Treatment Strategies for Methicillin-Resistant Staphylococcus aureus Infections in Pediatrics

Abstract

Staphylococcus aureus is an important pathogen that frequently causes clinical disease in children. A wide array of illnesses can be caused by this common pathogen ranging from non-invasive skin infections to severe, life-threatening sepsis. Additionally, as antibacterials have been used to eradicate S. aureus, it has developed resistance to these important therapeutic agents. Methicillin-resistant S. aureus (MRSA) has become an increasing problem in pediatric patients over the past decade. In this review, we discuss the epidemiology, pathogenesis, and treatment options available in treating MRSA infections in children. Specifically, we address the importance of abscess drainage in the treatment of skin and soft tissue infections, the most common clinical manifestation of MRSA infections, and highlight the various agents that are available for treating this common infection. In severe, life-threatening invasive MRSA infections the primary therapeutic option is vancomycin. In cases of MRSA toxic shock syndrome the addition of clindamycin is necessary. In other invasive MRSA infections, such as pneumonia and musculoskeletal infections, the empiric treatment of choice is clindamycin. Finally, newer agents and additional treatment options are discussed.

Common Bacterial Skin Infections in Children

“…Kotrimaksazol A grubu β-hemolitik streptokokların etkeni olduğu infeksiyonlarda yetersiz olduğundan, kültür ve antibiyotik duyarlılığı görülmeden ampirik olarak başlanmamalıdır. Şiddetli MRSA infeksiyonlarında ise intravenöz vankomisin esas seçenektir 10,27,28 . Çocuklarda sık görülen bakteriyel deri infeksiyonlarının tedavi seçenekleri Tablo 2'de özetlenmiştir.…”

Current concepts in the management of bacterial skin infections in children

“…[14] Outbreaks of CA-MRSA SSTIs are known to occur in child care centers and newborn nurseries. [15] In a study conducted amongst patients of all ages in south India, suffering from bacterial skin infections, the incidence of MRSA was found to be 10.9%. [8] In another hospital-based prospective study conducted among children in north India (2004), the incidence of CA-MRSA was found to be 6.9%, [16] indicating a lower prevalence of the organism in that region of the country during the study period.…”

“…[2,3] [1] Some strains of S. aureus show hetero-resistance (hVISA) to vancomycin. [15] Vancomycin-resistant enterococci (VRE) in the hospital setup remain a therapeutic challenge. [2] Factors promoting emergence of VRE include the following [2] : • Prolonged hospital/ intensive care unit stay • Recent surgery, renal failure • Immunosuppression and post organ transplantation • Close proximity to a hospitalized patient with VRE colonization…”

“…Recurrent skin abscess caused by MRSA is a common problem and may be related to the fact, that the organism causes environmental contamination and so eradication is difficult. [15] Recurrence may result from the following causes: • Inadequate treatment or inappropriate choice of antibiotics • Underlying skin disease which was left uncared for during treatment of infections, e.g., scabies, atopic dermatitis, tinea capitis, contact dermatitis and psoriasis • Colonization with drug-resistant strains of bacteria;…”

“…Against staphylococci and enterococci, linezolid is bacteriostatic, but is bactericidal for streptococci. [2] It is highly effective for the treatment of SSTIs due to MRSA in children (>90% cure rates, comparable to IV vancomycin), [15] but its use should be restricted only for treatment of multi drug resistant organisms. Though well tolerated in children, serious side effects may occur and the higher cost may limit its use.…”