Children's Mercy Hospital and Clinics, Section of Infectious Diseases, 2401 Gillham Rd, Kansas City, MO 64108, USA.
Pediatrics. 2010 Jun;125(6):e1294-300. doi: 10.1542/peds.2009-2867. Epub 2010 May 17.
The objective of this study was to describe trends in antibiotic management for Staphylococcus aureus infections among hospitalized children from 1999 to 2008.
A retrospective study was conducted by using the Pediatric Health Information Systems database to describe antibiotic treatment of inpatients with S aureus infection at 25 children's hospitals in the United States. Patients who were admitted from 1999 to 2008 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for S aureus infection were included. Trends in the use of vancomycin, clindamycin, linezolid, trimethoprim-sulfamethoxazole, cefazolin, and oxacillin/nafcillin were examined for percentage use and days of therapy per 1000 patient-days.
A total of 64813 patients had a discharge diagnosis for S aureus infection. The incidence of methicillin-resistant S aureus (MRSA) infections during this period increased 10-fold, from 2 to 21 cases per 1000 admissions, whereas the methicillin-susceptible S aureus infection rate remained stable. Among patients with S aureus infections, antibiotics that treat MRSA increased from 52% to 79% of cases, whereas those that treat only methicillin-susceptible S aureus declined from 66% to <30% of cases. Clindamycin showed the greatest increase, from 21% in 1999 to 63% in 2008. Similar trends were observed by using days of therapy per 1000 patient-days.
Antibiotic prescribing patterns for the treatment of S aureus infections have changed significantly during the past decade, reflecting the emergence of community-associated MRSA. Clindamycin is now the most commonly prescribed antibiotic for S aureus infections among hospitalized children. The substantial use of clindamycin emphasizes the importance of continuous monitoring of local S aureus susceptibility patterns.
本研究旨在描述 1999 年至 2008 年期间住院儿童金黄色葡萄球菌感染的抗生素管理趋势。
本研究采用回顾性研究方法，利用美国 25 家儿童医院的儿科健康信息系统数据库，描述金黄色葡萄球菌感染住院患者的抗生素治疗情况。纳入的患者为 1999 年至 2008 年因金黄色葡萄球菌感染而入院，国际疾病分类，第 9 版，临床修正版编码。研究检查了万古霉素、克林霉素、利奈唑胺、复方磺胺甲噁唑、头孢唑林和苯唑西林/萘夫西林的使用率和每 1000 个患者日治疗天数的趋势。
共有 64813 例患者出院诊断为金黄色葡萄球菌感染。在此期间，耐甲氧西林金黄色葡萄球菌（MRSA）感染的发生率增加了 10 倍，从每 1000 例入院 2 例增加到 21 例，而甲氧西林敏感金黄色葡萄球菌感染率保持稳定。在金黄色葡萄球菌感染患者中，治疗 MRSA 的抗生素从 52%增加到 79%，而仅治疗甲氧西林敏感金黄色葡萄球菌的抗生素从 66%下降到<30%。克林霉素的增幅最大，从 1999 年的 21%增加到 2008 年的 63%。通过每 1000 个患者日治疗天数也观察到类似的趋势。
在过去十年中，治疗金黄色葡萄球菌感染的抗生素处方模式发生了显著变化，反映了社区相关性 MRSA 的出现。克林霉素现在是住院儿童金黄色葡萄球菌感染最常用的抗生素。克林霉素的大量使用强调了持续监测当地金黄色葡萄球菌药敏模式的重要性。
