Community-acquired methicillin-resistant Staphylococcus aureus infections requiring admission to a Tunisian paediatric intensive care unit

##plugins.themes.academic_pro.article.sidebar##

Published Oct 28, 2011
Download
pdf
Vol. 89 No. 10 (2011): Issue Oct 2011

##plugins.themes.academic_pro.article.main##

Khaled Menif
Asma Bouziri
Ammar Khaldi
Asma Hamdi
Sarra Belhadj
Aida Borgi
Najla Ben Jaballah

Abstract

Background: There is limited literature describing severe community acquired methicillin-resistant S aureus (CA-MRSA) in children admitted to an intensive care unit.
Aim: To review clinical features and outcome of children admitted in a Tunisian pediatric intensive care with CA-MRSA.
Methods: Retrospective chart review of patients coded for CAMRSA over 10 years.
Results: There were 14 (0.32% of all admissions) patients identified with severe CA-MRSA. The median age was 3 months (range,0.5–156 months). All patients had pulmonary involvement. Six children (42.8%) developed septic shock. Two (14.3%) patients had multifocal infection with deep venous thrombosis. Two (14.3%)
patients died.
Conclusion : Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than reported in the literature

Keywords:

CAMRSA; severe sepsis; pediatric intensive care unit; necrotizing pneumonia

##plugins.themes.academic_pro.article.details##

References

  1. Sattler Cv, Correa Ag. Coagulase-positive staphylococcal infections (Staphylococcus aureus). In; Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds, Textbook of Pediatric Infectious Diseases, 5th ed, Philadelphia: PA Saunders, 2004:1099-1129.
  2. Martinez-Aguilar G, Hammerman Wa, Mason Eo Jr, Kaplan SL. Clindamycin treatment of invasive infections caused by community acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J 2003; 22:593-98.
  3. Centers For Disease Control And Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus— Minnesota and North Dakota, 1997-1999. JAMA 1999; 282:1123-125.
  4. Ochoa T, Mohr J, Wanger A, Murphy R, Heresi G. Community associated methicillin-resistant Staphylococcus aureus in pediatric patients. Emerg Infect Dis 2005; 11: 966-8.
  5. Kaplan S, Hulten K, Gonzalez B et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40: 1785-91.
  6. Gonzalez B, Hulten K, Dishop M et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis. 2005; 41: 583-90.
  7. Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason E, Kaplan S. Community-acquired, methicillinresistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr. Infect Dis J. 2004; 23:701-6.
  8. Gonzalez B, Martinez-Aguilar G, Hulten K et al. Severe staphylococcal sepsis in adolescents in the era of communityacquired methicillinresistant Staphylococcus aureus. Pediatrics 2005; 115: 642-7.
  9. Jensen AG. Importance of focus identification in the treatment of Staphylococcus aureus bacteraemia. J Hosp Infect 2002; 52:29-36.
  10. Miles F, Voss L, Segedin E et al. Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit. Arch Dis Child 2005; 90:1274-278.
  11. Castaldo Et, Yang EY. Severe sepsis attributable to communityassociated méthicilline resistant Staphylococcus aureus: An emerging fatal problem. Am Surg 2007; 73: 684-87.
  12. Pollack Mm, Ruutiman Ue, Getson PR. Pediatric risk of mortality (Prism) score. Crit Care Med 1988; 16:1110-6.
  13. Gillet Y, Vanhems P, Lina G, et al. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-valentine leukocidin.Clin Infect Dis 2007; 45:315-321.
  14. Creel Am, Durham Sh, Benner Kw, Alten Ja, Winkler MK, Severe invasive community-associated methicillin-resistant Staphylococcus aureus infections in previously healthy children. Pediatr Crit Care Med 2009;10, 323-27.
  15. Naimi Ts, Ledell Kh, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976-84.
  16. Hamilton Sm, Bryant Ae, Carroll KC, et al. In vitro production of panton valentine leukocidin among strains of methicillin-resistant Staphylococcus aureus causing diverse infections. Clin Infect Dis 2007; 45:1550-1558.
  17. Labandeira-Rey M, Couzon F, Boisset S, et al. Staphylococcus aureus Panton- Valentine leukocidin causes necrotizing pneumonia. Science 2007; 315:1130-133.
  18. Bubeck Wardenburg J, Bae T, Otto M, et al. Poring over pores: alpha-hemolysin and Panton-Valentine leukocidin in Staphylococcus aureus pneumonia. Nat Med 2007; 13:1405-406.
  19. Stevens Dl, Ma Y, Salmi DB, et al. Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillinsensitive and methicillinresistant Staphylococcus aureus. J Infect Dis 2007; 195:202-11
  20. Hageman Jc, Uyeki Tm, Francis JS, et al. Severe communityacquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis 2006; 12:894-99.
  21. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359:753-59.
  22. Wunderink RG. Another piece of the community-acquired pneumonia puzzle. Chest 2008; 134:1112-114.
  23. Nourse C, Starr M, Munckhof W. Community-acquired methicillin-resistant Staphylococcus aureus causes severe disseminated infection and deep venous thrombosis in children: Literature review and recommendations for management. J Paediatr Child Health 2007; 43: 656-61.