The role of antimicrobial therapy for treatment of uncomplicated skin and soft tissue infections from community-acquired methicillin-resistant Staphylococcus aureus in children
Ching-Shen Teng, Wen-Tsung Lo, Sheng-Ru Wang, Min-Hua Tseng, Mong-Ling Chu, Chih-Chien Wang
Received: February 29, 2008 Revised: April 6, 2008 Accepted: May 14, 2008
Chih-Chien Wang, Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Neihu 114, Taipei, Taiwan
Background and purpose:
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in skin and soft tissues are increasing in children in Taiwan. This study investigated the outcomes of therapy with or without appropriate antibiotics among children with CA-MRSA skin and soft tissue infections (SSTIs), and analyzed the outcomes of management among children with Panton-Valentine leukocidin (PVL)-positive strains and PVL-negative strains.
In this retrospective study, data for CA-MRSA SSTIs from 107 children younger than 18 years were analyzed. Worsening infection or other surgical therapy were considered treatment failure. Antimicrobial therapy was considered appropriate if it included at least 1 agent to which the organisms showed in vitro susceptibility.
The rate of successful treatment was 90.7% (97 episodes). Eighty six children (80.4%) underwent incision and drainage as part of their initial therapy. Four of 5 children (80%) treated with an appropriate antibiotic initially were treated successfully, compared with 93 of 102 children (91.2%) who did not receive an appropriate antibiotic agent (p=0.394; Fisher's exact test). Treatment failed for 5 of the 39 patients (12.8%) with PVL-positive SSTI CA-MRSA compared with only 1 treatment failure among 11 patients (9.1%) with PVL-negative SSTI CA-MRSA (p=1.0; Fisher's exact test).
The high rate of successful treatment among children with uncomplicated CA-MRSA SSTIs, even when given inappropriate antibiotic therapy, suggests that treatment of these uncomplicated infections without appropriate antibiotic therapy is possible. Incision and drainage may play an important role in the treatment of uncomplicated SSTIs.
Anti-bacterial agents; Community-acquired infections; Methicillin-resistant Staphylococcus aureus; Skin and connective tissue diseases.