Chiusaroli Lorenzo, Liberati Cecilia, Rulli Luigi, Barbieri Elisa, De Pieri Marica, Di Chiara Costanza, Mengato Daniele, Giaquinto Carlo, Donà Daniele
Pediatric Infectious Diseases, Department for Women's and Child's Health, University Hospital of Padova, 35128 Padua, Italy.
Hospital Pharmacy Department, University Hospital of Padova, 35128 Padua, Italy.
Antibiotics (Basel). 2023 Jan 28;12(2):261. doi: 10.3390/antibiotics12020261.
Methicillin-resistant (MRSA), methicillin-resistant coagulase-negative (MR-CoNS), and vancomycin-resistant (VRE) are increasing worldwide and represent a threat for the limited treatment options in pediatric patients and neonates compared to adults. Recommendations in pediatrics are mainly extrapolated from adults' studies.
A literature search for the treatment of these pathogens in children (<18 years old) was conducted in Embase, MEDLINE, and Cochrane Library. Studies reporting data on single-patient-level outcomes related to a specific antibiotic treatment for multidrug resistant (MDR) Gram-positive bacterial infection in children were included. Studies reporting data from adults and children were included if single-pediatric-level information could be identified (PROSPERO registration: CRD42022383867).
The search identified 11,740 studies (since January 2000), of which 48 fulfilled both the inclusion and the exclusion criteria and were included in the analysis: 29 for MRSA, 20 for VRE, and seven for MR-CoNS. Most studies were retrospective studies. Vancomycin was mainly used as a comparator, while linezolid and daptomycin were the most studied antimicrobials showing good efficacy.
Linezolid showed a safety and efficacy profile in a neonatal setting; daptomycin is increasingly used for MRSA, but the evidence is scarce for VRE.
耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林凝固酶阴性葡萄球菌（MR-CoNS）和耐万古霉素肠球菌（VRE）在全球范围内不断增加，与成人相比，这对儿科患者和新生儿有限的治疗选择构成威胁。儿科的建议主要是从成人研究中推断出来的。
在Embase、MEDLINE和Cochrane图书馆中对儿童（<18岁）这些病原体的治疗进行了文献检索。纳入报告与儿童耐多药（MDR）革兰氏阳性细菌感染的特定抗生素治疗相关的单患者水平结局数据的研究。如果可以识别单儿科水平信息，则纳入报告成人和儿童数据的研究（PROSPERO注册：CRD42022383867）。
检索确定了11740项研究（自2000年1月以来），其中48项符合纳入和排除标准并纳入分析：29项针对MRSA，20项针对VRE，7项针对MR-CoNS。大多数研究为回顾性研究。万古霉素主要用作对照，而利奈唑胺和达托霉素是研究最多且显示出良好疗效的抗菌药物。
利奈唑胺在新生儿环境中显示出安全性和有效性；达托霉素越来越多地用于MRSA，但针对VRE的证据很少。
