Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
J Am Acad Dermatol. 2010 May;62(5):804-11. doi: 10.1016/j.jaad.2009.07.030. Epub 2010 Feb 21.
Epidemiology and patterns of antibiotic resistance for Staphylococcus aureus are changing in the United States.
We sought to determine the epidemiology and antibiotic susceptibility profiles in S aureus cutaneous infections in a pediatric dermatology tertiary health care facility in North Carolina.
We conducted a prospective observational study involving pediatric patients (n = 93, age<18 years) with signs of skin and soft tissue infections seen at a pediatric dermatology clinic between 2005 and 2007.
We analyzed 141 cultures from 93 pediatric dermatology patients. S aureus was recovered from 97 cultures, of which 32% were methicillin-resistant S aureus (MRSA). In the pediatric dermatology clinic, children with atopic dermatitis accounted for 66% of the cultures; however, the presence of atopy did not represent a risk factor to acquire MRSA infection (P = .190; odds ratio = 1.643 [95% confidence interval: 0.672-4.014]). In all, 97 cultures were tested for antibiotic susceptibility and demonstrated the following resistance patterns: penicillin (86%), erythromycin (46%), methicillin (32%), clindamycin (22%), gentamicin (3%), vancomycin (0%), and trimethoprim-sulfamethoxazole (0%). Of the pediatric dermatology outpatient MRSA infections, the resistance patterns were as follows: erythromycin (71%), clindamycin (16%), gentamicin (2%), and trimethoprim-sulfamethoxazole (0%).
This study addressed a select population of children in North Carolina and may not generalize to different clinical settings or regions.
Cutaneous S aureus infections in an outpatient pediatric dermatology tertiary health care facility demonstrated less resistance than previously reported from inpatient and emergency department settings. In our population, clindamycin and tetracyclines are still effective antibiotic choices in the majority of MRSA infections. Local prevalence and susceptibility of community-acquired MRSA as well as individual risk factors should be considered for diagnosis and treatment.
美国的葡萄球菌属流行病学和抗生素耐药模式正在发生变化。
我们旨在确定北卡罗来纳州一家儿科皮肤科三级保健机构的金黄色葡萄球菌皮肤感染的流行病学和抗生素敏感性概况。
我们进行了一项前瞻性观察研究，涉及 2005 年至 2007 年在儿科皮肤科诊所就诊的有皮肤和软组织感染迹象的儿科患者（n = 93，年龄<18 岁）。
我们分析了 93 例儿科皮肤科患者的 141 份培养物。从 97 例培养物中分离出金黄色葡萄球菌，其中 32%为耐甲氧西林金黄色葡萄球菌（MRSA）。在儿科皮肤科诊所，特应性皮炎患儿占培养物的 66%；然而，特应性的存在并不是获得 MRSA 感染的危险因素（P =.190；比值比 = 1.643 [95%置信区间：0.672-4.014]）。共有 97 份培养物进行了抗生素敏感性测试，显示出以下耐药模式：青霉素（86%）、红霉素（46%）、甲氧西林（32%）、克林霉素（22%）、庆大霉素（3%）、万古霉素（0%）和复方磺胺甲噁唑（0%）。在儿科皮肤科门诊的 MRSA 感染中，耐药模式如下：红霉素（71%）、克林霉素（16%）、庆大霉素（2%）和复方磺胺甲噁唑（0%）。
本研究针对北卡罗来纳州的特定儿童人群，可能无法推广到不同的临床环境或地区。
在一家儿科皮肤科三级保健机构的门诊患者中，金黄色葡萄球菌皮肤感染的耐药性低于先前报道的住院患者和急诊科患者。在我们的人群中，克林霉素和四环素在大多数 MRSA 感染中仍然是有效的抗生素选择。应考虑社区获得性 MRSA 的当地流行情况和药敏情况以及个体危险因素，以进行诊断和治疗。
