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Methicillin-resistant Staphylococcus aureus in children: Treatment of invasive infections

Author
Sheldon L Kaplan, MD
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA, oxacillin minimum inhibitory concentration [MIC] ≥4 mcg/mL) has increased in prevalence worldwide as both a healthcare-associated and a community-associated pathogen. Community-associated MRSA most frequently causes skin and soft-tissue infections [1,2]. However, it is also associated with invasive infections, particularly pneumonia and musculoskeletal infections. (See "Methicillin-resistant Staphylococcus aureus infections in children: Epidemiology and clinical spectrum".)

An increasing proportion of MRSA isolates are resistant to additional antimicrobial agents, which complicates therapy [3]. The identification of S. aureus strains with intermediate and complete resistance to vancomycin has raised particular concern. Children with infections due to such organisms should be managed in consultation with an expert in infectious diseases.

The treatment of invasive infections caused by MRSA, vancomycin-intermediate S. aureus (VISA), and vancomycin-resistant S. aureus (VRSA) in children will be reviewed here. The genetic mechanisms responsible for methicillin resistance; the epidemiology, prevention, and control of MRSA infections in children; and the treatment of MRSA skin and soft-tissue infections in children are discussed separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology" and "Methicillin-resistant Staphylococcus aureus infections in children: Epidemiology and clinical spectrum" and "Suspected methicillin-resistant Staphylococcus aureus skin and soft tissue infections: Evaluation and management in children >28 days".)

MRSA, VISA, and VRSA infections in adults also are discussed separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of bacteremia and osteomyelitis" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of skin and soft tissue infections" and "Vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections".)

TREATMENT APPROACH

Clinical trials evaluating antimicrobial agents for invasive methicillin-resistant S. aureus (MRSA) infections in children are lacking. The treatment approach suggested in this topic review is based on case series, in vitro susceptibility testing, and the clinical experience of experts [4-6].

                          

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Literature review current through: Nov 2016. | This topic last updated: Thu Jun 23 00:00:00 GMT+00:00 2016.
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