35 P a g e. Pediatric Infectious Diseases Society of the Philippines Journal Vol 17 No.1 pp Jan

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1 PI DSPJ OURNAL Vo7,No January-June 6 ORI GI NALARTI CLES PEDI ATRI C I NFECTI OUS DI SEASE SOCI ETY OF THE PHI LI PPI NES Pr oca c on ngu dedan b o cther aphy n Ped a r cpa en :ASy ema crev ew A naba banocabe omd,j ef fraytfr anc c omd, AnnaL atongl m MD,Lor narabadmd 6 TheAoc a onofpr eoper a vehop as ayw hsur g cas e I nf ec onamongped a r cpa en Af erac eanneur our g ca Oper a on C eoannemar eedypaco,md,cec acmar ambalazar e,md 77 BRI EFREPORTS Aoc a onofc n caandlabor a or ypar ame er ofpa en w hneona asep Char enecap,md 834 Pr of eofcommun yacqu r edme h c nre ans aphy ococcu Aur eusk nandsof T uei nf ec onamongch dr enadm ed a heph p negener ahop a Pau netrey e So,MD,Sa v ac onrga c ha an,md 3544 Random z edcon r o edtr acompar ng heef f cacyof7% I opr opya cohohandrubver us andar dhandwah ngfor HandHyg eneamonghea hcar ewor ker Lor a y nmaeolagay aar ana,md 455 I NSTRUCTI VECASE YourD agno P eae:8year O dch dw hchr on cear D char ge,i nf r aor b au cer,andpneumon a Car o S ephan etan,md 556 Vo 7 No January-June 6

2 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH *Paune T Reye-So, MD *Savacon R Gachaan, MD * Deparmen of Pedarc, Unvery of he Phppne, Coege of Medcne- Phppne Genera Hopa Correpondence: Ema: eepupaunu@yahoocom The auhor decare ha he daa preened are orgna maera and have no been prevouy pubhed, acceped or condered for pubcaon eewhere; ha he manucrp ha been approved by a he auhor, who have me he requremen for auhorhp BRIEF REPORT PROFILE OF COMMUNITY-ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS SKIN AND SOFT-TISSUE INFECTIONS AMONG CHILDREN ADMITTEDD AT THE PHILIPPINE GENERAL HOSPITAL ABSTRACT Objecve: CA-MRSA nfecon a goba concern I mporan o deermne he oca prevaence of CA-MRSA kn and of-ue nfecon a h nformaon w provde a more accurae and raona ba for emprc reamen, mprove managemen and oucome n paen, and reduce he economc burden aocaed wh faed reamen Th udy wa conduced o deermne he cnca profe and prevaence of CA-MRSA kn and of ue nfecon among pedarc paen admed a he Phppne Genera Hopa Mehod: A propecve, obervaona udy wa performed nvovng a pedarc paen admed a U-PGH for kn and of-ue nfecon from Sepember o December Demographc profe, cnca characerc of paen, reu of aboraory examnaon, he oucome of reamen were decrbed and ummarzed Rk facor for acquon of MRSA were ao deermned Perod-prevaence wa compued Reu: There were 5 chdren admed for SSTI, 6 have pove cuure and 6 5% of hee had CA-MRSA The majory were mae chdren younger han 5 year od whou denfabe rk facor Infecon preened a oary mae and ceu uuay a he head and neck area Ioae were aken from aprae durng ncon and dranage Invave nfecon were een n 3 paen The engh of hopa ay, ype of anboc ued and urgery performed wa varabe A paen were dcharge we and here were no morae The perod prevaence of CA-MRSA among chdren wh SSTI wa 36 Concuon: CA-MRSA a a caue of SSTI n Fpno chdren an emergng concern, epecay n very young paen even whou rk facor Managemen of SSTI houd ncude ncon and dranage of abcee and promp ubmon of aprae for cuure and anboc envy eng The perod prevaence of pedarc paen wh SSTI hgh among hopazed paen Emprc anboc wh MRSA coverage uch a cndamycn and vancomycn houd be condered n cnca uaon wheren MRSA deemed key KEYWORDS: MRSA, CA-MRSA, Mehcn rean Saphyococcu aureu, kn and of ue nfecon 35 P a g e

