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Methicillin-resistant Staphylococcus aureus Pneumonia in Children: A Call for Increased Vigilance

Ekopimo Ibia, MD, MPH
Volume: 98 Issue: 11 November, 2005

Abstract:

During the past two decades in the United States, Staphylococcus aureus pneumonia has been infrequently encountered in healthy children. However, that trend may be changing, given the emerging reports from several parts of the country.1–3 These reports suggest that the organism may be playing an increasing role, not only as a cause of pneumonia in children but also of complicated pneumonia. Schultz et al1 recently published a 10-year (1993 to 2002) retrospective chart review of all pediatric discharges with a diagnosis of empyema and community-acquired pneumonia from a children’s hospital in Texas. Although the number of children admitted with empyema decreased over the study period, S aureus emerged as the most common isolated etiologic agent, accounting for 60% of all isolates in 2001 to 2002 (versus 18% in 1993 to 1994), with an increase in the absolute number of cases over the period. Although the reported change in the relative frequency of S aureus isolates could be partially explained by the effectiveness of the seven-valent pneumococcal vaccine as evidenced by the attendant decrease in invasive Streptococcus pneumoniae infections in the series by Schultz et al,1 the worrisome fact from that study is that 78% of the S aureusisolates were resistant to methicillin. In an earlier but similar study from another children’s hospital in the country, Buckingham et al2reported that the proportion of cases of complicated parapneumonic effusions caused by S aureus increased from 6% in the period 1996 to 2000 (all of which were methicillin susceptible) to 30% in 2001 (all methicillin resistant).

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References:

1.Schultz KD, Fan LL, Pinsky J, et al. The changing face of pleural empyemasin children: epidemiology and management. Pediatrics 2004;113:1735–1740.
 
2.Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatr Infect Dis J 2003;22:499–504.
 
3.Alfaro C, Fergie J, Purcell K. Emergence of community-acquired methicillin-resistant Staphylococcus aureus in complicated parapneumonic effusions. Pediatr Infect Dis J 2005;24:274–276.
 
4.Chartrand SA, McCracken GH Jr. Staphylococcal pneumonia in infants and children. Pediatr Infect Dis 1982;1:19–23.
 
5.Kuehnert MJ, Hill HA, Kupronis BA, et al. Methicillin-resistant Staphylococcus aureus Hospitalizations, United States. Emerg Infect Dis [serial on the Internet]. 2005 June. Available at:http://www.cdc.gov/ncidod/EID/vol11no06/04–0831.htm. Accessed July 11, 2005.
 
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13.Stephenson KB, Searle K, Stoddard GJ, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in rural communities, Western United States. Emerg Infect Dis [serial on the Internet]. 2005 June. Available at: http://www.cdc.gov/ncidod/EID/vol11no06/05–0156.htm. Accessed July 11, 2005.
 
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17.Mishaan AM, Mason EO, Martinez-Aguilar G, et al. Emergence of a predominant clone of community-acquired Staphylococcus aureus among children in Houston, Texas. Pediatr Infect Dis J2005;24:201–206.
 
18.Chambers HF. Community-associated MRSA: resistance and virulence converge. N Engl J Med2005;352:1485–1487.
 
19.Crawford SE, Daum RS. Epidemic community-associated methicillin-resistant Staphylococcus aureus: modern times for an ancient pathogen. Pediatr Infect Dis J 2005;24:459–460.
 
20.Braun L, Craft D, Williams R, et al. Increasing clindamycin resistance among methicillin-resistant Staphylococcus aureus in 57 Northeast United States military treatment facilities. Pediatr Infect Dis J2005;24:622–626.
 

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