Community-Acquired Staphylococcus aureus Infections in Term and Near-Term Previously Healthy Neonates

• Published in: Pediatrics (Evanston) Vol. 118; no. 3; pp. 874 - 881
• Main Authors: Fortunov, Regine M, Hulten, Kristina G, Hammerman, Wendy A, Mason, Edward O., Jr, Kaplan, Sheldon L
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-09-2006; American Academy of Pediatrics
• Subjects: Antibiotics; Babies; Biological and medical sciences; Care and treatment; Causes of; Children; Children & youth; Circumcision; Community-Acquired Infections; Diagnosis; DNA, Bacterial - analysis; Female; General aspects; Health aspects; Hospitals; Humans; Infant; Infant, Newborn; Infections; Male; Medical sciences; Methicillin Resistance; Methods; Pediatrics; Prognosis; Retrospective Studies; Risk factors; Sex Factors; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - genetics; Staphylococcus aureus - isolation & purification; Staphylococcus infections; Statistical analysis; United States; Human; Pediatrics; methicillin resistance; Infant; Birth; Infection; Community acquired infection; Newborn; Term pregnancy; Bacteriosis; community-acquired Staphylococcus aureus; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection; Staphylococcus aureus
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2006-0884

Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children.
Our goal is to describe the clinical presentation of neonatal community-acquired S aureus disease and provide molecular analyses of the infecting isolates.
We retrospectively reviewed the demographics and hospital course of term and near-term previously healthy neonates, < or = 30 days of age, with community-acquired S aureus infections presenting after nursery discharge between August 2001 and March 2005 at Texas Children's Hospital. Prospectively collected isolates were characterized by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type, and the presence of PVL genes.
Of 89 S aureus infections, 61 were methicillin-resistant S aureus; S aureus infections increased each year. Methicillin-resistant S aureus infections increased from 10 of 20 to 30 of 36 infections from 2002 to 2004. Most subjects, 65 of 89, were male. Symptoms began at 7 to 12 days of age for 26 of 45 male infants with methicillin-resistant S aureus. Most infections, 77 of 89, involved skin and soft tissue; 28 of 61 methicillin-resistant S aureus versus 7 of 28 methicillin-susceptible S aureus infections required drainage. Invasive manifestations included shock, musculoskeletal and urinary tract infection, perinephric abscess, bacteremia, empyema/lung abscess, and a death. Maternal S aureus or skin-infection history occurred with 13 of 61 methicillin-resistant S aureus versus 1 of 28 methicillin-susceptible S aureus infections. The predominant community clone, USA300 (PVL genes +), accounted for 55 of 57 methicillin-resistant S aureus and 3 of 25 methicillin-susceptible S aureus isolates.
Community-acquired methicillin-resistant S aureus is a substantial and increasing proportion of S aureus infections in previously healthy neonates. Male infants 7 to 12 days of age are affected most often. Neonatal community-acquired S aureus infection may be associated with concurrent maternal infection. USA300 is the predominant clone among these neonatal isolates in our region.