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Case Reports in Pediatrics
Volume 2013, Article ID 153239, 3 pages
http://dx.doi.org/10.1155/2013/153239
Case Report

Acute MRSA Sinusitis with Intracranial Extension and Marginal Vancomycin Susceptibility

Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of the King’s Daughters and EVMS, Norfolk, VA 23507, USA

Received 10 July 2013; Accepted 13 August 2013

Academic Editors: N.-C. Chiu and K.-H. Lue

Copyright © 2013 Parvathi S. Kumar and Kenji M. Cunnion. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Methicillin resistant Staphylococcus aureus (MRSA) is increasingly being described as a cause of acute sinusitis. We present a patient with acute MRSA sinusitis complicated by rapid intracranial extension, marginal vancomycin susceptibility (MIC = 2 mg/L), delayed drainage of intracranial abscess, and subsequent development of rifampin resistance. Given the relatively high risk of intracranial extension of severe acute bacterial sinusitis and high mortality associated with invasive MRSA infections, we suggest early surgical drainage of intracranial abscesses in these circumstances. We believe this is important given the limited intracranial penetration of currently available treatment options for MRSA, especially those with a vancomycin minimal inhibitory concentration (MIC) of ≥2 mg/L.