RESUMO
Objective: an increase 1n community-associated methicillin-resistant Staphylococcus aureus [CA-MRSA] infections has been reported in the literature. Most severe, life-threatening infections were previously thought to be associated with chronically ill patients. Our pediatric intensive care unit [PICU] in Zagazig University hospital and National Liver institute, Al- Minufiya University, Egypt has reported a recent dramatic increase in primary, severe invasive CA-MRSA infections in healthy children
Design: we have prospectively identified patients admitted to the 2 PICUs with a diagnosis of culture-proven severe sepsis during the period from June 2007 till March 2008. Patient records were reviewed, and MRSA isolates were obtained for susceptibility testing and DNA extraction. Isolates were tested for the presence of virulence gene Panton-Valentine leucocidin [PVL]
Results: eight previously healthy patients were admitted to our PJCUs with severe primary, invasive CA-MRSA during the study period. MRSA positive cultures represented 20% of the total positive blood cultures in this period [24/120].Thirty three percent [8/24] were proved to be CA-MRSA and 66% [16/24] were HA-MRSA. The mortality rate of the CA-MRSA was 25% compared with an overall PJCU mortality rate during the study period of 10% and 12% in both PICUs. The mean PJCU length of stay of these patients was 9 days compared with an Average PJCU length of stay of 5.5 days. Six patients had pulmonary involvement in the form of bilateral necrotizing pneumonia requiring prolonged mechanical ventilation. Despite initiation of treatment with vancomycin at admission to the PICU in the eight patients, patients took a mean of 5.6 days to convert to negative blood cultures. Six patients had bacteremia longer than 5 days
Conclusions: severe CA-MRSA infections in healthy children are increasing at an alarming rate in our institutions. This acute rise in incidence, coupled with an alarmingly high associated mortality rate, raises important questions about the initial empirical antibiotic therapy we use in caring for patients presenting with suspected life threatening CA-MRSA disease. Vancomycin monotherapy may not be adequate treatment for severe CAMRSA infections