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

Abstract

Background: Methicillin-resistant Staphylococcus aureus is a serious cause of morbidity and mortality in hospital environment, but also, lately, in the community. This case report is, to our knowledge, the first detailed description of a community-associated methicillin-resistant Staphylococcus aureus ST80 orbital cellulitis in a previously healthy neonate. Possible predisposing factors of microbial acquisition and treatment selection are also discussed. Case presentation: A 28-day-old Caucasian boy was referred to our hospital with diagnosis of right orbital cellulitis. His symptoms included right eye proptosis, periocular oedema and redness. Empirical therapy of intravenous daptomycin, rifampin and ceftriaxone was initiated. Culture of pus yielded a methicillin-resistant Staphylococcus aureus isolate and 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. Conclusions: Clinicians should be aware that young infants, even without any predisposing condition, are susceptible to orbital cellulitis caused by community-associated methicillin-resistant Staphylococcus aureus. Prompt initiation of the appropriate empirical therapy, according to the local epidemiology, should successfully address the infection, preventing ocular and systemic complications.