Invasive Infections By Methicillin Resistant Staphylococcus Aureus Acquired In The Community. Clinical And Evolutionary Presentation Observed In Two University Centers. Uruguay 2003-2007

Introduction: in Uruguay, since 2001, community acquired non-multiresistant methicillin-resistant staphylococcus aureus was defined as an emerging pathogen in child community acquired diseases. Between 2003 and 2004, the fast dissemination of infections caused by this germ resulted in several people dying and the uprising of a health alarm.Objective: to describe the main clinical features and evolution in children hospitalized due to community acquired methicillin resistant staphylococcus aureus in two university medical centers between 2003 and 2007.Method: the study was conducted in children with invasive community acquired methicillin resistant staphylococcus aureus infections, who were hospitalized in the Pediatric Hospital of the Pereira Rossell Health Care Center and in the Litoral de Paysandu Teaching Hospital between January 1, 2003 and December 31, 2007. We defined an infection as invasive when the germ was isolated in usually sterile sites. We analyzed age, sex, topography, complications and mortality.Results: 78 children were hospitalized; average age was 5.4 years old. The most common clinical presentations were empyema (n=28), osteoarticular infection (n=27), bacteremia secondary to skin and soft tissue infections (n=9). Among children with empyemia, 5 evidenced sepsis or septic shock, or both; 27 required thorax drain, 11 of which evidenced abcess in the chest cavity, 6 of which evidenced costal osteomyelitis, one of which required partial neumonectomy.Among the osteoarticular infection group, they all required drainage; 9 evidenced pandiaphystis, sepsis or septic sic, or both; 5 evidenced deep vein thrombosis, and 5 evolved to chronicity. Five children (6.4%) died; three of them with empyemia and two with osteoarticular infectionsConclusions: a large proportion of children with invasive community acquired methicillin resistant staphylococcus aureus infections presented sequelae; mortality in this series was 6.4%. Learning about the different forms of clinical presentation and possible evolution is essential for early diagnosis and the appropriate empirical treatment. Genetic characterization of strains could contribute to improving control and treatment.