Pediatric Pulmonology 43:203–205 (2008) Case Report Recognition and Treatment of Neonatal Community-Associated MRSA Pneumonia and Bacteremia Stephanie Yee-Guardino, DO, 1 Deepak Kumar, MD, MRCP, 2 Nazha Abughali, MD, 3 * Marion Tuohy, BS MT (ASCP), 4 Gerri S. Hall, PhD, 4 and Mary L. Kumar, MD 3 Summary. Community-associated strains of methicillin-resistant Staphylococcus aureus (CA-MRSA) have recently emerged as a major cause of serious infections among older children and are now being seen in NICU patients. We present the case of a preterm infant with CA-MRSA necrotizing pneumonia and secondary bacteremia. Pediatr Pulmonol. 2008; 43:203–205. ß 2007 Wiley-Liss, Inc. Key words: MRSA; CA-MRSA; preterm infants; pneumonia. Community-associated strains of methicillin-resistant Staphylococcus aureus (CA-MRSA) have emerged as a cause of serious infections among children and are now being seen in NICU patients. We present a case of the successful treatment of a preterm infant with CA-MRSA necrotizing pneumonia and secondary bacteremia. The patient was a 1,075 g twin born vaginally at 28 3 = 7 weeks following spontaneous rupture of membranes to a 29-year-old mother with negative prenatal screens. The infant was intubated and administered surfactant. Blood culture obtained after birth remained negative and the infant was treated empirically with ampicillin and gentamicin for 48 hours. The infant’s initial NICU course was unremarkable until day of life (DOL) 13 when the patient developed gastric aspirates. A babygram revealed new bilateral pul- monary infiltrates. Blood, urine, and endotracheal cultures were obtained in addition to rectal and conjunctival cultures for herpes simplex virus (HSV). Vancomycin, gentamicin, amphotericin, and acyclovir were started. The infant’s respiratory status continued to deteriorate, requiring high frequency oscillatory ventilation. An endotracheal aspirate culture grew MRSA susceptible to clindamycin, gentami- cin, rifampin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin. A disk diffusion induction test (D-test) for inducible clindamycin resistance was negative. Blood and urine cultures from DOL 13 remained negative as did cultures for HSV. Despite a left pneumothorax on DOL 15 and radio- graphic worsening with the development of multiple bilateral pneumatoceles (Fig. 1), the patient improved and was transitioned to conventional ventilation by DOL 17. Two days later the infant had increase in white blood cell count (WBC) from 21,000 to 42,000 cells/ml and C-reactive protein (CRP) from 8.6 to 22.6 mg/dL. The 1 Department of Pediatrics, Section of Pediatric Infectious Diseases, Cleveland Clinic, 9500 Euclid Ave., Cleveland, Ohio 44195. 2 Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, Ohio 44109. 3 Department of Pediatrics, Division of Infectious Diseases, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, Ohio 44109. 4 Department of Pathology and Laboratory Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, Ohio 44195. *Correspondence to: Dr. Nazha Abughali, MD, Department of Pediatrics, Division of Infectious Diseases, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH 44109. E-mail: nabughali@metrohealth.org Received 28 April 2007; Revised 19 August 2007; Accepted 20 August 2007. DOI 10.1002/ppul.20743 Published online 17 December 2007 in Wiley InterScience (www.interscience.wiley.com). ß 2007 Wiley-Liss, Inc.