Methicillin Resistant Staphylococcus aureus in Children

Background:The changing epidemiology of Methicillin Resistant Staphylococcus aureus (MRSA) became evident in the 1990s when community- acquired MRSA cases were first reported. Increasing prevalence of MRSA will inevitably increase the use of vancomycin, adding further to the problem of antimicrobial resistance.
The previous retrospective study during 1996-1998 in Rasool Akram Hospital determined the increasing prevalence of MRSA. The goal of this prospective descriptive study was to determine the antibiotic resistance pattern of Staphylococci spp responsible for upper respiratory infections in children.
Materials and Methods: From Dec 2001 to Dec 2003, we surveyed 73 Staphylococci spp (78.1%, S. aureus, 21.9% coagulase negative) obtained from children (1 month- 14 yrs) with upper respiratory infections (otitis media; mastoiditis; sinusitis; tracheitis,…). All isolates (blood; CSF or other sterile body fluids) after culturing and antibiogram were first evaluated by disc diffusion and then by Etesting for MIC detection.
Results: The results showed an increasing resistance to penicillin (100% vs 70%); and gentamicin (56.3% vs 30%); and a decreased resistance to erythromycin (47% vs 66%); oxacillin (11.6% vs 40%); and chloramphenicol (15.4% vs 22%). Only 6.8% of S.aureus and 25% of coagulase negative staph are MRSA.
MRSA prevalence in this study is 6.4% similar to the previous study (5.4%) and there has been no significant increase during 4 years. By using penicillinase inhibitor or other non beta lactam antibiotics more than 80% antibiotic coverage will be achieved. In a minority of cases (6.8%) vancomycin was needed.
Conclusion: We conclude that the prevalence of MRSA is rare in the present study. Therefore, vancomycin is not efficient for the empiric therapy of all Staphylococcal suspected infections. Penicillin is not appropriate for the treatment of children with suspected Staphylococcal infections. PRP plus one of the gentamicin; rifampin; clindamycin; chloramphenicol or Trimethoprim/ Sulfamethoxazole are recommended in severe cases. When staphylococci may be involved in more extensive infections, the empirical use of clindamycin provides appropriate coverage including the majority of community- acquired MRSA strains. Limiting broad spectrum antibiotic use will minimize the antibiotic pressure that favors selection of resistant strains. In severe, invasive staphylococcal infections, such as severe pneumonia or toxic shock syndrome, inclusion of vancomycin in an empiric antibiotic regimen may be prudent initially, particularly among children with predisposing risk factors for MRSA carriage.