Pediatric community-acquired methicillin-resistant Staphylococcus aureus infection and colonization: trends and management

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Abstract
The scourge of community-acquired methicillin-resistant Staphylococcus aureus in pediatrics continues unabated. This review provides information on changes in epidemiology, therapeutic considerations, and measures to control the epidemic. The epidemiology and clinical manifestations of methicillin-resistant S. aureus have undergone important changes that pose challenges in recognition, diagnosis, and treatment for the pediatrician. Community-acquired methicillin-resistant S. aureus used to be predominantly associated with localized disease among previously healthy children; however, there are recent reports of more invasive and severe diseases with some fatalities. The antibiotic susceptibility pattern is also changing with some community-acquired methicillin-resistant S. aureus having resistance patterns indistinguishable from that of hospital-acquired methicillin-resistant S. aureus. Thus the choice of antibiotics is becoming even more challenging in pediatrics, with an already-limited armamentarium of antibiotics. The management of common skin diseases such as furunculosis and boils now requires close collaboration between the general pediatrician and the infectious diseases specialist. As the burden of community-acquired methicillin-resistant S. aureus disease continues to increase, pediatricians must have a high index of suspicion and must institute appropriate antimicrobial therapy based on community or regional antibiotic susceptibility of community-acquired methicillin-resistant S. aureus. There is an urgent need for effective infection control programs, including active surveillance components, to help curb the epidemic.

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