3 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH INTRODUCTION Before he emergence of communy acqured Mehcn-rean Saphyococcu aureu (CA- aureu nfecon acqured from he communy MRSA), anboc reamen for Saphyococcu wa mpe becaue praccay a oae were ucepbe o pencnae-rean β-acam anboc uch a mehcn, oxacn, and cephaoporn Bu wh he changng epdemoogy of aphyococca nfecon repored n dfferen area around he word, he approach o he reamen of heee nfecon ha become more compex and chaengng a more anboc-rean Saphyococcu aureu ran are encounered n he communy- aureu eng Mehcn rean Saphyococcu (MRSA) are S aureu oae ha are rean o a avaabe pencn and oher bea-acam anboc They were prevouy een and confned moy n he hopa eng, oher heah care face and from paen expoed o hee medca care nuon Bu he recognon of an expove number of MRSA nfecon from popuaon ackng rk facor for expoure o heah care face ha ead o he denfcaon of a new MRSA ran caed communy-aocaed or communy-acqured MRSA (CA-MRSA) Th ran reponbe for he recen ncreaed deae burden and pubc heah concern aocaed wh h nfecon Ahough nvave and fe hreaenng nfecon occur, he majory of CA-MRSA-aocaed deae are kn and of-ue nfecon (SSTI),3,5,6,7,8 The cnca pecrum of hee SSTI wde, rangng from a mpe mpego o ma abcee, ceu or evere or exenve deae nvovng mupe e and deeper ofcaded-kn ue nfecon Focu and yndrome may ao occur bu o a eer frequency 3 The Phppne Genera Hopa a erary ranng and referra medca cener ha caer o varou knd of paen comng from dfferen area n he counry Ahough majory of paen come from Mero Mana and nearby provnce by vrue of proxmy, he compoon of paen comng for medca reamen varabe A one of he eadng referra cener n he counry, mporan o deermne he oca prevaence of MRSA nfecon parcuary among kn and of-ue nfecon a hee repreen he buk of communy-acqured MRSA Th udy wa nended o deermne preence or abence of rk facor for acquon of MRSA among pedarc paen wh CA-MRSA kn and of-ue nfecon and deermne anboc ucepby of cncay gnfcan MRSA oae n order o provde accurae recommendaon for emprc anboc reamen Informaon obaned from propecve ude w provde a more accurae and raona ba for oca gudene and recommendaon pecfcay on he emprc anboc reamen of SSTI Th w furher mprove he oucome of pedarc paen wh uch nfecon a we a reduce he economc burden aocaed wh hee nfecon MATERIALS AND METHODS: Th wa a propecvee obervaona udy nvovng a pedarc paen o 8 year of age admed a UP-PGH for kn and of-ue nfecon from Sepember o December Demographc profe and cnca characerc of paen were decrbed and abuaed Reu of approprae aboraory examnaon a deermned by he paen aendng phycan were ao ummarzed Saphyococca oae were cafed a MSSA, CA-MRSA, HA-MRSA baed on he CDC defnon 4 decrbed beow Rk facor for acquon of MRSA were ao denfed 36 P a g e D o w n o a d e d f r o m p d p h o r g

