Infecciones por Staphylococcus aureus resistente a meticilina adquiridas en la comunidad en niños antes sanos y en niños relacionados al hospital en la Argentina

Rev Chil Infect 2009  V.26 N.5  P.406-412

Hugo Paganini, M. Paula Della L., Beatriz Muller O., Gustavo Ezcurra, Macarena Uranga, Clarisa Aguirre, Gabriela Ensinck, Marys Kamiya, M. Rosa Miranda, Cristina Ciriaci, Claudia Hernández, Lidia Casimir, M. José Rial, Norma Schenonne, Estela Ronchi, M. del Carmen Rodríguez, Fabiana Aprile, Catalina De Ricco, Viviana Saito, Claudia Vrátnica, Laura Pons, Adriana Ernst, Sandra Morinigo, Marcelo Toffoli, Celia Bosque, Victoria Monzani, Andrea Mónaco, José L. Pinheiro, M. del Pilar López, Leonardo Maninno y Claudia Sarkis

Hospital Juan P. Garrahan (HP, MPDL, CH, LC, AM, JLP LM, CS)
Hospital Pedro de Elizalde (BMO, MJR, NS, CDR)
Santa Fe: Hospital Alassia (GE, MRSA, ER, CB)
Buenos Aires: Hospital de Niños de San Justo (MU, MDCR, FA)
Corrientes: Hospital Juan Pablo II (CA, VGS, CV)
Rosario: Hospital de Niños J. Vilela (GE, AE)
Resistencia: Hospital Pediátrico Dr. Avelino L. Castelán (MKDM, LP, SM)
Jujuy: Hospital de Niños Dr. Héctor Quintana (MRM, MT)
Mar del Plata: Hospital Materno Infantil de Mar del Plata Don Victorio Tetamanti (CC, VM, MDPL).

Introduction
Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA).

Objective
To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty.

Material and Methods
Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included.

Results
Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68%) were community-acquired. Among these 356 (61%) were CA-MRSA. In this group, 75 (21%) were HCA-MRSA and 281 (79%) CA-MRSA. The median age was 36 months (range: 1-201). Chronic skin disease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSA had more frequency of previous antibiotic treatment (63 vs 34%) and previous medical consult (76 vs 52%), invasive procedures (31 vs 8%), surgery (15 vs 0,3%) and fever (94 vs 74%) (p = <.05). Children with CA-MRSA had subcutaneous abscesses (34 vs 15%) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18% and 17 vs 11% respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1%), trimethoprim-sulphametoxazole (7 vs 1%) and clindamycin (25 vs 9%) (p = <.05). Four children (5%) with HCA-MRSA infections died and 3 (1%) in CA-MRSA group (p = .05).

Conclusion
Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our area.

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