Treatment strategies for methicillin-resistant Staphylococcus aureus infections in pediatrics.

Jason G Newland, Gregory L Kearns
Author Information
  1. Jason G Newland: Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA. jnewland1@cmh.edu

Abstract

Staphylococcus aureus is an important pathogen that frequently causes clinical disease in children. A wide array of illnesses can be caused by this common pathogen ranging from non-invasive skin infections to severe, life-threatening sepsis. Additionally, as antibacterials have been used to eradicate S. aureus, it has developed resistance to these important therapeutic agents. methicillin-resistant S. aureus (MRSA) has become an increasing problem in pediatric patients over the past decade. In this review, we discuss the epidemiology, pathogenesis, and treatment options available in treating MRSA infections in children. Specifically, we address the importance of abscess drainage in the treatment of skin and soft tissue infections, the most common clinical manifestation of MRSA infections, and highlight the various agents that are available for treating this common infection. In severe, life-threatening invasive MRSA infections the primary therapeutic option is vancomycin. In cases of MRSA toxic shock syndrome the addition of clindamycin is necessary. In other invasive MRSA infections, such as pneumonia and musculoskeletal infections, the empiric treatment of choice is clindamycin. Finally, newer agents and additional treatment options are discussed.

References

  1. Ann Intern Med. 1992 Sep 1;117(5):390-8 [PMID: 1503330]
  2. Antimicrob Agents Chemother. 2003 Sep;47(9):3002-4 [PMID: 12937013]
  3. Antimicrob Agents Chemother. 1989 Feb;33(2):181-4 [PMID: 2719462]
  4. MMWR Morb Mortal Wkly Rep. 2007 Apr 13;56(14):325-9 [PMID: 17431376]
  5. Curr Med Res Opin. 2006 Dec;22(12):2337-43 [PMID: 17257448]
  6. Clin Microbiol Infect. 2007 Jun;13 Suppl 2:25-9 [PMID: 17488373]
  7. Emerg Infect Dis. 2004 May;10(5):941-4 [PMID: 15200838]
  8. J Clin Microbiol. 2006 Mar;44(3):847-53 [PMID: 16517865]
  9. Infect Control Hosp Epidemiol. 2007 Mar;28(3):273-9 [PMID: 17326017]
  10. Pediatr Infect Dis J. 2004 Aug;23(8):701-6 [PMID: 15295218]
  11. Clin Infect Dis. 2004 Aug 15;39(4):539-45 [PMID: 15356818]
  12. Am J Dis Child. 1975 Nov;129(11):1273-8 [PMID: 1190158]
  13. Am J Respir Crit Care Med. 2006 Jul 15;174(2):221-7 [PMID: 16675783]
  14. MMWR Morb Mortal Wkly Rep. 1997 Jan 17;46(2):33-5 [PMID: 9011781]
  15. JAMA. 1998 Feb 25;279(8):593-8 [PMID: 9486753]
  16. Lancet Infect Dis. 2001 Oct;1(3):147-55 [PMID: 11871491]
  17. Pediatr Infect Dis J. 2004 Jul;23(7):619-24 [PMID: 15247599]
  18. Clin Infect Dis. 2000 Sep;31(3):684-9 [PMID: 11017816]
  19. Pediatr Infect Dis J. 2002 Oct;21(10):910-7 [PMID: 12394811]
  20. Antimicrob Agents Chemother. 2004 Dec;48(12):4665-72 [PMID: 15561842]
  21. J Antimicrob Chemother. 2004 Oct;54(4):818-20 [PMID: 15347637]
  22. Pediatr Infect Dis J. 2006 Apr;25(4):343-8 [PMID: 16567987]
  23. Am J Surg. 2005 Apr;189(4):425-8 [PMID: 15820454]
  24. Lancet. 2002 Mar 2;359(9308):753-9 [PMID: 11888586]
  25. Ann Pharmacother. 2006 Jun;40(6):1017-23 [PMID: 16720705]
  26. Emerg Infect Dis. 2006 Jun;12(6):894-9 [PMID: 16707043]
  27. Antimicrob Agents Chemother. 1988 Sep;32(9):1320-2 [PMID: 3195994]
  28. Infect Control Hosp Epidemiol. 1995 Jan;16(1):12-7 [PMID: 7897168]
