Staphylococcus aureus Central Nervous System Infections in Children

BACKGROUND:: Central nervous system (CNS) infections due to Staphylococcus aureus are uncommon in pediatric patients. We review the epidemiology, clinical features, and treatment in 68 patients with a S. aureus CNS infection evaluated at Texas Children’s Hospital (TCH). METHODS:: Cases of CNS infection in children with positive cerebrospinal fluid cultures or spinal epidural abscess for S. aureus at TCH from 2001-2013 were reviewed. RESULTS:: 70 cases of S. aureus CNS infection occurred in 68 patients. 49 (70%) cases were secondary to a CNS device, 5 (7.1%) were postoperative meningitis, 9 (12.8%) were hematogenous meningitis, and 7 (10%) were spinal epidural abscesses (SEA). 47 (67.2%) were caused by MSSA and 23 (32.8%) by MRSA. Community-acquired infections were more often caused by MRSA that was clone USA300/pvl. Most patients were treated with nafcillin (MSSA) or vancomycin (MRSA) with or without rifampin. Among patients with MRSA infection, 50% had a serum vancomycin trough obtained with the median level being 10.6 μg/mL (range, 5.4-15.7 μg/mL). Only 1 death was associated with S. aureus infection. CONCLUSIONS:: The epidemiology of invasive of S. aureus infections continues to evolve with MSSA accounting for most of the infections in this series. The majority of cases were associated with neurosurgical procedures; however, hematogenous S. aureus meningitis and SEA occurred as community acquired infections in patients without predisposing factors. Patients with MRSA CNS infections had a favorable response to vancomycin, but the beneficial effect of combination therapy of targeting vancomycin trough concentrations of 15–20 μg/mL remains unclear.