Community-acquired and clindamycin-susceptible methicillin-resistant Staphylococcus aureus in children

Background. Recognition of children with community-acquired (CA) infections caused by clindamycin-susceptible, methicillin-resistant Staphylococcus au reus (MRSA) prompted a retrospective study in two Chicago hospitals conduct ed from 1987 through 1997, Methods. Laboratory records of MRSA isolates, antibiotic susceptibilities a nd information from patient medical records were reviewed. Results. One hun dred eleven MRSA isolates from 103 children were studied with 51 isolates C A and 77 susceptible to clindamycin, The CA infections were less frequently associated with prior surgery (P = 0.0039) or a foreign body (P = 0.0001), and clindamycin-susceptible MRSA infections were less frequently associate d with a foreign body (P = 0.001) compared with nosocomially acquired or cl indamycin-resistant MRSA infections. Clindamycin-susceptible MRSA sources w ere mostly skin, wound or abscess (69%), Soft tissue diagnoses predominated (70%), but 16% were serious invasive infections. Ninety percent of clindam ycin-susceptible MRSA were susceptible to erythromycin and/or trimethoprim sulfamethoxazole, Antibiotic undertreatment (45%) or overtreatment (17%) of children with the clindamycin-susceptible MRSA occurred, but clindamycin a ppeared to be effective when used, Conclusion. The impact of these organisms could be substantial if they beco me more frequent or widespread. S. aureus is a potential pathogen in large numbers of pediatric patients; microbiologic evaluation and both presumptiv e and definitive treatment of all these children may need to be changed.