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 Vol. 9 No. 12, December 2008
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NeoReviews Vol.9 No.12 2008 e580
© 2008 American Academy of Pediatrics

Methicillin-resistant Staphylococcus aureus in Previously Healthy Neonates

Régine M. Fortunov, MD*
Sheldon L. Kaplan, MD{dagger}

* Neonatologist, Neonatology Associates, Ltd., Phoenix, Ariz
{dagger} Professor, Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex

Methicillin-resistant Staphylococcus aureus infections are increasing in previously healthy term and late preterm neonates. Male infants are at greater risk, with symptom onset most often occurring between 7 and 12 days of age. Infants and mothers may have concurrent infection, and a family history of skin or soft-tissue infection is a significant risk factor. Infections range in severity from pustulosis to invasive infection. Evaluation strategies vary but should be based on the severity of infection. Abscesses often require drainage. Some infections may be associated with sterile cerebrospinal fluid pleocytosis. Treatment strategies also vary. Community isolate antibiotic susceptibility patterns should determine the empiric antibiotic choice. Antibiotic coverage should be adjusted after antibiotic susceptibility results are available for the patient's specific isolate. Some patients who have no systemic symptoms, a reliable family, and good follow-up may complete treatment safely at home. Outpatients should be monitored closely for treatment failure. The appropriate length of treatment is not known but should continue at least until all symptoms have resolved for 48 hours. Recurrence of infection months or years after the neonatal infection is possible.

Abbreviations: CA: community-acquired • CSF: cerebrospinal fluid • MRSA: methicillin-resistant Staphylococcus aureus


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