Prevalence of Community‐Acquired Methicillin‐Resistant Staphylococcus Among Children with Skin and Soft‐Tissue Infections

Background:

The prevalence of community‐acquired methi‐cillin‐resistant Staphylococcus aureus (CA‐MRSA) infections among the pediatric population has been gradually increasing over the years. Similarly, the resistance to other families of antibiotics has also developed rapidly in community strains, leading to a large burden on the health system.

Methods:

The aim of the study was to determine the prevalence of CA‐MRSA among skin and soft‐tissue infections in children from a large community in north Brooklyn, New York. Secondary goals were to know the prevalence of resistance to cotrimoxazole, erythromycin, and clindamycin in accordance with the D‐test. We also describe and analyzed the most common diagnoses, days of hospitalization, and chosen antibiotics associated with CA‐MRSA. We retrospectively reviewed medical records of patients < 18 years seen in the hospital with a diagnosis of skin, bone, or soft‐tissue infections from January 2008 to August 2010. All those patients with cultures positive for MRSA were included and analyzed.

Results:

A total of 603 patients with skin and soft‐tissue infections were reviewed. In 181 of them, a culture was obtained. One hundred and twenty‐six of the cultures were positive for Staphylococcus aureus, of which 76 (60.3%) were CA‐MRSA. Of the isolates, 97.3% were sensitive to cotrimoxazole, 88.1% to clindamycin, and only 7.8% to erythromycin. The D‐test was negative in all those strains resistant to erythromycin and sensitive to clindamycin, confirming the susceptibility to this antibiotic. The main diagnosis associated with CA‐MRSA was gluteal abscess (34.2%), followed by leg cellulitis and abscess (11.8%). Of those with CA‐MRSA, 57.8% required hospitalization (mean, 3.3 ± 2.5 days). Clindamycin was the preferred drug in hospitalized patients (65.1%). Cephalexin (40.2%) followed by clindamycin (28.5%) were the favorites initial drugs prescribed for outpatient cases.

Conclusions:

The prevalence of CA‐MRSA is high (41.9%) among skin and soft‐tissue infections in children in our community. The sensitivity of CA‐MRSA to cotrimoxazole and clindamycin is still favorably high, and the presence of clindamycin‐inducible macrolide‐lincosamide‐streptogramin B resistance among the strains is very low in our community.

Disclosures:

C. Teran ‐ none; C. Donkor ‐ none; T. Lin ‐ none; S. Sura ‐ none; M. Tarek ‐none; M. Medows ‐ none