title: Methicillin-resistant Staphylococcus aureus mandibular osteomyelitis in an extremely low birth weight preterm infant.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen with frequent multidrug resistance. The immaturity of the immune system along with intravascular lines and empirical antibiotic treatments place hospitalized preterm infants at major risk of MRSA infection.We report a case of MRSA mandibular osteomyelitis complicating a persistent S. aureus bacteremia in a 23-week preterm infant. From the first weeks of life, the infant showed recurrent C-reactive protein (CRP) elevation, associated with S. aureus bacteremia. Antibiotic courses, including vancomycin and linezolid, were performed with transitory normalization of blood parameters. On day 74, the infant suddenly deteriorated and showed a significant increase of both CRP and procalcitonin. Empiric vancomycin and piperacillin-tazobactam treatment was started; nevertheless, she developed a progressive hard swelling of neck and mandible. Radiological evaluation revealed a mandibular osteomyelitis complicated by an abscess, whose culture grew MRSA. Vancomycin was thus changed to teicoplanin and complete clinical and radiological healing was gradually achieved.In the presence of major risk factors, persistent bacteremia and nonspecific symptoms, a localized focus of infection should be suspected. Microbiological diagnosis should always be attempted and antibiotic treatment should be guided by both susceptibility results and clinical response.
authors.affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. silvia.martini4@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. fabio.tumietto@unibo.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: Pediatric Radiology Operative Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. ritasciutti@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Sciutti
authors.affiliation: Pediatric Radiology Operative Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. laura.greco@aosp.bo.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Greco
authors.affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. giacomo.faldella@unibo.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faldella
authors.affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. luigi.corvaglia@unibo.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Corvaglia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008334:Mandible / Q000382:microbiology*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents