Abstract
Pediatric invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is very serious and occasionally fatal. This infectious disease is still a relatively rare and unfamiliar infectious disease in Japan. We report a positive outcome in a 23-month-old Japanese girl with meningitis, osteomyelitis, fasciitis, necrotizing pneumonia, urinary tract infection, and bacteremia due to CA-MRSA treated with linezolid. PCR testing of the CA-MRSA strain was positive for PVL and staphylococcal enterotoxin b and negative for ACME. SCC mec was type IVa. This case underscores the selection of effective combinations of antimicrobial agents for its treatment. We need to be aware of invasive CA-MRSA infection, which rapidly progresses with a serious clinical course, because the incidence of the disease may be increasing in Japan.
Highlights
Community-acquired methicillin-resistant Staphylococcus aureus (CA-Methicillin-resistant Staphylococcus aureus (MRSA)) has bacteriological and clinical properties different to those of hospital-acquired MRSA
HAMRSA infections are usually defined as MRSA infection in a patient with one of the following risk factors for hospital-acquired MRSA (HA-MRSA): isolation of MRSA ≥2 days after hospitalization; a history of hospitalization, surgery, dialysis, or residence in a long-term care facility within 1 year before the MRSA-culture date; the presence of a permanent indwelling catheter or percutaneous medical procedure at the time of culture; or previous isolation of MRSA [2]
HA-MRSA strains are typified by a USA100 or USA200 pulsed field gel electrophoresis pattern [4]
Summary
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has bacteriological and clinical properties different to those of hospital-acquired MRSA. CAMRSA is classified into staphylococcal cassette chromosome mec (SCC mec) type IV or type V, which codes a methicillin resistance. The Panton-Valentine leucocidin (PVL) gene of CA-MRSA sometimes occurs, but there is a low occurrence of positivity to this gene in Japan [1]. This infectious disease is very serious and occasionally fatal, regardless of age. Invasive CA-MRSA infection is still a relatively rare and unfamiliar infectious disease in Japan. We report the first successfully positive outcome in a 23-month-old Japanese girl with meningitis, osteomyelitis, fasciitis, necrotizing pneumonia, urinary tract infection, and sepsis due to CA-MRSA
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