Invasive community associated methicilin-resistant Staphylococcus aureus infection in healthy child
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Abstract
Objective: The emergence of infections by communityassociated methicillinresistant Staphylococcus aureus (CAMRSA) in children has been a challenge due to its rapid global spread and the significant morbidity and mortality especially in recent years, with major impact in this population. At this study, we describe the case of a previously healthy child with no risk factors for infection with CAMRSA. Case description: This is newborn male, 28 days old, admitted to the hospital for treatment of cellulitis in the chest, in use of oxacillin and ceftriaxone. On clinical examination on admission he had impetigo lesions in upper chest and arms, with diffuse redness, and areas of cyanosis and intense edema to the groin. Patient progressed rapidly with extensive necrotizing fasciitis in the thoracic region. There was spontaneous drainage of 925 mL of pus in intermamilar and back region. Patient presented with tachypnea, slowed capillary refill, palmarplantar vasodilation and metabolic acidosis. Due to the severity of the case, the antimicrobial regimen was changed to vancomycin and cefepime, the latter being suspended after positive result of chest secretion for CAMRSA. Patient developed clinically well after treatment. Discussion: This report emphasizes the importance of a differentiated antimicrobial intervention for cases of staphylococcal infection with rapid clinical evolution, without improvement with the use of βlactams. Modification is suggested in conduct regarding treatment of staphylococcal infections and initial empirical coverage with trimethoprimsulfamethoxazole, clindamycin or vancomycin, depending on the severity of the condition, for patients with suspected infection with CAMRSA.
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