Community-acquired Staphylococcus aureus bacteremia: 17 years of experience in Argentine children

Background. Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). Objectives. To analyze clinical, epidemiologi-cal, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007). Material and methods. Retrospective, observational and comparative study. All children older than 1 month of age and CASaB were included. Results. During the study period 647 SaB were diagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSaB, respectively. The median age of patients was 5.9 and 4.8 years, respectively (p = NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p < 0.05), respectively. Skin infection and septic shock were similar in both periods (78% vs. 67% and 5% vs. 8%; p = NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p < 0.05). Resistance rates to clindamycin and gentamicin were more high during the second period (10% vs. 2% and 20% vs. 3%, respectively) (p < 0.05). Patients in the second period had longer antibiotic treatment (X 16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p < 0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p < 0.05). The mortality rate was higher in the first period (13% vs. 4%) (p= NS). Conclusion. A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.