  29. Infect Control Hosp Epidemiol. 2003 Jun;24(6):427-30 [PMID: 12828319]
  30. Am J Med. 1994 Mar;96(3):200-9 [PMID: 8154507]
  31. Paediatr Drugs. 2005;7(1):11-25 [PMID: 15777108]
  32. Clin Infect Dis. 2005 Jun 15;40(12):1785-91 [PMID: 15909267]
  33. Circulation. 2005 Jun 14;111(23):e394-434 [PMID: 15956145]
  34. Ann Thorac Cardiovasc Surg. 2004 Aug;10(4):252-4 [PMID: 15458379]
  35. Pediatr Emerg Care. 2006 Oct;22(10):717-23 [PMID: 17047471]
  36. Clin Infect Dis. 2007 Jan 15;44(2):178-85 [PMID: 17173213]
  37. MMWR Morb Mortal Wkly Rep. 1999 Aug 20;48(32):707-10 [PMID: 21033181]
  38. Pediatrics. 2004 Jun;113(6):1735-40 [PMID: 15173499]
  39. Pediatr Infect Dis J. 2002 Oct;21(10):950-6 [PMID: 12394819]
  40. J Hosp Infect. 2001 Feb;47(2):98-103 [PMID: 11170772]
  41. Int J Antimicrob Agents. 2006 Apr;27(4):300-2 [PMID: 16527459]
  42. Clin Infect Dis. 2003 Oct 1;37(7):933-8 [PMID: 13130405]
  43. JAMA. 2007 Oct 17;298(15):1763-71 [PMID: 17940231]
  44. Clin Infect Dis. 2003 Apr 1;36(7):858-62 [PMID: 12652386]
  45. Clin Infect Dis. 2006 Oct 15;43(8):953-60 [PMID: 16983604]
  46. Pediatr Infect Dis J. 2001 May;20(5):488-94 [PMID: 11368105]
  47. Clin Infect Dis. 2003 Feb 15;36(4):429-39 [PMID: 12567300]
  48. Pediatrics. 2006 Sep;118(3):e547-53 [PMID: 16908618]
  49. Arch Pediatr Adolesc Med. 1999 Aug;153(8):864-8 [PMID: 10437762]
  50. JAMA. 1979 Aug 24-31;242(8):721-6 [PMID: 379379]
  51. Pediatrics. 2000 Dec;106(6):E87 [PMID: 11099630]
  52. Int J Clin Pharmacol Ther. 1999 Aug;37(8):386-92 [PMID: 10475141]
  53. Arch Dis Child. 2005 Dec;90(12):1274-8 [PMID: 16301556]
  54. Clin Infect Dis. 2004 Feb 15;38(4):521-8 [PMID: 14765345]
  55. J Pediatr. 1963 May;62:742-7 [PMID: 14013906]
  56. Clin Infect Dis. 2001 May 1;32(9):1249-72 [PMID: 11303260]
  57. Pediatrics. 2005 Mar;115(3):642-8 [PMID: 15741366]
  58. Clin Infect Dis. 2006 Jan 15;42(2):181-5 [PMID: 16355327]
  59. N Engl J Med. 2006 Aug 17;355(7):653-65 [PMID: 16914701]
  60. Pediatr Infect Dis J. 2006 Jun;25(6):562-4 [PMID: 16732160]
  61. Hum Exp Toxicol. 1999 Jun;18(6):392-9 [PMID: 10413244]
  62. Laryngoscope. 2006 Feb;116(2):288-91 [PMID: 16467721]
  63. J Infect Dis. 2006 Dec 15;194(12):1761-70 [PMID: 17109350]
  64. Clin Infect Dis. 2002 Jun 1;34(11):1481-90 [PMID: 12015695]
  65. Clin Infect Dis. 1999 Jan;28(1):106-14 [PMID: 10028079]
  66. Lancet. 1963 Apr 27;1(7287):904-7 [PMID: 13957735]
  67. Acta Otolaryngol. 2002 Dec;122(8):827-30 [PMID: 12542200]
  68. Pediatr Infect Dis J. 2004 Feb;23(2):123-7 [PMID: 14872177]
  69. Clin Infect Dis. 2005 Sep 1;41(5):583-90 [PMID: 16080077]
  70. Ann Intern Med. 1991 Nov 1;115(9):674-80 [PMID: 1929035]
  71. Am J Med. 1976 Mar;60(3):419-25 [PMID: 1045861]
  72. Microbiol Immunol. 2002;46(4):277-84 [PMID: 12061630]
  73. Pediatr Infect Dis J. 2006 Apr;25(4):349-53 [PMID: 16567988]
  74. Antimicrob Agents Chemother. 1997 Nov;41(11):2497-501 [PMID: 9371356]
  75. Antimicrob Agents Chemother. 1990 Jun;34(6):1227-31 [PMID: 2393284]
  76. J Hosp Infect. 1997 Sep;37(1):39-46 [PMID: 9321727]
  77. J Antimicrob Chemother. 1996 Nov;38(5):865-9 [PMID: 8961057]
  78. J Antimicrob Chemother. 1988 Dec;22(6):873-80 [PMID: 3266621]
  79. MMWR Recomm Rep. 1990 Oct 19;39(RR-13):1-43 [PMID: 2122225]
  80. Antimicrob Agents Chemother. 2005 Nov;49(11):4658-66 [PMID: 16251309]
  81. Antimicrob Agents Chemother. 1993 Nov;37(11):2401-6 [PMID: 8285624]
