Cutaneous Community-associated Methicillin-resistant Staphylococcus aureus among All Skin and Soft-tissue Infections in Two Geographically Distant Pediatric Emergency Departments

Abstract

Objectives To describe the culture results of cutaneous infections affecting otherwise healthy children presenting to two pediatric emergency departments (EDs) in the southeastern United States and southern California. Methods Medical records of 920 children who presented to the pediatric EDs with skin infections and abscesses (International Classification of Diseases, Ninth Revision codes 680.0–686.9) during 2003 were reviewed. Chronically ill children with previously described risk factors for community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) were excluded. Data abstracted included the type of infection; the site of infection; and, if a culture was obtained, the organism grown, along with their corresponding sensitivities. Results Of the 270 children who had bacterial cultures obtained, 60 (22%) were CA‐MRSA–positive cultures, most cultured from abscesses (80%). Of all abscesses cultured, CA‐MRSA grew in more than half (53%). All CA‐MRSA isolates tested were sensitive to vancomycin, trimethoprim‐sulfamethoxazole, rifampin, and gentamicin. One isolate at each center was resistant to clindamycin. The sensitivities at both institutions were similar. Conclusions The authors conclude that CA‐MRSA is responsible for most abscesses and that the pattern of CA‐MRSA infections in these geographically distant pediatric EDs is similar. These data suggest that optimal diagnostic and management strategies for CA‐MRSA will likely be widely applicable if results from a larger, more collaborative study yield similar findings.

Life-threatening infection due to community-acquired methicillin-resistant Staphylococcus aureus: case report and review

“…This report supports the suggestion that aggressive antistaphylococcal therapy should be initiated in critically ill patients with suspected MRSA infection and shifted to less aggressive therapy as soon as culture results are obtained and MRSA is excluded [16]. CA-MRSA is usually associated with soft tissue superficial infections [14]; however, it may cause invasive and severe infections and even deaths in previously healthy children [5,12]. Admissions to a Pediatric Intensive Care Unit (PICU) in the USA due to multifocal invasive CA-MRSA infections were increased during 2002-2004 compared to previous years [12].…”

Cutaneous Methicillin-Resistant Staphylococcus aureus in a Suburban Community Hospital Pediatric Emergency Department

“…Recent data from EDs around the United States have suggested that MRSA is the most common pathogen isolated from SSTIs (11,12). Although there have been several recent reports looking at the epidemiology of MRSA in the tertiary universityaffiliated ED setting, there are limited data looking at the prevalence of MRSA in the community hospital setting in children.…”

The loop technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED

“…Overall, the incidence of skin and soft tissue infections in US emergency departments has tripled from 1993 to 2005 and now exceeds 3.4 million cases annually [1]. With the recent spread of community-acquired methicillin-resistant staphylococcus aureus (ca-MRSA), communities report prevalence rates of 53% to 80% for these drug-resistant organisms [2][3][4]. With so much effort being spent on producing more antibiotics, little resources are utilized to better treat skin abscesses.…”