4 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH Cncay gnfcan oae of CA-MRSobaned from paen and her anboc were ucepby paern were deermned Managemen baed on he dcreon of he aendng phycan ncudng medca and/or urgca procedure were anayzed Anboc reamen, he engh of hopa ay and cnca oucome of paen were kewe deermned Perod prevaence of CA-MRSA among paen wh kn and of-ue nfecon wa compued baed on he number of CA-MRSA nfecon denfed durng he udy perod Baed on he CDC defnon 4, he foowng defnon of erm were ued n he udy Mehcn-enve Saphyococcu aureu (MSSA) S aureu oae ucepbe o oxacn and cefoxn Communy-acqured mehcn-rean Saphyococcu aureu (CA-MRSAnfecon wh MRSA dagnoed by a cuure pove for MRSA whn 48 hour of admon o he hopa whou medca hory of MRSA nfecon or coonzaon, no medca hory of hopazaon, day, urgery or admon o a nurng home, ked nurng facy or hopce n he pa year and abence of permanen ndweng percuaneou caheer or medca devce ha pa hrough he kn no he body 3 Hopa-aocaed mehcn-rean Saphyococcu aureu (HA-MRSA) MRSA organm oaed >7 hour afer admon o he hopa and wh any one of he rk facor ed above For he purpoe of h udy, MRSA coonzaon a evdenced by pove naa wab cuure for MRSA wa no rouney done for each paen hence h wa no condered a par of he crera o dfferenae CA-MRSA from HA-MRSA Ao, f MRSA wa oaed from a paen afer 48 hour from admon bu cnca evdence uggeed ha wa communy acqured, hen he oae wa cafed a CA-MRSA For exampe, f MRSA wa oaed from an exudae aken from an ncon and dranage procedure performed afer 48 hour from admon bu he eon wa aready preen on admon, hen he oae wa cafed a communy-acqured In addon o he rk facor for MRSA acquon aed above, he preence of underyng chronc deae and recen anboc ue were ao ncuded n he ncuon crera for HA-MRSA Th udy wa approved by he UP-PGH Ehc and Revew Board A wren nformed conen and aen were obaned from he parcpan and/or from he paren or ega guardan of he paen The udy wa ef-funded RESULTS A oa of 5 pedarc paen were admed for kn and of-ue nfecon a UP-Phppne Genera Hopa from Sepember o Ocober (Tabe ) Of hee paen, nne paen or 36% dd no grow any oae from bood, aprae and/or ue cuure A he 9 paen were evenuay dchargedd mproved Two of he 3 paen wh growh of MSSA n wound cuure preened a abce and ceu, and underwen dranage and debrdemen, repecvey Boh paen were reaed wh Oxacn The hrd paen who grew MSSA n bood cuure had ceu and wa reaed wh anboc aone A 3 paen were en home cncay we A wo-year od eukema paen who wa admed due o perorba ceu had wound dcharge cuure of Mehcn rean Saphyococcu epdermd (MRSE) Th paen wa en home mproved afer 8 day of nravenou Vancomycn for cavernou nu hrombo On he oher hand, a -year-od paen underwen ncon and dranage of a ef 37 P a g e D o w n o a d e d f r o m p d p h o r g

5 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH aera neck abce whch grew Enerococcu pp Th paen wa gven Cndamycn and wa dcharged we Tabe Drbuon of Paen Accordng o Ioae from Cuure Sude No Ioae 9 Wh Ioae 6 MRSA CA-MRSA HA-MRSA MSSA 3 MRSE Enerococcu pp Eeven (43%) of he paen admed for kn and of-ue nfecon had growh of MRSA n cuure Among hee, one had HAadmed o MRSA (Tabe ) Th paen wa anoher hopa for pneumona and deveoped rgh perorba weng 3 day afer admon Wh he deveopmen of ezure and progreon of eye weng, he paen wa ranferred o PGH Eye dcharge cuure howed MRSA bu nce he eon from where he cuure wa aken deveoped 7 hour afer admon from he prevou hopa, h wa cafed a hopa-acqured MRSA baed on he CDC crera The paen expred afer wo week of admon due o progreng pneumona The demographc and cnca