title: [Community-acquired Staphylococcus aureus bacteremia: 17 years of experience in Argentine children].
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B).
  
  
  OBJECTIVE
  To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007).
  
  
  METHODS
  Retrospective, observational and comparative study. All children older than 1 month of age and CASaB were included.
  
  
  RESULTS
  During the study period 647 SaB were diagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSaB, respectively. The median age of patients was 5.9 and 4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septic shock were similar in both periods (78% vs. 67% and 5% vs. 8%; p= NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p <0.05). Resistance rates to clindamycin and gentamicin were more high during the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X 16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). The mortality rate was higher in the first period (13% vs. 4%) (p= NS).
  
  
  CONCLUSIONS
  A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.
authors.affiliation: Servicio de Control Epidemiológico e Infectología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan. hpaganini@intramed.net.ar
authors.forename: Hugo R
authors.initials: HR
authors.lastname: Paganini
authors.forename: Paula
authors.initials: P
authors.lastname: Della Latta
authors.forename: Adriana
authors.initials: A
authors.lastname: Soto
authors.forename: Lidia
authors.initials: L
authors.lastname: Casimir
authors.forename: Andrea
authors.initials: A
authors.lastname: Mónaco
authors.forename: Virginia
authors.initials: V
authors.lastname: Verdaguer
authors.forename: Griselda
authors.initials: G
authors.lastname: Berberian
authors.forename: María T
authors.initials: MT
authors.lastname: Rosanova
authors.forename: Fernando
authors.initials: F
authors.lastname: González
authors.forename: Claudia
authors.initials: C
authors.lastname: Sarkis
mesh_terms: D001118:Argentina; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors