Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario;
Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
Can J Infect Dis Med Microbiol. 2014 Spring;25(1):13-6. doi: 10.1155/2014/267901.
First-generation cephalosporins and antistaphylococcal penicillins are typically the first choice for treating skin and soft tissue infections (SSTI), but are not effective for infections caused by methicillin-resistant Staphylococcus aureus (MRSA). It is currently unclear what percentage of SSTIs is caused by community-associated MRSA in different regions in Canada.
To determine the incidence of MRSA in children presenting to a pediatric emergency department with SSTI, and to determine which antibiotics were used to treat these infections.
All visits to a pediatric emergency department were reviewed from April 15, 2010 to April 14, 2011. Diagnoses of cellulitis, abscess, impetigo, folliculitis and skin infection (not otherwise specified) were reviewed in detail to determine whether a culture was taken and which antibiotic was prescribed.
There were 367 cases of SSTI diagnosed over the study period. Forty-five (12.3%) patients had lesions that were swabbed for culture and sensitivity. S aureus was the most common organism found, with 14 (66%) methicillin-sensitive cases and seven (33%) methicillin-resistant cases. Of the seven cases of MRSA identified, only one patient had clear risk factors for hospital-acquired MRSA. First-generation cephalosporins were initially prescribed for 280 (76%) patients.
The overall incidence of MRSA in the population presenting to a pediatric emergency department in Newfoundland and Labrador appeared to be low, although only a small percentage of infections were cultured. At this time, there appears to be no need to change empirical antibiotic coverage, which remains a first-generation cephalosporin.
第一代头孢菌素和抗葡萄球菌青霉素通常是治疗皮肤和软组织感染（SSTI）的首选药物，但对耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染无效。目前尚不清楚加拿大不同地区有多少比例的 SSTI 是由社区相关 MRSA 引起的。
确定儿童因 SSTI 就诊于儿科急诊时 MRSA 的发生率，并确定用于治疗这些感染的抗生素。
回顾了 2010 年 4 月 15 日至 2011 年 4 月 14 日期间儿科急诊的所有就诊情况。详细回顾了蜂窝织炎、脓肿、脓疱病、毛囊炎和皮肤感染（未特指）的诊断，以确定是否进行了培养以及开出了哪种抗生素。
在研究期间共诊断出 367 例 SSTI。45 名（12.3%）患者的病变进行了拭子培养和药敏试验。金黄色葡萄球菌是最常见的病原体，其中 14 例（66%）为甲氧西林敏感，7 例（33%）为甲氧西林耐药。在确定的 7 例 MRSA 中，只有 1 例患者有明确的医院获得性 MRSA 危险因素。最初为 280 名（76%）患者开了第一代头孢菌素。
在纽芬兰和拉布拉多省的儿科急诊就诊人群中，MRSA 的总体发生率似乎较低，尽管只有一小部分感染进行了培养。目前，似乎没有必要改变经验性抗生素覆盖范围，仍以第一代头孢菌素为主。