characerc of paen wh CA-MRSA kn and/or of-ue nfecon are hown n Tabe The majory of he paen admed wh CA- beow 5 MRSA nfecon were mae chdren year od, wh a mean age of 385 monh and he medan age of 35 monh The buk of hee paen were from Mero Mana and he re from neghborng provnce of Cave, Laguna, and Buacan No rk facor for MRSA nfecon were denfed n a hee paen Prevou anboc ue a a rk facor for MRSA wa no condered n fve paen who were gven ora anboc for he SSTI by anoher phycan few day pror o admon o he hopa a he nfecon and eon were aready preen before naon of he reamen Hory of MRSA coonzaon a a rk facor, however, wa no ncuded n he crera nce no a he paen had naa wab cuure done Of he wo paen wh naa wab cuure, no MRSA wa oaed Seven of he paen wh CA-MRSA had norma nurona au for age Two paen had md wang and one had moderae wang A arge proporon of he paen had oary eon, ocaed moy n he head and neck area, and he re were een eher a he runk or he ower exreme Paen wh CAwh eon eher a MRSA nfecon preened an abce or a ceu A he na compee bood coun of he paen had eevaed whe bood ce coun wh neurophc predomnance The WBC coun range from 68 o 395, wh a mean of 33 Fever wa preen n a he paen a he me of admon Of he 5 paen wh ceu, four were reaed wh anboc aone and one underwen ue and bone debrdemen n conjuncon wh anboc admnraon A he fve paen wh abce were ubjeced o ncon and dranage of he abce ogeher wh anboc admnraon MRSA wa oaed n cuure of exudae obaned from egh paen Three of he paen had boh bood and abce cuure done bu ony one paen grew he organm n boh bood and aprae cuure Ade from abce aprae, oher ource of cuure ncude ear and eye dcharge a we a wound wab n a paen wh eg ceu wh a 38 P a g e D o w n o a d e d f r o m p d p h o r g

6 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH dranng nu The paen who preened wh eg ceu and Tabe Demographc and cnca profe of pedarc paen wh CA-MRSA kn and of-ue nfecon Age (monh) Range Mean Medan Sex Mae Femae Type of Infecon Abce Ceu Abce and ceu WBC coun n CBC Range Mean 5 4 Pace of Orgn Mero Mana Cave Laguna Buacan Rk facor for MRSA Recen hopazaon Chronc deae Admon o ong erm care facy Day Surgery Permanen ndweng caheer or devce Hory of MRSA nfecon Prevou anboc ue Nurona au Norma Md wang Moderae wang Locaon of Infecon Soary Head/cap Trunk Lower exremy Mupe Se underwen ue and bone debrdem MRSA n he cuure of bone debr (T Four of he paen w reaed wh nravenou Oxacn bu hfed o Cndamycn once cuure r known Three paen receved Cndamycn emprcay and were h Cndamycn n wo paen and Cor one paen upon dcharge The pae 39 P a g e D o w n o a d e d f r o m p d p h o r g men howed Tabe 3) were nay u evenuay reu were nravenou fed o ora moxazoe n en who wa Medan Managemen Anboc reamen aone Anboc + ncon and drana Anboc + debrdemen Anboc Oxacn Cndamycn Oxacn Cndamycn Cndamycn Cormoxazoe Vancomycn age Lengh of Hopa Say (Day) Range Mean Medan Oucome Dcharged Tranferred o anoher hopa Wen home agan medca advce Moray gven Cormoxazoe had peren MRSA growh n bood cuure depe day of nravenou Cndamycn, o whch he organm wa enve o Ahough he growh n bood remaned, he paen wa cncay mprovng hence he wa dcharged A nge paen wa reaed wh Vancomycn due o he exenon of he perorba ceu o he cavernou nu area

