David Michael Z, Crawford Susan E, Boyle-Vavra Susan, Hostetler Mark A, Kim Daniel C, Daum Robert S
University of Chicago, Chicago, Illinois 60637, USA.
Emerg Infect Dis. 2006 Apr;12(4):631-7. doi: 10.3201/eid1204.050960.
We performed a prospective study of all inpatient and outpatient methicillin-resistant Staphylococcus aureus (MRSA) isolates identified at the University of Chicago Hospitals from November 2003 through November 2004. Differences in resistance to non-beta-lactam antimicrobial drugs were determined after stratification of the 578 MRSA isolates into 4 groups by patient age (pediatric vs. adult) and onset location (community vs. hospital). Non-beta-lactam resistance was significantly greater among the 288 adult than the 177 pediatric community-associated isolates for erythromycin (93.2 vs. 87.0%, p = 0.03), clindamycin (51.8 vs. 7.3%, p<0.001), ciprofloxacin (62.1 vs. 10.7%, p<0.001), gentamicin (11.1 vs. 1.1%, p<0.001), and tetracycline (19.9 vs. 6.4%, p<0.001). In contrast, hospital-associated MRSA isolates from children and adults had similar rates of non-beta-lactam antimicrobial drug resistance. In our region, clindamycin is an appropriate empiric therapy of community-associated MRSA infection in children but should be used with caution in adults.
我们对2003年11月至2004年11月在芝加哥大学医院鉴定出的所有耐甲氧西林金黄色葡萄球菌（MRSA）住院和门诊分离株进行了一项前瞻性研究。在将578株MRSA分离株按患者年龄（儿科与成人）和发病部位（社区与医院）分为4组后，确定了对非β-内酰胺类抗菌药物耐药性的差异。对于红霉素（93.2%对87.0%，p = 0.03）、克林霉素（51.8%对7.3%，p<0.001）、环丙沙星（62.1%对10.7%，p<0.001）、庆大霉素（11.1%对1.1%，p<0.001）和四环素（19.9%对6.4%，p<0.001），288例成人社区相关分离株的非β-内酰胺类耐药性显著高于177例儿科社区相关分离株。相比之下，儿童和成人医院相关的MRSA分离株对非β-内酰胺类抗菌药物的耐药率相似。在我们地区，克林霉素是儿童社区相关MRSA感染的合适经验性治疗药物，但在成人中应谨慎使用。
