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).