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Severe invasive community-associated methicillin-resistant Staphylococcus aureus infections in previously healthy children *

Creel, Amy M. MD; Durham, Spencer H. PharmD; Benner, Kim W. PharmD; Alten, Jeffrey A. MD; Winkler, Margaret K. MD

Pediatric Critical Care Medicine: May 2009 - Volume 10 - Issue 3 - p 323-327
doi: 10.1097/PCC.0b013e3181988798
Continuing Medical Education Article

Objective: An increase in community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been reported in the literature. Most severe, life-threatening infections were previously thought to be associated with chronically ill or frail patients. Our pediatric intensive care unit (PICU) has seen a recent dramatic increase in primary, severe invasive CA-MRSA infections in healthy children.

Design/Setting: A retrospective chart review of all previously healthy patients admitted to our 19-bed combined medical-surgical PICU with a primary diagnosis of severe invasive, culture-proven CA-MRSA disease during the past 6 years.

Results: Eleven previously healthy patients were admitted to our PICU with severe, primary, invasive CA-MRSA infections from March 2006 through September 2007, in contrast to no patients meeting these criteria in the preceding 5 years. The mortality rate was 27%, compared with an overall PICU mortality rate during the study period of <7%. The mean PICU length of stay of these patients was 14.9 days, compared with an average PICU length of stay of 2.4 days. Despite initiation of treatment with vancomycin at admission to the PICU in all but one case, patients took a mean of 5.7 days to convert to negative blood cultures. Eight patients had bacteremia longer than 4 days. Six of the patients developed bilateral necrotizing pneumonia requiring prolonged mechanical ventilation.

Conclusions: Severe CA-MRSA infections in healthy children are increasing at an alarming rate in our institution. This acute rise in incidence, coupled with an alarmingly high associated mortality rate, raises important questions about the initial empirical antibiotic therapy we use in caring for patients presenting with suspected life-threatening CA-MRSA disease. Vancomycin monotherapy may not be adequate treatment for severe CA-MRSA infections.

Associate Professor of Pediatrics (AC), Louisiana State University Health Sciences Center, New Orleans, LA; Pediatric Clinical Pharmacy Specialist (SHD), Sacred Heart Children’s Hospital, Pensacola, FL; Associate Professor of Pharmacy Practice (KB), Samford University McWhorter School of Pharmacy, Homewood, AL; and Assistant Professor of Pediatrics (JA, MKW), University of Alabama at Birmingham, Birmingham, AL.

This case report was reviewed and approved for publication by the Institutional Review Board of the University of Alabama at Birmingham.

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©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies