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MRSA increased worldwide during the past 10 years
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NEW YORK CITY – Community-acquired methicillin-resistant Staphylococcus aureus increased worldwide during the last 10 years with the main manifestations being skin and soft tissue infections.
“Obtaining cultures is key to local surveillance, but more data are required for determining the most appropriate antibiotics for treatment and management strategies-subject of two large NIH studies about to start,” said Sheldon K. Kaplan, MD, chief of Infectious Disease Service and Clinic at Texas Children's Hospital, Baylor College of Medicine, during a presentation at the 23rd Annual Infectious Diseases in Children Symposium, held here.
Kaplan presented a review of the current epidemiology of community-acquired MRSA infections; described clinical manifestations of community-acquired MRSA infections in children and selected diagnostic considerations; reviewed trials evaluating the need for antibiotics in addition to incision and drainage of abscesses; and discussed management approaches and unknowns for treatment and prevention strategies for community-acquired MRSA infections.
Based on data from 33 children’s hospitals, incidence rates of S. aureus and MRSA increased significantly between 2002 and 2007. In addition, Kaplan said during his presentation, the annual number of children seen at his institution with community-acquired S. aureus infections increased steadily through July 2008, which was the end of the seventh year of a surveillance study. In the eighth year of the study, the number of community-acquired S. aureus isolates declined for the first time compared with the previous surveillance year. In the eighth year of the study, 76% of community S. aureus isolates were MRSA, Kaplan said.
As result of this increase in circulation of CA-MRSA, 99% of skin and soft tissue infections are caused by this organism. These include hordeola, furuncles, carbuncles, impetigo (bullous and nonbullous), abscess, paronychia, ecthyma, cellulitis, omphalitis, parotitis, lymphadenitis and wound infections, according to Kaplan.
Currently these isolates remain susceptible for trimethoprim-sulfamethoxazole, clindamycin and doxycycline/minocycline. Kaplan also said that among the community-acquired S. aureus isolates in the study, non-susceptibility to clindamycin increased to 11% in year eight of the study. Susceptibility to trimethoprim-sulfamethoxazole was greater than 98% in year eight. For community-onset, health care associated isolates, non-susceptibility to clindamycin was 17% to 20%, said Kaplan.
“Cephalexin, a beta-lactam antibiotic, is ineffective against MRSA. However, after drainage, there is no statistically significant difference in the number of cases fully resolved after 7 days, as compared to clindamycin,” Kaplan said.
Kaplan also reviewed characteristics for choosing antibiotic treatment in addition to incision and drainage of skin and soft tissue infections:
- Extremes of age
- Underlying condition or immunosuppression
- Fever or other systemic signs or symptoms
- Location-face, hand, perineum
- Surrounding cellulitis
- Failed treatment with incision and drainage alone
Regarding treatment, vancomycin remains the gold standard of treating invasive CA-MRSA infection in children, according to Kaplan. - by Cassandra Richards
For more information:
- Kaplan SL. MRSA issues: Where are we 10 years into the epidemic. Presented at: the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21, 2010; New York City.
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