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

Disclosures

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.

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