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Background  The nation-wide concern over methicillin-resistant  Staphylococcus aureus  (MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset  S. aureus  infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy.    Methods  From January 2005–June 2008, children (0–18 years old) admitted to the Children's Hospital of Illinois with community-onset  S. aureus  infections were identified by a computer-assisted laboratory-based surveillance and medical record review.    Results  Of 199 patients, 67 (34%) had invasive infections, and 132 (66%) had skin and soft tissue infections (SSTIs). Among patients with invasive infections,  S. aureus  isolates were more likely to be susceptible to methicillin (MSSA 63% vs. MRSA 37%), whereas patients with SSTIs,  S. aureus  isolates were more likely to be resistant to methicillin (MRSA 64% vs. MSSA 36%). Bacteremia and musculoskeletal infections were the most common invasive infections in both groups of  S. aureus . Pneumonia with empyema was more likely to be caused by MRSA ( P  = 0.02). The majority (~90%) of MRSA isolates were non-multidrug resistant, even in the presence of healthcare-associated risk factors.    Conclusion  Epidemiological data at the local level is important for antimicrobial decision-making. MSSA remains an important pathogen causing invasive community-onset  S. aureus  infections among hospitalized children. In our hospital, nafcillin in combination with vancomycin is recommended empiric therapy in critically ill patients with suspected invasive staphylococcal infections. Because up to 25% of MSSA circulating in our area are clindamycin-resistant, clindamycin should be used cautiously as empiric monotherapy in patients with suspected invasive staphylococcal infections.

Epidemiology of community-onset Staphylococcus aureus infections in pediatric patients: an experience at a Children's Hospital in central Illinois