European ST80 community-associated methicillin-resistant Staphylococcus aureus orbital cellulitis in a neonate

A 28-day-old Caucasian boy was referred to our hospital with the diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular edema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. The culture of pus yielded a methicillin-resistant S. aureus isolate and the molecular analysis revealed that it was a Panton-Valentine leukocidine-positive ST80 strain. The combination antimicrobial therapy was continued for 42 days and the infection was successfully controlled.Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant S. aureus. Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.Over the past 2 decades, the incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has constantly been rising, due to the emergence of highly virulent and transmissible strains [1]. In a recent study performed in our area, CA-MRSA was found to be increasing as a cause of skin and soft tissue infections, as well as of the invasive ones, among all pediatric ages [2]. Fortunov et al. have reported that CA-MRSA infections are also increasing in previously healthy neonates without traditional risk factors and males are most often affected between 7 to 12 days of age [3,4].Greece is a country with increased incidence of CA-MRSA. This expansion is associated mainly with the wide spread in the community of a single virulent clone, the European ST80. In our area, the proportion of staphylococcal pediatric infections caused by a CA-MRSA isolate increased from 51.5% in 2003-2006 to 63.4% in 2007-2009 [2]. In addition, an increasing rate of resistance to clindamycin has been noted. The rate of clindamycin resistance in MRSA isolates betwe