7 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH One of he wo paen gven Oxacn wa a cae of mupe carbunce and ma abcee n a neonae The famy oped o ranfer he paen o anoher hopa even pror o he reeae of he reu of wound cuure ude The oher paen wa a 5-monh-owh cap abce a he empora area who paen underwen ncon and dranage, gven nravenou Oxacn for hree day a he emergency room and en home on ora Coxacn The cuure reu howng MRSA came ou afer he paen wa dcharged Eghy percen of he paen wh MRSA were dcharged wh a mean hopa ay of 6 day and wh no moray een The paen on Vancomycn wen home agan advce due o fnanca conran and anoher paen wa ranferred o anoher hopa for compeon of anboc The paen wh he onge hopa ay were hoe wh oeomye, bacerema and cavernou nu hrombo wh 43, 7 and 6 day, repecvey A he MRSA oae howed good envy o Cndamycn, Eryhromycn, and Teracycne Oher anboc commony ued o rea MRSA uch a Vancomycn and Lnezod were no eed Cormoxazoe wa ony eed n one pecmen The perod prevaence of CA-MRSA kn and of-ue nfecon among chdren n Phppne Genera Hopa from Sepember o December 36 Tabe 3 Drbuon of CA-MRSA oae accordng o pecmen ype Type of Cuure Specmen Wound/ abce aprae (exudae) Bone Bood No of Paen 9 Tabe 4 Percenage Reance of CA-MRSA oae for Anboc Teed Anboc* Toa number of oae eed CA-MRSA % (n) Choramphenco 5 % () Cprofoxacn Cndamycn Cormoxazoe Eryhromycn Oxacn Pencn G Teracycne 4 5% () 8 %(8) % () 8 % (8) 8 % (8) 8 % (8) 5 % (5) *Vancomycn and Lnezod were no eed DISCUSSION: Among pedarc paen admed for kn and of-ue nfecon, 64% had oae from cuure ude wh majory of hem howng communy-acqured MRSA The mechanm of reance of MRSA conferred by he preence of meca gene n he S aureu chromoome The gene encode for he producon of unque pencn-bndng proen (PBP) wh markedy reduced bndng affny o bea-acam anboc compared o an nrnc e of PBP However, here are ome cae of MRSA nfecon whch demonrae he abence of h meca gene The mechanm of reance n hee parcuar cae hypohezed o be from hyperproducon of bea-acamae Th udy, ahough wh a med number of paen, furher uppor he fndng of prevou ude ha CA-MRSA are ypcay aocaed wh kn and of-ue nfecon,3,5,6,7,8, preenng moy a mpe oary abcee or ceu n our cohor of paen Thee nfecon were moy een among very 4 P a g e D o w n o a d e d f r o m p d p h o r g

8 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH young heahy mae chdren wh no known rk facor for MRSA In conra o a udy done n Texa where hey concuded ha here no dfference n age and ex among pedarc paen wh CA-MRSA and CA-MSSA, he fndng n h preen udy are conen wh oher repor of SSTI due o CA-MRSA beng more frequen among mae 3 A prevou ude 3,,,3 have coneny hown ha many paen wh CA-MRSA nfecon are heahy chdren who do no have denfed rk facor for acquon of MRSA a demonraed ao n h udy Th obervaon doe no ony corroborae he reu of prevou ude bu ao emphaze ha communy-acqured MRSA nfecon are becomng more frequen n our pedarc paen depe he abence of rk facor for MRSA Noeworhy from h udy are he fndng of very young chdren wh medan age of 35 monh who have CA-MRSA SSTI nfecon ocaed mo commony n he head and neck regon Fndng n he udy of Ahar e a 4 ao howed ha he head and neck wa he mo frequen e of of ue abcee n chdren However, here wa a hgh frequency of manourhmen among her ubjec whch n conra o he majory of he paen een n our udy who had norma wegh for age Th obervaon may be arbuabe o a eecon ba n erm of he quay of paen admed o our nuon, where paen who are very young, ck-ookng and wh more compcaed eon ocaed a crca area are key o be brough o he hopa for a conu and are evenuay admed Th uppored by he preence of gn and ympom of yemc nvovemen uch a fever upon admon n a our paen wh CA-MRSA and he fndng of reavey hgh na perphera WBC coun wh mean and medan vaue of 333 and, repecvey On he oher hand, Sryjewk and Chamber 3 repor ha abce and ceu caued by CA-MRSA are uuay oary eon ocaed a he exreme, wh fever and eukocyo ofen aben n paen wh an abce Smar o he fndng of Uy-Aragon e a, he mo common ource of oae for CA- MRSA nfecon n h udy were from exudae whch ncude abce aprae, wound wab, ear and eye dcharge Ahough CA-MRSA nfecon predomnany preen a kn and of-ue nfecon and ony one of he hree paen wh bood cuure yeded pove reu n h udy, he aby of h organm o caue nvave deae mu ao be emphazed 5,7,,5 Incuded among he cnca yndrome aocaed wh CA-MRSA nfecon whch were een n our paen were bacerema, oeomye and cavernou nu hrombo whch preened nay a preperorba weng, aurcuar, hgh, and repecvey CA-MRSA can be dfferenaed from heah care-aocaed MRSA (HA-MRSA) by moecuar characerc HA-MRSA aocaed wh arge aphyococca chromooma caee mec (SCCmec) eemen beongng o ype I, II and III wherea CA-MRSA carre maer SCCmec of ype IV or V The formerr ofen rean o many cae of non-bea acam anboc bu CA-MRSA uuay rean o fewer cae of non-bea acam and hey ao frequeny carry he vruence facor Panon-Vaenne eukocdn (PVL) whch reaed o abce formaon and,, 3 ue necro An nernaona urveance udy from Sepember 4 o Augu 6 nvovng 7 medca nuon from egh Aan counre ncudng he Phppne, demonraed an ncreang prevaence of MRSA nfecon MRSA accouned for 55% of a communy acqured Saphyococcu aureu nfecon and 674% of 4 P a g e D o w n o a d e d f r o m p d p h o r g

9 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH hopa aocaed nfecon Among CA-MRSA nfecon, he mo common ype wa kn and of-ue nfecon comprng 667% Ao noeworhy he fndng from he above udy ha MRSA oae of SCCmec ype IV, repreenng a major genoype of CA-MRSA n Aan counre, were found among hopan Tawan, aocaed (HA-MRSA) nfecon Korea, and he Phppne The preence of ome HA-MRSA oae wh he ame genoypc characerc a ha of CA-MRSA ugge he pread of MRSA beween he communy and hopa n hee counre 9 However, nce ony one nuon from he Phppne parcpaed n h udy, unknown f he ame fndng hod rue for he whoe naon Smary, evera ude have been conduced n major eachng and ranng hopa documenng h ncreang rend of MRSA nfecon from he communy In a propecve obervaona udy done n a erary rena cener from November 8 o Ocober 9, MRSA compred 3% of a Saphyococcu aureu oae Among hee MRSA oae, 43% were communy acqured (CA-MRSA) and a gnfcany hgh proporon of 69% of hee CAof-ue MRSA preened a kn and nfecon Lkewe, a revew of S aureu nfecon from 99 o n Phppne Chdren Medca Cener, a erary governmen hopa, howed an ncreang rend of S aureu and MRSA nfecon A more recen udy from 4-6 conduced n he ame nuon ao howed ha MRSA coned 57% of communy acqured S aureu nfecon Managemen of pedarc paen wh CAwe defned MRSA SSTI no aboue and very In h udy, managemen of paen varabe Admnraon of anboc and/or performance of urgca procedure depend moy on