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at time of the study, Pediatric Specialty Pharmacy Resident, University of Kentucky Chandler Medical Center, Lexington, KY; now, Assistant Professor, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, Oklahoma City, OK
Professor of Pharmacy Practice and Science and Surgery, Colleges of Pharmacy and Medicine, University of Kentucky
Associate Professor of Pediatrics, College of Medicine, University of Kentucky
Professor of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky
Supervisor, Department of Clinical Microbiology, University of Kentucky Medical Center; Associate Professor of Allied Health, University of Kentucky
Professor of Pharmacy Practice and Science and Pediatrics, Colleges of Pharmacy and Medicine, University of Kentucky
Reprints: Dr. Kuhn, 800 Rose St., C-113, University of Kentucky, Lexington, KY 40536, fax 859/323-2049, rjkuhn1{at}uky.edu
BACKGROUND: Limited data exist concerning characteristics of community-acquired Staphylococcus aureus infections (CA-SAI) in central and eastern Kentucky.
OBJECTIVE: To describe the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from January 1, 2004 through December 31, 2005, compare the number of CA-MRSA infections between years, and contrast treatment interventions and antibiotic susceptibility patterns of CA-SAI.
METHODS: A concurrent and retrospective study was conducted in 125 patients less than 18 years of age with CA-SAI admitted to the hospital/clinic based on criteria from the Centers for Disease Control and Prevention. Data on demographics, length of stay, antibiotic therapy, and antibiotic susceptibilities were collected.
RESULTS: Seventy patients were included for analysis (CA-MRSA, n = 51; community-acquired methicillin-susceptible S. aureus [CA-MSSA], n = 19). No statistically significant differences were noted between the number of CA-MRSA infections and the total CA-SAI (9/15 in 2004 vs 42/55 in 2005; p = 0.15). Approximately 75% of patients with CA-SAI were admitted to the hospital with no significant difference in length of stay. Ninety percent of CA-SAI were skin and soft tissue infections. There was a significant difference between groups with cutaneous abscesses (CA-MRSA, n = 37 vs CA-MSSA, n = 6; p = 0.002). Greater than 95% of all isolates were susceptible to vancomycin and trimethoprim/sulfamethoxazole. Half of CA-MRSA patients received inappropriate antibiotic therapy with ß-lactam antibiotics or clindamycin without confirmatory disk diffusion test. Twenty-five (49%) patients with CA-MRSA received surgical debridement (S/D) and/or incision and drainage (I/D) with concomitant antibiotic therapy. Four patients with CA-MRSA were rehospitalized for subsequent infections; all 4 received appropriate antibiotic therapy.
CONCLUSIONS: A noticeable increase in CA-MRSA infections with cutaneous abscess between 2004 and 2005 was noted. In patients receiving inappropriate antibiotic therapy, treatment success was attributed to concomitant S/D and I/D. Further analysis should focus on the impact of antibiotic therapy alone or in combination with S/D and I/D on the incidence of subsequent CA-MRSA infections.
Key Words: Kentucky, methicillin-resistant Staphylococcus aureus, pediatrics
Published Online, July 24, 2007. www.theannals.com, DOI 10.1345/aph.1K118
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