The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has become of great concern in both hospital and community settings. To evaluate the prevalence and risk factors for methicillin resistance among Staphylococcus aureus, blood isolates in our Emergency Department (ED) were collected. All patients with S. aureus bacteremia (SAB) who presented to the ED from January 2000 to August 2005 were included, and a retrospective study was performed. A total of 231 patients with SAB were enrolled (median age, 59 yr; M:F, 125:106). Among these patients, methicillin-resistant strains accounted for 27.3% (63 patients). Catheter-related infection was the most frequent primary site of SAB (39.0%), followed by skin and soft tissue infection (16.5%). In multivariate analysis, recent surgery (OR, 3.41; 95% CI, 1.48-7.85), recent hospitalization (2.17; 1.06-4.62), and older age (> or =61 yr) (2.39; 1.25-4.57) were independently associated with the acquisition of methicillin-resistant strains. When antimicrobial therapy is considered for the treatment of a patient with suspected SAB, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage for patients with risk factors: older age, recent hospitalization, and recent surgery.
Adult ; Age Factors ; Aged ; Anti-Bacterial Agents/pharmacology/therapeutic use ; Cross Infection/blood/drug therapy/microbiology ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Methicillin/pharmacology/*therapeutic use ; *Methicillin Resistance ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/blood/drug therapy/*microbiology ; Staphylococcus aureus/*drug effects/isolation & purification

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study.
Agammaglobulinemia/complications/*diagnosis/immunology ; Anti-Bacterial Agents/therapeutic use ; Ceftriaxone/therapeutic use ; Drug Resistance, Bacterial ; Empyema, Pleural/*diagnosis/etiology/radiography ; Female ; Humans ; IgA Deficiency/*diagnosis/immunology ; Immunoglobulin A/blood ; Immunoglobulin G/blood ; Infant ; Staphylococcal Infections/*diagnosis/drug therapy/microbiology ; Tomography, X-Ray Computed