title: Recurrent community-associated Staphylococcus aureus infections in children presenting to Texas Children's Hospital in Houston, Texas.
abstract: BACKGROUND
  There are limited data characterizing recurrent staphylococcal disease in children. We sought to define the clinical features and laboratory findings of children with recurrent community-associated Staphylococcus aureus infections presenting to Texas Children's Hospital in Houston, TX.
  
  
  METHODS
  Medical records of children with recurrent, culture-proven community-associated S. aureus infections at Texas Children's Hospital from 8/1/2001 to 7/29/2009 were reviewed, and antibiotic susceptibility patterns were obtained for all S. aureus isolates.
  
  
  RESULTS
  Six hundred ninety-four otherwise healthy patients presented to Texas Children's Hospital with 2-7 episodes of community-associated S. aureus infection, accounting for 1495 encounters, 823 hospitalizations and 3337 inpatient days. In 90% of patients with ≤12 months separating their initial and recurrent infections, the methicillin susceptibility of the initial and recurrent isolates was the same, compared with 79% of patients with > 12 months separating their infections. The overall antibiotic susceptibility pattern did not change between isolates in 71% of otherwise healthy children compared with only 33% of children with eczema. Ninety-two percent of otherwise healthy children had only recurrent skin and soft tissue infections; 8% had ≥1 non-skin and soft tissue infections. The location of skin and soft tissue infections varied by age, with children≤36 months of age being more likely to have ≥1 S. aureus infection located in the diaper area.
  
  
  CONCLUSIONS
  Our study demonstrates that recurrent staphylococcal disease requiring emergency center or inpatient care is common, accounting for significant utilization of hospital resources. Children with recurrent staphylococcal infections are likely to have repeated infections from the same staphylococcal strain (by antibiotic susceptibility pattern), indicating that persistent colonization, frequent exposure to others who are chronically colonized, or environmental contamination is playing a role in recurrent disease. Finally, our study emphasizes the need for repeat cultures in children with recurrent disease, as 29% of healthy children and 67% of children with a predisposing risk factor (such as eczema) have a change in the antibiotic susceptibility pattern between S. aureus isolates.
authors.affiliation: From the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Bocchini
authors.forename: Edward O
authors.initials: EO
authors.lastname: Mason
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Hulten
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Hammerman
authors.forename: Sheldon L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004485:Eczema / Q000453:epidemiology / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D012008:Recurrence; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D013781:Texas / Q000453:epidemiology