title: Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children's Hospital.
abstract: BACKGROUND
  Community-acquired Staphylococcus aureus (SA) pneumonia has increased in children, yet few studies have focused on this infection.
  
  
  METHODS
  Patients with SA pneumonia (not ventilator-associated) were identified from our surveillance database. Medical records were reviewed; isolates were genotyped by PFGE and Panton-Valentine leukocidin genes detected by polymerase chain reaction.
  
  
  RESULTS
  From August 2001 to April 2009, 117 patients had SA pneumonia. The rate of SA pneumonia per 10,000 admissions increased from 4.81 hospitalizations in year 1 to 9.75 in year 7 (P = 0.04). Methicillin-resistant SA (MRSA) caused 74% and methicillin-susceptible SA (MSSA) caused 26% of the infections. USA300 represented 75/82 (92%) of the MRSA and 14/28 (50%) of the MSSA isolates (P < 0.01). Patients with MRSA were younger (median [range], 0.8 years [0.1-16.9 years]) than patients with MSSA infections (2.5 years [0.2-20.9 years]) (P = 0.008). Clinical presentation was pneumonia with or without effusion in 30, empyema in 72, or lung abscess in 15 cases. Viral coinfections in 18/68 patients tested were associated with respiratory failure (72% vs. 24% [P < 0.001]). Thirty-five children were intubated and 68 had intensive care unit care; 89, 25, and 3 had video-assisted thoracoscopy (VATS), thoracentesis, and lobectomy, respectively. VATS was used more for USA300 than non-USA300 infections (80% vs. 57% [P = 0.03]). In all, 88 children received clindamycin. Improvement or cure occurred in 103 patients (88%), unscheduled visit or readmission related to the same problem in 6, respiratory sequelae in 7, and death in 1 patient.
  
  
  CONCLUSIONS
  SA pneumonia increased in frequency over the study years and most were caused by community-acquired MRSA and USA300 isolates. Viral coinfection in 15% of the cases was associated with respiratory failure. Clindamycin is an effective treatment for susceptible-SA pneumonia; VATS was more common in patients with USA300 infections.
authors.affiliation: Infectious Diseases Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Carrillo-Marquez
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Hulten
authors.forename: Wendy
authors.initials: W
authors.lastname: Hammerman
authors.forename: Linda
authors.initials: L
authors.lastname: Lamberth
authors.forename: Edward O
authors.initials: EO
authors.lastname: Mason
authors.forename: Sheldon L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D015897:Comorbidity; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing; D011023:Pneumonia, Staphylococcal / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D016133:Polymerase Chain Reaction; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D037521:Virulence Factors / Q000235:genetics; D014777:Virus Diseases / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors; D002981:Clindamycin