Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 30, Num. 1, 2012, pp. 113-113

Indian Journal of Medical Microbiology, Vol. 30, No. 1, January-March, 2012, pp. 113

Correspondence

Suppurative sialadenitis in a neonate by methicillin-resistant Staphylococcus aureus: Do we need search and kill superbug strategy?

C Mukhopadhyay¹, KE Vandana¹, F Munim¹, LE Lewis²

¹ Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104, India
² Professor and Unit Head of Neonatology, Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104, India

Correspondence Address:
C Mukhopadhyay
Department of Microbiology, Kasturba Medical College, Manipal University, Manipal, Karnataka- 576104
India
chiranjay@yahoo.co.in

Code Number: mb12027

PMID: 22361778

DOI: 10.4103/0255-0857.93087

Dear Editor,

Suppurative sialadenitis is a rare disease in neonates and children. Neonatal disease is usually associated with risk factors like prematurity, congenital anomalies and prolonged orogastric feeding. ^[1] We report a case of suppurative sialadenitis of parotid and submandibular glands in a term healthy neonate due to methicillin-resistant Staphylococcus aureus (MRSA).

A 12-day-old male neonate was admitted with one-day history of incessant cry, swelling below the left angle of jaw and restricted movements of head. He was born at 40 weeks of gestation by lower segment caesarean section.Examination revealed 6.5 x 4 cm diffuse, erythematous swelling over the left pre-auricular region with restricted movements of head. Ultrasonography suggested inflammation of the parotid and submandibular gland. After sending pus draining from the Wharton′s duct and blood for culture, empirically intravenous ampicillin and amikacin was initiated. Methicillin-resistant S.aureus was isolated from the pus while blood culture remained sterile. It was sensitive to cotrimoxazole, doxycycline, vancomycin, teicoplanin, rifampicin and linezolid. Treatment was now changed to syrup cotrimoxazole. Upon screening, cultures from anterior nares, axilla, groin, fingertips and throat from the baby and mother grew MRSA with similar susceptibility patterns as that from salivary gland pus.Mother's breast milk was negative for MRSA. Both were decolonized with nasal application of mupirocin ointment and triclosan bathing.Baby recovered completely after 14 days of cotrimoxazole therapy.

Though various Gram positive and Gram negative bacteria cause suppurative sialadenitis, ^[1],[2],[3] increasing infection rates by MRSA in the hospital and community should draw our attention for inclusion of anti-MRSA drugs as empirical therapy in treating such infections pending culture and susceptibility results in neonatal group. Screening of the infected neonates and the caregivers for carrier status, followed by decolonisation therapy would be helpful in preventing recurrences and spread of infections. Nevertheless, handwashing and infection control practices should be strictly adhered to in neonatal intensive care units. Mandatory universal MRSA screening is not warranted when the incidence of MRSA is low. ^[4] More evidence is needed to study effectiveness of maternal screening for MRSA during perinatal period to reduce infections in newborns.

References

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