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Purulent Pericarditis Secondary to Community-acquired, Methicillin-resistant Staphylococcus aureus in Previously Healthy Children. A Sign of the Times?
MedLine Citation:
PMID:  23802820     Owner:  NLM     Status:  In-Data-Review    
Rationale: Purulent pericarditis secondary to community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) is a potentially lethal infection that has yet to be described in the pediatric population. Only four cases of purulent pericarditis secondary to CA-MRSA have been described in the English literature, all of whom were adults. Objectives: We report on the first two pediatric cases of purulent pericarditis secondary to CA-MRSA to increase awareness of this potentially fatal condition. Methods: Clinical data were obtained from an 8-year-old male patient and a 7-month-old female patient, both previously healthy, who presented to our hospital for treatment of severe shock and multiorgan failure. Literature review was performed using MEDLINE and Cochrane databases. Pulsed-field gel electrophoresis was performed to confirm the organism type. Measurements and Main Results: Our previously healthy patients presented with refractory shock and were found to have purulent pericarditis with tamponade secondary to CA-MRSA. Both patients required emergent pericardiocentesis and surgical pericardial debridement. Isolates from both patients were found to be MRSA USA type 300, a common type of CA-MRSA that has become the most frequent cause of skin and soft tissue infections in the United States. Conclusions: Purulent pericarditis survival hinges upon early empiric antibiotic therapy targeting resistant Staphylococcus, rapid diagnostic efforts, and expeditious pericardial drainage when diagnosed. An aggressive multidisciplinary approach provided for complete recovery in both cases, and both children were discharged with normal cardiac function. These two cases emphasize the need for consideration of CA-MRSA presenting with purulent pericarditis as an etiology for refractory shock.
Jeffrey E Lutmer; Andrew R Yates; Tammy L Bannerman; Mario J Marcon; Todd J Karsies
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the American Thoracic Society     Volume:  10     ISSN:  2325-6621     ISO Abbreviation:  Ann Am Thorac Soc     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101600811     Medline TA:  Ann Am Thorac Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  235-8     Citation Subset:  IM    
1 Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital.
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