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Incidence of CA-MRSA increasing among neonates
Prospective studies, close follow-up needed to determine best strategies for management.
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Community-associated methicillin-resistant Staphylococcus aureus infections are being seen with increasing frequency among previously healthy infants aged younger than 30 days, according to a recent study.
The increasing prevalence in neonatal and maternal cases in Houston, where the study took place, and in other metropolitan areas across the United States emphasizes the need to identify neonates who may be infected and to institute effective therapy methods, according to Sheldon L. Kaplan, MD, and colleagues.
Currently there are no consensus guidelines regarding the appropriate evaluation and treatment for this patient population. Thus, the researchers conducted a retrospective review of the evaluation and treatment of CA-MRSA infections in term and late-preterm previously healthy neonates aged 30 days or younger.
Their findings, along with several potential treatment options, were published in a recent issue of Pediatrics.
“We hope that our data and recommendations provide some helpful guidance to the practicing pediatricians who may encounter these infections in young infants,” Kaplan, chief of infectious disease service at Texas Children’s Hospital and member of the Infectious Diseases in Children editorial board, said in an interview.
Kaplan and colleagues prospectively identified patients with CA-MRSA infections and collected their S. aureus isolates from a clinical microbiology laboratory.
The organisms were isolated within 48 hours of hospitalization, during an outpatient visit or after 48 hours of hospitalization when clinical evidence had suggested infection.
Patients were excluded from the study if they had an underlying illness which predisposed them to frequent hospitalizations or medical visits, indwelling catheters or percutaneous medical devices, or hospitalization within the last year.
The researchers selected patients (n=126) from the database aged 30 days or younger at age of symptom onset who were seen at the Texas Children’s Hospital between August 2001 and July 2006. All of the patients selected were previously healthy neonates born at 36 weeks gestation or later, treated for S. aureus and presented after discharge from the normal newborn nursery.
According to the researchers, the patients were classified by skin and soft tissue manifestation type. Any infections extending beyond the skin and soft tissue structures were considered invasive.
Incidence of infection
The researchers identified 43 cases of pustulosis, 68 cases of cellulitis/abscess and 15 invasive infections. Eighty-four of the isolates were methicillin-resistant, and 42 were methicillin-susceptible.
An evaluation of systemic infection for the neonates included urine (n=79), blood (n=102) and cerebrospinal fluid (n=84) cultures. The culture results indicated one S. aureus urinary tract infection, six S. aureus bacteremias and 11 cases of aseptic cerebrospinal fluid pleocytosis with unclear cause, according to the researchers.
One hundred six of the patients were admitted to the hospital, five were transferred to other hospitals, and 15 afebrile patients were discharged with oral or topical antibiotics.
Treatment strategies varied among physicians. Upon discharging the patient following inpatient treatment, 43 patients were not prescribed antibiotics, whereas 62 patients were prescribed either topical or oral antibiotics.
After reviewing the data, Kaplan and colleagues recommended topical antibiotics for cases of simple, local pustulosis if the infant is otherwise healthy with an unremarkable birth history. For pustulosis found in more than one area, an oral agent is recommended. In cases where the infection is categorized as being more severe, systemic IV treatment should be initiated.
According to the researchers, it is essential that criteria for the length of inpatient therapy are established for patients with noninvasive infections who are being discharged to continue treatment at home.
“We need to be sure that these babies have almost 100% resolution of signs and symptoms of their illness prior to discharge,” Kaplan said. “There is not a lot of experience treating these types of infections as an outpatient, so minimum inpatient durations need to be established, if possible.” – by Cara Dickinson
For more information:
- Fortunov RM, Hulten KG, Hammerman WA, et al. Evaluation and treatment of community-acquired Staphylococcus aureus infections in term and late-preterm previously healthy neonates. Pediatrics. 2007;120:937-945.