Atypical Pneumonia Linked to Community-Acquired <b><i>Staphylococcus aureus</i></b> Cross-Transmission in the Nursery

Abstract

We report the observation of a necrotizing pneumonia due to methicillin-resistant Staphylococcus aureus harboring the Panton-Valentine leukocidin-encoding gene in a previously healthy neonate, with favorable clinical outcome in spite of extensive radiologic lesions. The case was linked to a cluster of 3 neonates colonized by Panton-Valentine leukocidin-producing, methicillin-resistant S. aureus through cross-transmission in the nursery, underlining the need to comply with standard infection control precautions in the maternity ward.

Multiple Pneumatoceles in a 6-Week-Old Infant

“…1,2,4,6,9 Although the mean age of S. aureus pneumonia is typically approximately 9 months 1,2,8 (range, 3.5 mo to 4 y), this infection is increasingly being seen in younger age groups. 4,6,7 Consistent with this trend, the development of necrotizing pneumonia in our patient confirms the occurrence of this disease in young infants and neonates, and highlights the emergence of a virulent MRSA strain and stresses the need for optimal management and infection control measures.…”

“…1,7,26 PVL + SA colonization has also been reported to occur through breastfeeding. 7,27 Nevertheless, the immediate household contacts of our patient were all negative for MRSA colonization. Unfortunately, it is not possible to determine whether the infection could have occurred due to contact with others in the community.…”

“…1,2,7 Pulmonary manifestations of MRSA have been described previuosly 2,8 and usually include empyema or lung abscess, but more often multiple, thin-walled, air-filled, cystlike foci, often referred to as pneumatoceles, which are seen as sequelae from acute pneumonia due to MRSA. 1,2,4,6,9 Although the mean age of S. aureus pneumonia is typically approximately 9 months 1,2,8 (range, 3.5 mo to 4 y), this infection is increasingly being seen in younger age groups.…”

“…17,18 PVL + SA is known to be necrotizing and proinflammatory; thus, it is essential that optimal MRSA treatment includes both bactericidal and antitoxin agents. 5,7 Clindamycin and linezolid markedly suppress the formation of PVL. The suppression of toxin production may improve the outcome, 17,19 and therefore vancomycin alone may not be the optimal treatment for PVL + SA pneumonia.…”

New Threats from an Old Foe: Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infections in Neonates

“…Other risk factors for MRSA infections include prolonged hospitalization, overcrowding and understaffing in neonatal wards, long-term use of respiratory support, intravascular catheters, antibiotics, and total parenteral nutrition, as well as surgical procedures [6, 18, 19]. The clinical manifestation of MRSA infections may range from mild focal infections, such as conjunctivitis and skin and soft tissue infections, to more severe forms like toxic shock syndrome [24] and even invasive infections such as sepsis, necrotizing pneumonia, meningitis, endocarditis, osteomyelitis, liver abscesses, and urinary tract infections [2, 18, 23, 25-27]. Sepsis, especially late-onset sepsis, is currently the most common manifestation of invasive MRSA infections, with one third of cases presenting as MRSA sepsis [2, 25].…”