Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 937-945 (doi:10.1542/peds.2007-0956)
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ARTICLE

Evaluation and Treatment of Community-Acquired Staphylococcus aureus Infections in Term and Late-Preterm Previously Healthy Neonates

Regine M. Fortunov, MDa,b,c, Kristina G. Hulten, PhDa,d,e, Wendy A. Hammerman, RNa,d,e, Edward O. Mason, Jr, PhDa,d,e and Sheldon L. Kaplan, MDa,d,e

a Department of Pediatrics
b Sections of Neonatology
d Infectious Diseases, Baylor College of Medicine, Houston, Texas
c Department of Neonatology
e Infectious Disease Service, Texas Children's Hospital, Houston, Texas

OBJECTIVE. We describe the evaluation and treatment of neonatal community-acquired Staphylococcus aureus disease in the era of community-acquired methicillin-resistant S aureus.

METHODS. We retrospectively reviewed the evaluation and treatment of 126 community-acquired S aureus infections of term and late-preterm previously healthy neonates who were ≤30 days of age between August 2001 and July 2006 at Texas Children's Hospital.

RESULTS. S aureus infections included 43 pustulosis, 68 cellulitis/abscess, and 15 invasive infections. We found 84 methicillin-resistant and 42 methicillin-susceptible S aureus isolates. Twenty-one patients received outpatient antibiotics before hospital presentation. Systemic infection evaluation included urine, blood, and cerebrospinal fluid cultures in 79, 102, and 84 neonates, respectively. Culture revealed S aureus urinary tract infections in 1, S aureus bacteremias in 6, and aseptic cerebrospinal fluid pleocytosis of unclear cause in 11 neonates. Physicians admitted 106, transferred 5 to other hospitals, and discharged 15 afebrile patients with topical or oral antibiotics. Clindamycin was the predominant antistaphylococcal intravenous and oral antibiotic for pustulosis and cellulitis/abscess infections. One patient with systemic S aureus and herpes simplex virus infection died. At discharge after inpatient treatment, physicians prescribed no antibiotics for 43 patients and oral or topical antibiotics for 62 patients. Outpatient treatment failed for 1 patient who was discharged after intravenous therapy and was readmitted. Eighty percent (16 of 20) of patients with mastitis alone completed treatment with outpatient oral antibiotics.

CONCLUSIONS. Evaluation and treatment strategies for neonatal community-acquired S aureus disease are varied at our hospital. Prospective studies are needed to determine optimal management strategies.

Key Words: community-acquired Staphylococcus aureus • methicillin resistance • infant • newborn • therapy

Abbreviations: CA—community-acquired • MRSA—methicillin-resistant Staphylococcus aureus • TCH—Texas Children's Hospital • SBI—serious bacterial infection • CSF—cerebrospinal fluid • UTI—urinary tract infection • CFU—colony-forming units • WBC—white blood cell • PFGE—pulsed-field gel electrophoresis • HSV—herpes simplex virus • MSSA—methicillin-susceptible Staphylococcus aureus

Accepted May 30, 2007.




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