Increasing use of extracorporeal life support in methicillin-resistant Staphylococcus aureus sepsis in children

Background. Pediatric cases of fulminant community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections requiring extracorporeal life support (ECLS) have been reported, but the frequency of ECLS use for severe presentations of staphylococcal disease is unknown. Objective: To describe the frequency and characteristics of children with MRSA infections requiring ECLS using local and international databases. Methods. The reasons for use of ECLS in children 0-18 yrs of age were determined in both the Vanderbilt Children's Hospital medical record system and the Extracorporeal Life Support Organization database during the years 1994-2005. Demographic characteristics, ventilatory management, and measurements of cardiopulmonary status in subjects undergoing ECLS with a pre-ECLS diagnosis of infection with Staphylococcus aureus and MRSA were included. Results. Three subjects with MRSA sepsis requiring ECLS were identified at Vanderbilt since 2000. Before that time, no cases due to MRSA were reported. The three subjects were previously healthy adolescents with severe necrotizing pneumonia associated with skin/soft-tissue infection and two died. A total of 45 patients requiring ECLS for MRSA infection were identified in the International Extracorporeal Life Support Organization database, with nearly half reported in the past 2 yrs (20 of 45 patients). The median age was 2.4 yrs (interquartile range, 0.36-14 yrs), with peaks noted in infancy and adolescence. In Extracorporeal Life Support Organization subjects with MRSA, survival to discharge was highest in infants and young children aged 1-4 yrs (65% and 71%, respectively) and lowest in the age ranges of 5-9 yrs and 13-18 yrs (0% and 31%, respectively). There were no statistically significant differences in pre-ECLS ventilatory settings, cardiopulmonary status, or frequency of complications between survivors and nonsurvivors. Conclusions. The use of ECLS for MRSA infection seems to be increasing both locally and internationally. High mortality rates, particularly in older patients, are concerning and highlight the increasing problem with this pathogen.