Skip to main content
SpringerLink
Log in

Radiological findings of community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus pediatric pneumonia in Hawaii

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Community-acquired Staphylococcus aureus (CA-SA) infections are common among pediatric patients in Hawaii.

Objective

We wanted to characterize the radiological features of methicillin-susceptible (CA-MSSA) and methicillin-resistant (CA-MRSA) staphylococcal pneumonia in Hawaiian children.

Materials and methods

We retrospectively reviewed medical records and imaging studies of children with SA pneumonia identified from 1996 through 2007.

Results

Of 40 children, 26 (65%) had CA-MRSA pneumonia and 14 patients (35%) had CA-MSSA pneumonia. CA-MRSA patients were significantly younger than CA-MSSA patients (65% younger than 1 year vs. 36% older). In a majority (62%) of CA-MRSA patients, the consolidation was unilateral; in most of the CA-MSSA cases (79%), the consolidation was bilateral. Fifty percent of the patients with CA-MRSA and 21% of those with CA-MSSA had pneumatoceles (P = 0.1). CA-MRSA patients more commonly had pleural effusions (85% vs. 64% for CA-MSSA) and pleural thickening (50% vs. 36% for CA-MSSA).

Conclusion

This case series describes the radiologic characteristics of CA-MRSA and CA-MSSA pneumonia in children in a highly endemic area. We found that CA-MRSA pneumonias are unilateral in a majority of pediatric pneumonia cases, are more common in children 1 year or younger, and have higher rates of complications in comparison to CA-MSSA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Boyce JM, Causey WA (1982) Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 3:377–383

    CAS  PubMed  Google Scholar 

  2. Jarvis WR, Thornsberry C, Boyce J et al (1985) Methicillin-resistant Staphylococcus aureus at children’s hospitals in the United States. Pediatr Infect Dis J 4:651–655

    Article  CAS  Google Scholar 

  3. Salgado CD, Farr BM, Calfee DP (2003) Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis 36:131–139

    Article  PubMed  Google Scholar 

  4. Dietrich DW, Auld DB, Mermel LA (2004) Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. Pediatrics 113:E347–E352

    Article  PubMed  Google Scholar 

  5. Frank AL, Marcinak JF, Mangat PD et al (1999) Community-acquired and clindamycin-susceptible methicillin-resistant Staphylococcus aureus in children. Pediatr Infect Dis J 18:993–1000

    Article  CAS  PubMed  Google Scholar 

  6. Groom AV, Wolsey DH, Naimi TS et al (2001) Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 286:1201–1205

    Article  CAS  PubMed  Google Scholar 

  7. Herold BC, Immergluck LC, Maranan MC et al (1998) Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 279:593–598

    Article  CAS  PubMed  Google Scholar 

  8. Maguire GP, Arthur AD, Boustead PJ et al (1996) Emerging epidemic of community-acquired methicillin-resistant Staphylococcus aureus infection in the Northern Territory. Med J Aust 164:721–723

    CAS  PubMed  Google Scholar 

  9. Roghman M (2000) Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcal aureus bacteremia. Arch Intern Med 160:1001–1004

    Article  Google Scholar 

  10. Shurland S, Zhan M, Bradham DD et al (2007) Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcal aureus. Infect Control Hosp Epidemiol 28:273–279

    Article  PubMed  Google Scholar 

  11. Cosgrove SE, Qi Y, Kaye KS et al (2005) The impact of methicillin resistance in Staphylococcal aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26:166–174

    Article  PubMed  Google Scholar 

  12. Cosgrove SE, Sakoulas G, Perencevich EN et al (2003) Comparison of mortality-associated methicillin-resistant and methicillin-susceptible Staphylococcal aureus bacteremia: a meta-analysis. Clin Infect Dis 36:53–59

    Article  PubMed  Google Scholar 

  13. Bartlett JG, Mundy LM (1995) Community acquired pneumonia. NEJM 333:1618–1624

    Article  CAS  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention (1999) Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus—Minnesota and North Dakota, 1997–1999. JAMA 282:1123–1125

    Article  Google Scholar 

  15. Fridkin SK, Hageman JC, Morrison M et al (2005) Methicillin-resistant Staphylococcus aureus disease in three communities. New Engl J Med 352:1436–1444

