The number of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus shot up at an “alarming” rate across the United States between 2001 and 2006, according to a recent report.
Sixty percent of these MRSA cases were community acquired rather than nosocomial, and nearly half were resistant to clindamycin—reversals of the patterns that methicillin-resistant S. aureus (MRSA) infections have shown until now.
“Expeditious culture of suspected head and neck infections is highly recommended to avoid further resistant patterns,” said Dr. Iman Naseri of the department of otolaryngology, head and neck surgery, at Emory University, Atlanta, and his associates (Arch. Otolaryngol. Head Neck Surg. 2009;135:14–6).
The investigators used a national microbiology database to assess trends in MRSA prevalence, “in light of the clinical and epidemiologic concerns regarding increasing [anecdotal] reports of MRSA nationally.” The database includes strain-specific antimicrobial drug resistance test results from clinical laboratories that serve more than 300 hospitals.
Dr. Naseri and colleagues reviewed the reports on 21,009 patients aged 0–18 years (mean age, 7 years) whose head and neck infections were cultured between 2001 and 2006. The cultures were taken from the oropharynx/neck (60%), nasal or sinus cavity (38%), and middle or external ear (2%).
Overall, a total of 4,534 samples (22%) were infected with MRSA. In 2001, approximately 12% of S. aureus infections were methicillin resistant. This proportion rose steadily during the 5 years of the study to more than 28%.
Approximately 60% of these MRSA infections developed in outpatients, suggesting that community-acquired MRSA may now be more common than hospital-acquired infection.
Also, about 47% of the MRSA infections were resistant to clindamycin. Previously, 93% of community-acquired MRSA has been susceptible to clindamycin, Dr. Naseri and his associates reported.