Changes in community-associated methicillin-resistant staphylococcus aureus skin and soft tissue infections presenting to the pediatric emergency department: Comparing 2003 to 2008

OBJECTIVES: This study aimed to compare the differences in the type and location of skin infections, organisms cultured, and antibiotic resistance patterns presenting to the same pediatric emergency department from 2003 to 2008 with specific focus on community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. METHODS: We performed a retrospective chart review of children younger than 18 years who presented to the pediatric emergency department with a skin or soft tissue infection from January 1 to December 31, 2008, and compared these data to a similar data set collected at the same institution from January 1 to December 31, 2003. RESULTS: From 2003 to 2008, the proportion of abscesses among all skin or soft tissue infections increased from 14% (95% confidence interval [CI], 8.4%-21.2%) to 65% (95% CI, 58.4%-70.6%). Cultures positive for MRSA increased from 21% (95% CI, 14.3%-29.0%) in 2003 to 42% (95% CI, 35.2%-47.8%) in 2008 (z score = -3.98, P < 0.001). Similar to 2003, all MRSA culture-positive abscesses were sensitive to trimethoprim- sulfamethoxazole and vancomycin in 2008. The most common anatomic location for MRSA abscesses in 2003 and 2008 was the buttocks, with a wider variation of anatomic sites in 2008 to include head/neck, trunk, and extremities. CONCLUSIONS: The prevalence of CA-MRSA skin infections, specifically abscesses, has significantly increased at our institution from 2003 to 2008. The antibiotic resistance patterns have not significantly changed. The most common anatomic location for CA-MRSA abscesses continues to be the buttocks, but more children are presenting with multiple abscesses in a wider variety of anatomic locations.