Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates

Regine M. Fortunov, Kristina G. Hulten, Wendy A. Hammerman, Edward Mason, Sheldon Kaplan

Research output: Contribution to journalArticlepeer-review

94 Scopus citations

Abstract

BACKGROUND. Community-acquired, methicillin-resistant Staphylococcus aureus infections are increasing among children. OBJECTIVE. Our goal is to describe the clinical presentation of neonatal community-acquired S aureus disease and provide molecular analyses of the infecting isolates. PATIENTS AND METHODS. We retrospectively reviewed the demographics and hospital course of term and near-term previously healthy neonates, ≤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. RESULTS. 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. CONCLUSIONS. 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.

Original languageEnglish (US)
Pages (from-to)874-881
Number of pages8
JournalPediatrics
Volume118
Issue number3
DOIs
StatePublished - Sep 1 2006

Keywords

  • Community-acquired Staphylococcus aureus
  • Infant
  • Methicillin resistance
  • Newborn

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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