Management and Outcome of Children With Skin and Soft Tissue Abscesses Caused by Community-Acquired Methicillin-Resistant Staphylococcus Aureus

Michael C. Lee, MD; Ana M. Rios, MD; Monica Fonseca Aten, MD; Asuncion Mejias, MD; Dominick Cavuoti, DO; George H. Mccracken Jr., MD; R. Doug Hardy, MD


Pediatr Infect Dis J. 2004;23(2) 

In This Article

Abstract and Introduction

Background: Although the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been explored in many investigations, management of this emerging infection has not been well-studied. For non-methicillin-resistant Staphylococcus aureus skin and soft tissue abscesses, incision and drainage is generally adequate therapy without the use of antibiotics, but this has not been established for CA-MRSA.
Methods: Children presenting to Children's Medical Center of Dallas for management of skin and soft tissue abscesses caused by culture-proved CA-MRSA were prospectively followed. We analyzed data from the initial evaluation and from two follow-up visits that focused on the management and outcome of CA-MRSA infection. Retrospective chart review was performed 2 to 6 months after the initial visit.
Results: Sixty-nine children were identified with culture-proved CA-MRSA skin and soft tissue abscess. Treatment consisted of drainage in 96% of patients and wound packing in 65%. All children were treated with antibiotics. Five patients (7%) were prescribed an antibiotic to which their CA-MRSA isolate was susceptible before culture results were known. Four patients (6%) required hospital admission on the first follow-up; none of these patients had received an antibiotic effective against CA-MRSA. A significant predictor of hospitalization was having a lesion initially >5 cm (P = 0.004). Initial ineffective antibiotic therapy was not a significant predictor of hospitalization (P = 1.0). Of the 58 patients initially given an ineffective antibiotic and managed as outpatients, an antibiotic active against CA-MRSA was given to 21 (36%) patients after results of cultures were known. No significant differences in response were observed in those who never received an effective antibiotic than in those who did.
Conclusions: Incision and drainage without adjunctive antibiotic therapy was effective management of CA-MRSA skin and soft tissue abscesses with a diameter of <5 cm in immunocompetent children.

The epidemiology of pediatric community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been explored in many investigations, but questions remain regarding the management of this infection. MRSA is an increasingly common community-acquired pathogen in pediatric populations.[1,2,3] Sattler et al.[1] found no significant differences in the exposure to risk factors (antibiotic exposure, prior hospitalizations, health care visits, day-care, health care worker or nursing home resident exposure and presence of any underlying illness) in children with CA-MRSA than in those with community-acquired methicillin-susceptible Staphylococcus aureus infection; in addition no significant risk factors for CA-MRSA were identified among household contacts. Other investigators have also demonstrated that CA-MRSA infections are no longer confined to children with previously established risk factors.[1]

Incision and drainage, without the use of adjuvant antibiotics, is generally effective therapy for skin and soft tissue abscesses in otherwise healthy patients. This has not been established for CA-MRSA infections.[4,5] Some investigators have reported that MRSA bacteremia is associated with a significantly increased attributable mortality compared with methicillin-susceptible S. aureus bacteremia, whereas others have reported that methicillin resistance does not influence the outcome of S. aureus bacteremia.[6,7,8]

We present a prospective observational study on the management and outcome of skin and soft tissue abscesses caused by CA-MRSA in children.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.