[Community-acquired methicillin-resistant Staphylococcus aureus infections in children].
BACKGROUND
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections were first reported in the 1990s. Young, healthy individuals are frequently affected. The incidence of CA-MRSA in Spain is increasing.


METHODS
All children seen between August 2006 and January 2009 with CA-MRSA infections were included. The S. aureus isolates were studied by conventional techniques, their antibiotic susceptibility by agar disk diffusion, the presence of mecA gene was detected by multiplex polymerase chain reaction (PCR) and the gene encoding the Panton-Valentine leukocidin (PVL) by conventional PCR. CA-MRSA colonization was studied both in patients and their family members.


RESULTS
CA-MRSA was isolated in 15 samples from 12 patients, aged between 6 days and 14 years. Half of them were not native. Eight patients required hospital admission. The most common clinical presentation was skin and soft tissue infection (92%). Secondary CA-MRSA bacteraemia was present in two patients. All strains were PVL producers and two were resistant to macrolides associated to methicillin resistance and one of them was also resistant to lincosamides. An intra-familial transmission was identified. The clinical outcome was favourable in all patients.


CONCLUSIONS
CA-MRSA infections are emerging in Spain. Empirical treatment of skin and soft tissue infections should not be changed, since their incidence is still low. The drainage of CA-MRSA suppurative infections plays an important role in their treatment. Clindamycin or trimethoprim-sulfamethoxazole should be used for mild or moderate skin and soft tissue infections. Controlling the spread of these strains presents a challenge in the community today.
Frick
Marie Antoinette
MA
Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España.
Moraga-Llop
Fernando A
FA
Bartolomé
Rosa
R
Larrosa
Nieves
N
Campins
Magda
M
Roman
Yuani
Y
Vindel
Ana
A
Figueras
Concepció
C
D000038:Abscess / Q000453:epidemiology / Q000382:microbiology; D000293:Adolescent; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000032:analysis; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D054242:Emigrants and Immigrants; D005098:Exotoxins / Q000032:analysis; D005192:Family Health; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000032:analysis; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D046915:Penicillin-Binding Proteins; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology
D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; C487789:mecA protein, Staphylococcus aureus