Elliott Daniel J, Zaoutis Theoklis E, Troxel Andrea B, Loh Andrew, Keren Ron
Christiana Care Health System, Christiana Hospital, Room 4B01, 4755 Ogletown-Stanton Rd, Newark, DE 19718, USA.
Pediatrics. 2009 Jun;123(6):e959-66. doi: 10.1542/peds.2008-2428. Epub 2009 May 26.
The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region.
A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.
Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess.
Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.
在耐甲氧西林金黄色葡萄球菌（MRSA）流行地区，比较β-内酰胺类、克林霉素或甲氧苄啶-磺胺甲恶唑单药治疗在门诊处理未引流、未培养的皮肤及软组织感染（SSTIs）中的临床疗效。
对来自社区获得性MRSA流行地区5家城市儿科诊所的一组患者进行回顾性巢式病例对照试验。2004年1月至2007年3月期间，所有受试者均作为门诊患者接受口服单药治疗未引流、未培养的SSTIs。主要结局为治疗失败，定义为在28天内进行引流手术、住院、更换抗生素或开具第二种抗生素处方。
在2096例未引流、未培养的SSTIs患儿中，104例（5.0%）被确定为治疗失败，并与480例对照受试者进行匹配。与β-内酰胺类治疗相比，克林霉素疗效相当，但甲氧苄啶-磺胺甲恶唑与治疗失败风险增加相关。与失败独立相关的其他因素包括在急诊科进行初始治疗、发热史或当前发热、硬结或小脓肿的存在。
在一组接受门诊治疗的未引流、未培养的SSTIs患儿中，与β-内酰胺类相比，克林霉素单药治疗无益处，而甲氧苄啶-磺胺甲恶唑与治疗失败风险增加相关。即使在社区获得性MRSA流行地区，β-内酰胺类药物仍可能是治疗此类感染患儿的合适一线经验性治疗药物。