he cnca preenaon of he paen and he evauaon of her admng phycan In he cohor of ubjec ncuded n h udy, a paen wh abce underwen ncon and dranage procedure n conjuncon wh anboc admnraon Th conform o exper recommendaon ha urgca dranage eena for he cure of of-ue abcee hence mu be he prmary reamen for hee nfecon 3,5 The roe of urgca dranage aone n he cnca cure of paen conrovera However, exper recommend anboc herapy n addon o urgery n paen wh abcee >5cm n dameer 3, wh yemc or exenve deae, n hoe wh comorbde, mmunouppreon or exreme age, hoe wh eon a area dffcu o dran and n paen who dd no repond o ncon and dranage 5 The varaby n he managemen of SSTI n chdren ao evden n he choce of anboc admnered o paen The majory of paen were nay gven Oxacn bu were evenuay hfed o Cndamycn once cuure reu were known The genera recommendaon regardng he choce of emprc anboc for oupaen wh SSTI o gve bea-acam for nonpuruen ceu 5,6 and emprc coverage for CA-MRSA pendng cuure reu for puruen ceu 6 For hopazed paen wh compcaed SSTI, e hoe wh deep-eaed nfecon, urgca or raumac wound, major abcee, ceu and nfeced burn and ucer houd receve coverage for MRSA 6 Some auhor conder he prevaence of CA-MRSA oae n a communy a -5% or more houd warran emprc reamen for MRSA 6 In our udy, he fourfor CA-MRSA among monh perod prevaence chdren wh SSTI 36 whch reavey hgh However, he udy wa ony done over a hor duraon of me hence may no accuraey repreen he acua prevaence of CA-MRSA n he communy Nonehee, houd no 4 P a g e D o w n o a d e d f r o m p d p h o r g

10 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH dcoun he fndng of h udy ha CA-MRSA SSTI an emergng concern among Fpno chdren A CA-MRSA oae howed ucepby o cndamycn, eracycne, and cormoxazoe Teracycne no recommended for paen <8 year od wherea cormoxazoe no recommended by ome exper due o aocaon wh reamen faure for nonpuruen SSTI caued by group A repococcu 6,6, med daa on effcacy a a reamen for MRSA and ue of hyperenvy and bone marrow uppreon 6 For hopazed paen wh compcaed SSTI, vancomycn recommended 5 Bu due o he hgh co of h drug, Cndamycnn a good aernave a emprc herapy epecay f he paen abe 5 However, he exence of nducbe reance o cndamycn houd cauon medca praconer o reque for D- e for a eryhromycn-rean cndamycne no ucepbe MRSA oae 6 If he done rouney n he aboraory and cncan houd monor paen coey for gn of cnca faure In uch cae wheree reamen faure wh cndamycn key and reamen of ceran cnca condon uch a CNS nfecon where cndamycn no ued, vancomycn he recommended herapy 5 I reaonabe ha hoe paen preenng nay wh SSTI bu wh deep-eaenvave nfecon w requre proonged and hopa ay Depe hee compcaed deae, no moray wa een among he paen and majory of hem weree dcharged we However, foow-up po-dcharge wa no ncuded n he cope of h udy hence, he oa duraon of anboc herapy, cnca cure, recurrence of nfecon or reape, or compcaon, f any, were no deermned Lmaon of h udy ncude he hor duraon of obervaon and he ncuon of paen preenng nay wh SSTI ony, boh of whch may no accuraey capure he acua oca prevaence and demographc of CA-MRSA nfecon among our pedarc paen In addon, no foow-up wa done afer dcharge hence duraon of anboc, repone o reamen or occurrence of compcaon were unknown CONCLUSIONS: CA-MRSA a a caue of kn and of-ue nfecon n Fpno chdren