BACKGROUND: Methicillin-resistant Staphylococcus aureus is a serious cause of morbidity and mortality in hospital environment, but also, lately, in the community. This case report is, to our knowledge, the first detailed description of a community-associated methicillin-resistant S. aureus ST80 orbital cellulitis in a previously healthy neonate. Possible predisposing factors of microbial acquisition and treatment selection are also discussed. CASE PRESENTATION: A 28-day-old Caucasian boy was referred to our hospital with the diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular edema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. The culture of pus yielded a methicillin-resistant S. aureus isolate and the molecular analysis revealed that it was a Panton-Valentine leukocidine-positive ST80 strain. The combination antimicrobial therapy was continued for 42 days and the infection was successfully controlled. CONCLUSIONS: Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant S. aureus. Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.
BACKGROUND:Methicillin-resistant Staphylococcus aureus is a serious cause of morbidity and mortality in hospital environment, but also, lately, in the community. This case report is, to our knowledge, the first detailed description of a community-associated methicillin-resistant S. aureus ST80 orbital cellulitis in a previously healthy neonate. Possible predisposing factors of microbial acquisition and treatment selection are also discussed. CASE PRESENTATION: A 28-day-old Caucasian boy was referred to our hospital with the diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular edema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. The culture of pus yielded a methicillin-resistant S. aureus isolate and the molecular analysis revealed that it was a Panton-Valentine leukocidine-positive ST80 strain. The combination antimicrobial therapy was continued for 42 days and the infection was successfully controlled. CONCLUSIONS: Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant S. aureus. Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.
Authors: Catherine Liu; Arnold Bayer; Sara E Cosgrove; Robert S Daum; Scott K Fridkin; Rachel J Gorwitz; Sheldon L Kaplan; Adolf W Karchmer; Donald P Levine; Barbara E Murray; Michael J Rybak; David A Talan; Henry F Chambers Journal: Clin Infect Dis Date: 2011-01-04 Impact factor: 9.079
Authors: Regine M Fortunov; Kristina G Hulten; Wendy A Hammerman; Edward O Mason; Sheldon L Kaplan Journal: Pediatrics Date: 2006-09 Impact factor: 7.124
Authors: Daisuke Kobayashi; Laurence B Givner; R Patrick Yeatts; Evelyn Y Anthony; Avinash K Shetty Journal: J AAPOS Date: 2011-04-03 Impact factor: 1.220
Authors: Régine M Fortunov; Kristina G Hulten; Coburn H Allen; Wendy A Hammerman; Linda B Lamberth; Edward O Mason; Sheldon L Kaplan Journal: Pediatr Infect Dis J Date: 2011-01 Impact factor: 2.129
Authors: Regine M Fortunov; Kristina G Hulten; Wendy A Hammerman; Edward O Mason; Sheldon L Kaplan Journal: Pediatrics Date: 2007-11 Impact factor: 7.124