Wolf Joshua, Daley Andrew J, Tilse Martyn H, Nimmo Graeme R, Bell Sydney, Howell Alison J, Keil Anthony D, Lawrence Andrew, Curtis Nigel
Infectious Diseases Unit, Department of General Medicine, University of Melbourne, Victoria, Australia.
J Paediatr Child Health. 2010 Jul;46(7-8):404-11. doi: 10.1111/j.1440-1754.2010.01751.x. Epub 2010 Jun 2.
Staphylococcus aureus is an important cause of serious illness in children. Antibiotic resistance is an international problem and affects initial antibiotic choice. We aimed to describe susceptibility patterns of S. aureus isolates from Australian children to inform optimal empiric treatment of staphylococcal infections in this population.
We analysed susceptibility data for all S. aureus isolates from children at Australian tertiary paediatric hospitals in 2006. Susceptibility rates were compared between hospitals and states, and with published studies of S. aureus isolates from Australian adults.
Overall, the proportion of methicillin-resistant S. aureus (MRSA) in Australian children was low (9.8%), and in each state it was less than for the comparable adult population. There were significant differences in susceptibility patterns between different states. Most MRSA isolates were susceptible to clindamycin (73%) and all isolates were reported as susceptible to vancomycin. Susceptibility patterns for isolates from bacteraemic patients were similar to those for isolates from all patients.
These data support current Australian recommendations for the use of flucloxacillin or a first-generation cephalosporin as initial treatment of non-life-threatening staphylococcal infections. However, broad spectrum antibiotic therapy including agents that are effective against MRSA should be considered for more serious infections. Appropriate specimens should be collected for susceptibility testing to enable directed treatment for MRSA and other resistant organisms. This study highlights the importance of using local, age-specific data in planning antibiotic treatment guidelines, as results vary substantially from city to city and between adults and children.
金黄色葡萄球菌是儿童严重疾病的重要病因。抗生素耐药性是一个国际性问题，会影响初始抗生素的选择。我们旨在描述从澳大利亚儿童中分离出的金黄色葡萄球菌的药敏模式，为该人群中葡萄球菌感染的最佳经验性治疗提供依据。
我们分析了2006年澳大利亚三级儿科医院儿童中所有金黄色葡萄球菌分离株的药敏数据。比较了不同医院和不同州之间的药敏率，并与已发表的关于澳大利亚成年人金黄色葡萄球菌分离株的研究进行了比较。
总体而言，澳大利亚儿童中耐甲氧西林金黄色葡萄球菌（MRSA）的比例较低（9.8%），且在每个州该比例均低于相应的成年人群。不同州之间的药敏模式存在显著差异。大多数MRSA分离株对克林霉素敏感（73%），所有分离株均对万古霉素敏感。血行感染患者分离株的药敏模式与所有患者分离株的药敏模式相似。
这些数据支持澳大利亚目前关于使用氟氯西林或第一代头孢菌素作为非危及生命的葡萄球菌感染初始治疗的建议。然而，对于更严重的感染，应考虑使用包括对MRSA有效的药物在内的广谱抗生素治疗。应采集适当的标本进行药敏试验，以便针对MRSA和其他耐药菌进行定向治疗。本研究强调了在制定抗生素治疗指南时使用当地、特定年龄数据的重要性，因为不同城市以及成人和儿童之间的结果差异很大。