common, preenng a mpe oary abcee or ceu a he head and neck area n he majory of cae and a deep-eaed nfecon n ome SSTI were moy een among very young heahy mae chdren wh no known rk facor for MRSA Managemen of SSTI houd ncude ncon and dranage of abcee and promp ubmon of he aprae pecmen for cuure and envy eng a h w key yed he eoogc agen In h udy, he perod prevaence of CA-MRSA among pedarc paen wh SSTI hgh bu h maybe an over or underemaon of he rue prevaence of CA- eng Hence, he MRSA nfecon n he oca choce of emprc anboc for SSTI among pedarc paen admed n our nuon houd be ndvduazed and mu be baed on ound cnca evauaon and judgmen Emprc anboc wh MRSA coverage uch a cndamycn or vancomycn houd be condered n approprae cnca uaon where MRSA key REFERENCES Davd MZ and Daum RS Communy-aocaed mehcn-rean Saphyococcu aureu: epdemoogy and cnca conequence of an emergng epdemc Cn Mcrobo Rev ; 3: P a g e D o w n o a d e d f r o m p d p h o r g

11 Pedarc Infecou Deae Socey of he Phppne Journa Vo 7 No pp Jan Jun 6 Reye-So PT, Gachaan SR Profe of Chdren wh CA-MRSA nfecon a PGH Kapan SL, Huen KG and Maon EO Saphyococcu aureu nfecon (coaguae-pove aphyococc) In: Fegn and Cherry Texbook of Pedarc Infecou Deae 9 Chaper 9 pp Sryjewk ME and Chamber HF Skn and of-ue nfecon caued by communy-acqured mehcn- D 8; rean Saphyococcu aureu Cn Infec 46: S CDC Mehcn-rean Saphyococcu aureu (MRSA) hp://wwwcdcgov/mra/defnon/ndexhm acceed 6/6/ 5 Kapan SL, Huen KG, Gonzaez BE, e a Three-year urveance of communy-acqured Saphyococcu aureu nfecon n chdren Cn Infec D 5; 4: Kapan SL Treamen of communy-aocaed mehcn-rean Saphyococcu aureu nfecon Pedar Infec D J 5; 4: Marnez-Aguar G, Avao-Mhaaan A, Huen K, e a Communy acqured, mehcn-rean and mehcn-ucepbe Saphyococcu aureu mucuokeea nfecon n chdren Pedar Infec D J 4; 3: Mer LG, Perdreau-Remngon F, Bayer AS, e a Cnca and epdemoogc characerc canno dnguh communy-aocaed mehcn-rean Saphyococcu aureu nfecon from mehcna propecve ucepbe S aureu nfecon: nvegaon Cn Infec D 7; 44: Song JH, Hueh PR, Chung DR e a Spread of mehcn-rean Saphyococcu aureu beween he communy and he hopa n Aan counre: an ANSORP udy J Anmcrob Chemoher ; -9 Arakama MH, Mendoza M, Fernandez P, e a Emergence of Mehcn-rean Saphyococcu aureu among paen n a erary rena medca cener Ph J Mcrobo Infec D ; 39: 8-33 Uy-Aragon MJ, Gonzae ML, Ong-Lm, A The cnca and epdemoogc profe of communy-aocaed mehcn-rean Saphyococcu aureu nfecon among pedarc paen admed a he Phppne Genera Hopa PIDSP Journa ; : - Marcnak JF and Frank AL Treamen of communy- Saphyococcu aureu n acqured mehcn rean chdren Curr Opn Infec D 3; 6: Saer CA, Maon EO and Kapan SL Propecve comparon of rk facor and demographc and cnca characerc of communy-acqured, mehcn-rean veru mehcn-ucepbe Saphyococcu aureu nfecon n chdren Pedar Infec D J ; : Ahar MS, Mehmood MT, Ahraf MS, e a Sof-ue abcee n pedarc paen: I more prevaen n manourhed chd? Pakan Journa of Surgery 8; 4: 8-5 Lu C, Bayer A, Cogrove SE, e a Cnca pracce gudene by he Infecou Deae Socey of Amerca for he reamen of mehcn-rean Saphyococcu aureu nfecon n adu and chdren CID ; 5: Eo DJ, Zaou TE, Troxe AB, e a Emprc anmcroba herapy for pedarc kn and of-ue nfecon n he era of mehcn-rean Saphyococcu aureu Pedarc 9; 3: e P a g e D o w n o a d e d f r o m p d p h o r g