72%) total patients with pleural effusions had MRSA infection and all required chest tube placements. Two (5%) patients died; both had MRSA infection.
  
  
  CONCLUSIONS
  Younger Pacific Islander/Native Hawaiian children were affected disproportionately and had MRSA infection more frequently. MRSA infected patients appeared to have severe disease with frequent chest tube placement, intubation, and fatality. Overall, both MRSA and MSSA pneumonia resulted in prolonged hospitalization, multiple complications, and significant healthcare costs.
authors.affiliation: Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96826, USA. kyra.len@kapiolani.org
authors.forename: Kyra A
authors.initials: KA
authors.lastname: Len
authors.forename: Lora
authors.initials: L
authors.lastname: Bergert
authors.forename: Shilpa
authors.initials: S
authors.lastname: Patel
authors.forename: Marian
authors.initials: M
authors.lastname: Melish
authors.forename: Chieko
authors.initials: C
authors.lastname: Kimata
authors.forename: Guliz
authors.initials: G
authors.lastname: Erdem
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000208:ethnology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D044468:Native Hawaiian or Pacific Islander; D011023:Pneumonia, Staphylococcal / Q000208:ethnology* / Q000401:mortality*; D012189:Retrospective Studies