Amato Malena, Pershing Susann, Walvick Matthew, Tanaka Stephen
Kaiser Permanente Department of Ophthalmology, Union City, California, USA.
J AAPOS. 2013 Jun;17(3):243-7. doi: 10.1016/j.jaapos.2012.12.151. Epub 2013 Apr 24.
To determine pediatric clinical trends of ocular and periocular methicillin-resistant Staphylococcus aureus (MRSA) in a large northern California healthcare system.
This study was a retrospective cross-sectional review of all pediatric cases (aged 0-18) with culture-positive ophthalmic MRSA isolates identified between January 2002 and December 2009. Medical record review included history, presentation, infection site, acquisition (community or nosocomial), antibiotic sensitivity/resistance, treatment, and clinical outcome. Incidence was classified by year, sex, and age. Parameters were analyzed for statistical significance by trend and χ(2) analysis.
A total of 399 ocular and periocular MRSA cases were included. Cases trended upward from 2002 to 2009, peaking in 2006. Of the 137 pediatric cases (0-18 years), 58% were community acquired. Conjunctivitis was the predominant presentation (40%), followed by stye/chalazion (25%), orbital cellulitis/abscess (19%), dacryocystitis (11%) and brow abscess (3%). Significant predictors for ocular infection with MRSA included male sex (61%), neonates (38%), and multiple infection sites on the body (38%). Resistance was high to bacitracin (80.9%) and ofloxacin (48.3%) but remained low for trimethoprim/sulfamethoxazole (8.7%). Topical therapy was effective in 29% of cases; oral antibiotics, in 47%. Intravenous therapy was required in 12% of cases and incision/drainage or surgery in 19%. Initial oral antibiotic treatment, primarily cephalosporins (24%), was ineffective in 37% of patients. There was a significant increase in resistance to antibiotic therapy (P < 0.001) during the study period. No patients developed permanent visual impairment.
Pediatric ocular and periocular MRSA is increasing in incidence and resistance in our patient population. Outcomes can be improved by early recognition, proper antibiotic selection, and obtaining cultures and sensitivities when resistant or severe ocular infections are present.
确定加利福尼亚州北部一个大型医疗系统中儿童眼部及眼周耐甲氧西林金黄色葡萄球菌（MRSA）感染的临床趋势。
本研究是一项回顾性横断面研究，纳入了2002年1月至2009年12月间所有培养出阳性眼科MRSA菌株的儿科病例（0至18岁）。病历回顾包括病史、临床表现、感染部位、感染源（社区或医院获得性）、抗生素敏感性/耐药性、治疗及临床结局。发病率按年份、性别和年龄进行分类。通过趋势分析和χ²分析对参数进行统计学显著性分析。
共纳入399例眼部及眼周MRSA病例。病例数从2002年至2009年呈上升趋势，2006年达到峰值。在137例儿科病例（0至18岁）中，58%为社区获得性感染。结膜炎是最主要的临床表现（40%），其次是睑腺炎/睑板腺囊肿（25%）、眼眶蜂窝织炎/脓肿（19%）、泪囊炎（11%）和眉部脓肿（3%）。眼部MRSA感染的显著预测因素包括男性（61%）、新生儿（38%）以及身体上有多个感染部位（38%）。对杆菌肽的耐药率较高（80.9%），对氧氟沙星的耐药率为48.3%，但对甲氧苄啶/磺胺甲恶唑的耐药率仍较低（8.7%）。局部治疗在29%的病例中有效；口服抗生素治疗在47%的病例中有效。12%的病例需要静脉治疗，19%的病例需要切开引流或手术治疗。初始口服抗生素治疗（主要为头孢菌素，24%）在37%的患者中无效。在研究期间，抗生素治疗的耐药率显著增加（P < 0.001）。没有患者出现永久性视力损害。
在我们的患者群体中，儿童眼部及眼周MRSA感染的发病率和耐药率正在上升。通过早期识别、合理选择抗生素以及在出现耐药或严重眼部感染时进行培养和药敏试验，可以改善治疗结局。