    Article  CAS  PubMed  Google Scholar 

  16. Francis JS, Doherty MC, Lopatin U et al (2005) Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis 40:100–107

    Article  PubMed  Google Scholar 

  17. Hageman JC, Uyeki TM, Francis JS et al (2006) Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis 12:894–899

    PubMed  Google Scholar 

  18. Centers for Disease Control and Prevention (2007) Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza—Louisiana and Georgia, December 2006-January 2007. MMWR 56:325–329

    Google Scholar 

  19. Micek ST, Dunne M, Kollef MH (2005) Pleuropulmonary complications of Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus: importance of treatment with antimicrobials inhibiting exotoxin production. Chest 128:2732–2738

    Article  CAS  PubMed  Google Scholar 

  20. Frazee BW, Salz TO, Lambert L et al (2005) Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult. Ann Emerg Med 46:401–404

    Article  PubMed  Google Scholar 

  21. Fergie J, Purcell K (2002) Community-acquired methicillin-resistant Staphylococcus aureus infections in South Texas children. Pediatr Infect Dis J 20:860–863

    Google Scholar 

  22. Johnston BL (1994) Methicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia—a critical review. Semin Respir Infect 9:199–206

    CAS  PubMed  Google Scholar 

  23. Ibia E (2005) Methicillin-resistant Staphylococcus aureus pneumonia in children: a call for increased vigilance. South Med J 98:1059–1060

    Article  PubMed  Google Scholar 

  24. Gillet Y, Issartel B, Vanhems P et al (2002) Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotizing pneumonia in young immunocompetent patients. Lancet 359:753–759

    Article  CAS  PubMed  Google Scholar 

  25. Nguyen ET, Kanne JP, Hoang LP et al (2008) Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: radiographic and computed tomography findings. J Thorac Imaging 23:13–19

    Article  PubMed  Google Scholar 

  26. Gonzalez C, Rubio M, Romera-Vivas J et al (1999) Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 29:1171–1177

    Article  CAS  PubMed  Google Scholar 

  27. Centers for Disease Control and Prevention (2004) Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders—Hawaii, 2001–2003. MMWR 53:767–770

    Google Scholar 

  28. Estivariz CF, Park SY, Hageman JC et al (2007) Emergence of community-associated methicillin-resistant Staphylococcus aureus in Hawaii, 2001–2003. J Infect 54:349–357

    Article  PubMed  Google Scholar 

  29. Canty TG, Goscienski P, Edwards D et al (1978) Staphylococcal pneumonia. West J Med 129:201–209

    CAS  PubMed  Google Scholar 

  30. Schultz KD, Fan LL, Pinsky J et al (2004) The changing face of pleural empyemas in children: epidemiology and management. Pediatrics 113:1735–1740

    Article  PubMed  Google Scholar 

  31. Ochoa TJ, Mohr J, Wanger A et al (2005) Community-associated methicillin-resistant Staphylococcal aureus in pediatric patients. Emerg Infec Dis 11:966–968

    Google Scholar 

  32. Martinez-Aguilar G, Hammerman WA, Mason EO et al (2003) Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcal aureus in children. Pediatr Infect Dis J 22:593–598

    Article  PubMed  Google Scholar 

  33. Tenover FC, Goering RV (2009) Methicillin-resistant Staphylococcus aureus strain USA300: origin and epidemiology. J Antimicrob Chemother 64:441–446

    Article  CAS  PubMed  Google Scholar 

  34. Bubeck Wardenburg J, Palazzolo-Ballance AM, Otto M et al (2008) Panton-Valentine leukocidin is not a virulence determinant in murine models of community-associated methicillin-resistant Staphylococcus aureus disease. J Infect Dis 198:1166–1170

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine, 1319 Punahou St., Room 755, Honolulu, HI, 96826, USA

    Guliz Erdem, Lora Bergert, Kyra Len & Marian Melish

  2. Department of Radiology, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA

    Kevin Kon & Robert DiMauro

Authors
  1. Guliz Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lora Bergert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyra Len
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marian Melish
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin Kon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert DiMauro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guliz Erdem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erdem, G., Bergert, L., Len, K. et al. Radiological findings of community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus pediatric pneumonia in Hawaii. Pediatr Radiol 40, 1768–1773 (2010). https://doi.org/10.1007/s00247-010-1680-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-010-1680-0

Keywords

Search

Navigation