50 Years Ago in The Journal of Pediatrics:

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Yow MD, Desmond MM, and Nickey LN. J Pediatr 1959;54:409-28.

Yow et al began their article on the management of childhood staphylococcal disease with the statement, “The increasing incidence and severity of staphylococcal disease are phenomena of grave worldwide concern,” words that seem just as timely today. The patients described by Yow consisted of 200 children with staphylococcal disease who were hospitalized at Jefferson Davis Hospital in Houston in the mid-1950s. Approximately three quarters of the patients were younger than 2 months of age, many either preterm or full-term newborns, and almost 80% of their infections were nosocomial. Yow found that the patients' ages significantly influenced their risk for disease-associated morbidity and death. Among patients with serious disease, defined as anything more serious than impetigo or conjunctivitis, the mortality rate was 43% in premature infants, 26% in full-term babies, and 12% in children older than 2 years of age. Most of the bacteria infecting the newborn infants were phage type 81, virulent strains that were resistant to penicillin, tetracycline, streptomycin, and erythromycin, the antimicrobial mainstays of the day. Treatment of staphylococcal infections with the aforementioned antibiotics was often associated with poor clinical outcomes. Thus these clinicians treated some of their patients with the new bactericidal antibiotics, bacitracin and kanamycin, and they reported significantly improved clinical outcomes. Although vancomycin was available, it was used infrequently because of difficulties with intravenous administration of medications in the pediatric age group. In addition to antimicrobials, the authors noted the critical importance of adequate incision and drainage of any abscesses that were present to ensure resolution of the infections. Although the epidemiology of staphylococcal disease today has changed from that reported 50 years ago, with a lower incidence of both neonatal disease and nosocomial infections, these problems still occur with some frequency. We are currently in the midst of a “new” epidemic of Staphylococcus aureus disease, caused this time by community-acquired methicillin-resistant bacteria.¹ The Staphylococcus aureus bacteria will almost certainly be with us human beings for many years to come.

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1. Daum RS. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007;357:380–390
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