This prospective study was designed to evaluate predictors of skin and soft tissue infections (SSTI) due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Consecutive patients who were hospitalized with S aureus SSTI were enrolled. CA-MRSA infection was diagnosed in 76% of the children. MRSA SSTI was associated with black race (P = .0001) and with infection involving the lower trunk (P = .008). Only 21% of the patients in this study had S aureus colonization in their nares, and in 3 cases there was discordance between the nares and the infection site cultures. Sensitivity, specificity, and predictive values of the risk factors examined were limited in their ability to predict CA-MRSA infection. Given the high prevalence of MRSA in our community and the inability of nasal cultures to reliably predict CA-MRSA infection, empirical antibiotic therapy active against CA-MRSA and contact isolation of patients are recommended.
Kaplan SL, Hulten KG, Gonzalez BE, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis. 2005;40:1785-1791.
2.
Sattler CA, Mason EO Jr, Kaplan SLProspective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis J. 2002;21: 910-917.
3.
Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998;279:593-598.
4.
Fergie JE, Purcell K.Community-acquired methicillin-resistant Staphylococcus aureus infections in south Texas children. Pediatr Infect Dis J. 2001;20:860-863.
5.
Labandeira-Rey M., Couzon F., Boisset S., et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science. 2007;315:1130-1133.
6.
Gonzalez BE, Martinez-Aguilar G., Hulten KG, et al. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics. 2005;115:642-648.
Davis SL, Perri MB, Donabedian SM, et al. Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection. J Clin Microbiol. 2007;45:1705-1711.
9.
McDougal LK, Steward CD, Killgore GE, Chaitram JM, McAllister SK, Tenover FCPulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol. 2003;41:5113-5120.
Miller LG, Perdreau-Remington F., Bayer AS, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation . Clin Infect Dis.2007;44:471-482.
12.
Creech CB 2nd , Kernodle DS, Alsentzer A., Wilson C., Edwards KMIncreasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatr Infect Dis J.2005;24:617-621.
13.
Ellis MW, Hospenthal DR, Dooley DP, Gray PJ, Murray CKNatural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis. 2004;39:971-979.
14.
von Eiff C. , Becker K., Machka K., Stammer H., Peters G.Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med. 2001;344:11-16.
15.
Wertheim HF , Vos MC, Ott A., et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004;364:703-705.
16.
Centers for Disease Control and Prevention.Community-associated MRSA information for clinicians. http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html. Accessed September 19, 2009.
17.
National Committee on Clinical Laboratory Standards (NCCLS).Performance Standards for Antimicrobial Susceptibility Testing. 9th Informational Supplement. Wayne, PA: NCCLS; 1999.
18.
Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-2239.
19.
Lina G., Piemont Y., Godail-Gamot F., et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis.1999;29:1128-1132.
Altman DG, Bland JMDiagnostic tests 2: predictive values. BMJ. 1994;309:102.
22.
Goodman SNToward evidence-based medical statistics. 2: the Bayes factor. Ann Intern Med.1999;130:1005-1013.
23.
Young DM, Harris HW, Charlebois ED, et al. An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. Arch Surg. 2004;139:947-951.
24.
Fridkin SK, Hageman JC, Morrison M., et al; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med.2005;352:1436-1444.
25.
Naimi TS, LeDell KH, Como-Sabetti K., et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureusinfection. JAMA.2003;290: 2976-2984.
26.
King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HMEmergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections . Ann Intern Med. 2006;144:309-317.
