title: Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections in a pediatric hospital in Argentina.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) emerged at the Pediatric Hospital of Misiones Province, north Argentina, in 2003 as a cause of community-acquired (CA) infections, mostly associated with skin and soft tissue infections (SSTIs). This study aimed to assess the microbiological, epidemiological, and clinical features of CA-MRSA SSTIs treated at the hospital.
  
  
  METHODS
  From 2003 through 2006, a longitudinal study on CA-MRSA SSTIs was conducted. Clinical, bacteriological, and molecular data were collected and analyzed by multiple correspondences and cluster analysis (MCCA).
  
  
  RESULTS
  A total of 138 children were enrolled; 55.8% of the children required hospitalization. The main clinical presentation was abscesses (51%). Antibiotic therapy in the previous six months was registered in 41% of the patients, and 72% of the patients had relatives with similar symptoms. Resistance to non-b-lactam antibiotics was found in less than 12% of patients. All 44 isolates carried staphylococcal cassette chromosomemec (SCCmec) type IV, and 30/44 had Panton-Valentine leucocidin (PVL) coding genes. Six pulsed-field gel electrophoresis (PFGE) patterns were detected from 17 isolates. MCCA hierarchic classification resulted in four distinctive patient classes (new variable). No relationship could be observed regarding the PVL detection, as PVL (+) isolates were detected in all classes; the same lack of significance was observed concerning the distribution of resistance to non-β-lactam antibiotics.
  
  
  CONCLUSIONS
  This study increases the understanding and knowledge about CA-MRSA skin and soft tissue infections in pediatric patients. Continuous efforts should be made to control this significant public health problem.
authors.affiliation: Hospital Provincial de Pediatría "Dr F. Barreyro", Posadas Misiones, Argentina. mvonspecht@fceqyn.unam.edu.ar.
authors.forename: Martha Helena
authors.initials: MH
authors.lastname: von Specht
authors.forename: Noella
authors.initials: N
authors.lastname: Gardella
authors.forename: Clotilde
authors.initials: C
authors.lastname: Ubeda
authors.forename: Sandra
authors.initials: S
authors.lastname: Grenon
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gutkind
authors.forename: Marta
authors.initials: M
authors.lastname: Mollerach
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D037521:Virulence Factors / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D037521:Virulence Factors; D047090:beta-Lactams