  82. Antimicrob Agents Chemother. 1992 May;36(5):1109-14 [PMID: 1324637]
  83. Antimicrob Agents Chemother. 1981 May;19(5):726-35 [PMID: 7294764]
  84. Antimicrob Agents Chemother. 1995 Apr;39(4):953-7 [PMID: 7786002]
  85. MMWR Morb Mortal Wkly Rep. 2003 Oct 17;52(41):992-6 [PMID: 14561958]
  86. N Engl J Med. 1980 Dec 18;303(25):1436-42 [PMID: 7432402]
  87. Pediatr Infect Dis J. 2003 Sep;22(9 Suppl):S164-71 [PMID: 14520142]
  88. Am J Dis Child. 1983 Aug;137(8):764-7 [PMID: 6869336]
  89. J Antimicrob Chemother. 1999 Aug;44(2):263-73 [PMID: 10473234]
  90. Arch Pediatr Adolesc Med. 2005 Oct;159(10):980-5 [PMID: 16203945]
  91. Ann Pharmacother. 2007 Feb;41(2):235-44 [PMID: 17299012]
  92. J Infect Dis. 2005 Jun 15;191(12):2149-52 [PMID: 15898002]
  93. J Infect Dis. 1989 May;159(5):938-44 [PMID: 2523432]
  94. Pediatr Infect Dis J. 2003 Sep;22(9 Suppl):S172-7 [PMID: 14520143]
  95. MMWR Morb Mortal Wkly Rep. 2002 Jul 5;51(26):565-7 [PMID: 12139181]
  96. Antimicrob Agents Chemother. 1993 Feb;37(2):281-6 [PMID: 8452359]
  97. Clin Infect Dis. 2005 Nov 15;41(10):1407-15 [PMID: 16231250]
  98. Pediatr Infect Dis J. 2003 Aug;22(8):677-86 [PMID: 12913766]
  99. J Am Med Assoc. 1954 Feb 6;154(6):468-72 [PMID: 13117639]
  100. Clin Infect Dis. 2003 Oct 15;37(8):1050-8 [PMID: 14523769]
  101. MMWR Morb Mortal Wkly Rep. 2006 Mar 31;55(12):329-32 [PMID: 16572100]
  102. Clin Infect Dis. 2005 Feb 15;40(4):562-73 [PMID: 15712079]
  103. Antimicrob Agents Chemother. 2001 Jun;45(6):1843-6 [PMID: 11353635]
  104. Antimicrob Agents Chemother. 2001 Aug;45(8):2304-8 [PMID: 11451689]
  105. N Engl J Med. 2003 Sep 18;349(12):1157-67 [PMID: 13679531]
  106. Pediatr Infect Dis J. 2001 Sep;20(9):860-3 [PMID: 11734764]
  107. Clin Infect Dis. 2004 Sep 15;39(6):776-82 [PMID: 15472807]
  108. Clin Infect Dis. 2005 May 15;40(10):1429-34 [PMID: 15844065]
  109. J Pediatr Orthop. 2006 Nov-Dec;26(6):703-8 [PMID: 17065930]
  110. N Engl J Med. 1980 Dec 18;303(25):1429-35 [PMID: 7432401]
  111. Science. 2007 Feb 23;315(5815):1130-3 [PMID: 17234914]
  112. J Antimicrob Chemother. 2007 Dec;60(6):1361-9 [PMID: 17913720]
  113. Antimicrob Agents Chemother. 2000 Dec;44(12):3438-40 [PMID: 11083654]
  114. Emerg Infect Dis. 2005 Jun;11(6):966-8 [PMID: 15963299]
  115. South Med J. 2006 Nov;99(11):1295-6 [PMID: 17195430]
  116. N Engl J Med. 2005 Apr 7;352(14):1436-44 [PMID: 15814879]

Grants

  1. 1 U10 HD31313-14/NICHD NIH HHS

MeSH Term

Anti-Bacterial Agents
Child
Humans
Methicillin-Resistant Staphylococcus aureus
Soft Tissue Infections
Staphylococcal Infections
Staphylococcal Skin Infections

Chemicals

Anti-Bacterial Agents

Word Cloud

Created with Highcharts 10.0.0infectionsMRSAaureustreatmentcommonagentsStaphylococcusimportantpathogenclinicalchildrenskinseverelife-threateningStherapeuticoptionsavailabletreatinginvasiveclindamycinfrequentlycausesdiseasewidearrayillnessescancausedrangingnon-invasivesepsisAdditionallyantibacterialsusederadicatedevelopedresistanceMethicillin-resistantbecomeincreasingproblempediatricpatientspastdecadereviewdiscussepidemiologypathogenesisSpecificallyaddressimportanceabscessdrainagesofttissuemanifestationhighlightvariousinfectionprimaryoptionvancomycincasestoxicshocksyndromeadditionnecessarypneumoniamusculoskeletalempiricchoiceFinallyneweradditionaldiscussedTreatmentstrategiesmethicillin-resistantpediatrics

Similar Articles

Cited By (2)