Shapiro Adam, Raman Sudha, Johnson Marilee, Piehl Mark
Department of Pediatrics, University of North Carolina at Chapel Hill, USA.
N C Med J. 2009 Mar-Apr;70(2):102-7.
The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and present a large burden to the health care system and to afflicted families.
Our aims were to characterize the patterns of CA-MRSA resistance to common antibiotics and to identify significant risk factors for CA-MRSA infection in healthy children at a large urban hospital. Additional goals were to discover the prevalence of CA-MRSA in the institution and to observe any notable trends surrounding CA-MRSA infection in the facility.
We retrospectively analyzed the medical records of patients under 18 years of age in the WakeMed Health and Hospitals system with cultures positive for Staphylococcus aureus over a period of seven and a half months in 2006. Cases were classified as community-acquired, and we then analyzed risk factors and examined trends surrounding CA-MRSA infection.
A total of 229 cases of Staphylococcus aureus infection were identified over the study period, of which 142 were CA-MRSA, a prevalence of 75.9% (95% CI, 69.5-82.3). Our CA-MRSA isolates were 98.6% sensitive to trimethoprim-sulfamethoxasole, 94.4% sensitive to tetracycline, 90.8% sensitive to clindamycin, and 59.9% sensitive to levofloxacin. Risk factors for CA-MRSA infection included parental employment in a school or daycare, family history of boils or MRSA, and antibiotic use by children in the past six months.
Our definition of CA-MRSA is based on retrospective data from patient and family verbal histories in the medical record. We did not perform molecular genotyping of MRSA samples to confirm community-associated strains.
CA-MRSA is now the predominant strain of Staphylococcus aureus causing childhood infections in this central North Carolina hospital. Thus, standard antibiotic therapy with penicillins or first generation cephalosporins is no longer adequate for most pediatric skin and soft tissue infections in this population. Trimethoprim-sulfamethoxasole and clindamycin both appear as reasonable alternatives for empiric therapy.
在过去十年中，儿童社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染的发生率急剧上升。CA-MRSA感染通常对标准门诊抗生素耐药，给医疗保健系统和患病家庭带来沉重负担。
我们的目的是描述CA-MRSA对常用抗生素的耐药模式，并确定一家大型城市医院中健康儿童CA-MRSA感染的重要危险因素。其他目标是发现该机构中CA-MRSA的流行情况，并观察该机构中围绕CA-MRSA感染的任何显著趋势。
我们回顾性分析了维克梅德健康与医院系统中2006年七个半月期间金黄色葡萄球菌培养阳性的18岁以下患者的病历。病例被分类为社区获得性，然后我们分析了危险因素并研究了围绕CA-MRSA感染的趋势。
在研究期间共确定了229例金黄色葡萄球菌感染病例，其中142例为CA-MRSA，患病率为75.9%（95%CI，69.5-82.3）。我们的CA-MRSA分离株对甲氧苄啶-磺胺甲恶唑的敏感性为98.6%，对四环素的敏感性为94.4%，对克林霉素的敏感性为90.8%，对左氧氟沙星的敏感性为59.9%。CA-MRSA感染的危险因素包括父母在学校或日托机构工作、有疖或MRSA家族史以及儿童在过去六个月内使用过抗生素。
我们对CA-MRSA的定义基于病历中患者和家属口头病史的回顾性数据。我们没有对MRSA样本进行分子基因分型以确认社区相关菌株。
在北卡罗来纳州中部的这家医院，CA-MRSA现在是导致儿童感染的主要金黄色葡萄球菌菌株。因此，对于该人群中的大多数儿科皮肤和软组织感染，使用青霉素或第一代头孢菌素的标准抗生素治疗已不再足够。甲氧苄啶-磺胺甲恶唑和克林霉素似乎都是经验性治疗的合理替代药物。
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