Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness.
Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness.
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DOI：
10.1093/cid/ciy495
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发表时间：
2019-01-18
期刊：
影响因子：
--
通讯作者：
Pediatric Intensive Care Influenza Investigators from the Pediatric Acute Lung Injury and Sepsis Investigator’s Network
中科院分区：
文献类型：
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作者：
Randolph AG;Xu R;Novak T;Newhams MM;Bubeck Wardenburg J;Weiss SL;Sanders RC;Thomas NJ;Hall MW;Tarquinio KM;Cvijanovich N;Gedeit RG;Truemper EJ;Markovitz B;Hartman ME;Ackerman KG;Giuliano JS Jr;Shein SL;Moffitt KL;Pediatric Intensive Care Influenza Investigators from the Pediatric Acute Lung Injury and Sepsis Investigator’s Network
流感病毒和耐甲氧西林金黄色葡萄球菌（MRSA）共同感染可导致儿童致命的坏死性肺炎。零星发生率妨碍了抗菌效力的评价。我们评估了流感-MRSA肺炎危重患儿的临床特征和结局，并评估了抗生素的使用情况。我们招募了2008年11月至2016年5月在34个儿科重症监护病房患有流感感染和呼吸衰竭的儿童（<18岁）。我们比较了MRSA合并感染、非MRSA细菌合并感染和无细菌合并感染儿童的基线特征、临床病程和治疗。我们招募了170名儿童（127名甲型流感，43名乙型流感B）。患有流感-MRSA肺炎的儿童（N = 30，87%以前健康）比非MRSA（N = 61）或无细菌合并感染（N = 79）的儿童年龄大。与两组相比，流感-MRSA与白细胞减少、急性肺损伤、血管加压药使用、体外生命支持和死亡率增加相关（P ≤ .0001）。与MRSA相关的流感相关死亡率为40%，而没有MRSA的为4.3%（相对危险度[RR]，9.3; 95%置信区间[CI]，3.8-22.9）。在29/30例住院24小时内接受万古霉素治疗的MRSA患儿中，如果治疗还包括第二种抗MRSA抗生素，死亡率为12.5%（N = 2/16），而万古霉素单药治疗的死亡率为69.2%（N = 9/13）（RR，5.5; 95% CI，1.4，21.3; P = 0.003）。万古霉素给药不影响初始谷浓度; 78%<10 µg/mL。流感-MRSA合并感染与危重患儿的高病死率相关。这些数据支持在疑似严重病例中，在万古霉素基础上早期添加第二种抗MRSA抗生素。流感-耐甲氧西林金黄色葡萄球菌（MRSA）合并感染与儿童高病死率相关。在这项多中心研究中，与接受万古霉素单药治疗的重症儿童相比，早期接受万古霉素以外的第二种抗MRSA抗生素治疗的重症儿童死亡率较低。
Coinfection with influenza virus and methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening necrotizing pneumonia in children. Sporadic incidence precludes evaluation of antimicrobial efficacy. We assessed the clinical characteristics and outcomes of critically ill children with influenza–MRSA pneumonia and evaluated antibiotic use. We enrolled children (<18 years) with influenza infection and respiratory failure across 34 pediatric intensive care units 11/2008–5/2016. We compared baseline characteristics, clinical courses, and therapies in children with MRSA coinfection, non-MRSA bacterial coinfection, and no bacterial coinfection. We enrolled 170 children (127 influenza A, 43 influenza B). Children with influenza–MRSA pneumonia (N = 30, 87% previously healthy) were older than those with non-MRSA (N = 61) or no (N = 79) bacterial coinfections. Influenza–MRSA was associated with increased leukopenia, acute lung injury, vasopressor use, extracorporeal life support, and mortality than either group (P ≤ .0001). Influenza-related mortality was 40% with MRSA compared to 4.3% without (relative risk [RR], 9.3; 95% confidence interval [CI], 3.8–22.9). Of 29/30 children with MRSA who received vancomycin within the first 24 hours of hospitalization, mortality was 12.5% (N = 2/16) if treatment also included a second anti-MRSA antibiotic compared to 69.2% (N = 9/13) with vancomycin monotherapy (RR, 5.5; 95% CI, 1.4, 21.3; P = .003). Vancomycin dosing did not influence initial trough levels; 78% were <10 µg/mL. Influenza–MRSA coinfection is associated with high fatality in critically ill children. These data support early addition of a second anti-MRSA antibiotic to vancomycin in suspected severe cases. Influenza–methicillin-resistant Staphylococcus aureus (MRSA) coinfection is associated with high fatality in children. In this multicenter study, mortality was lower in critically ill children treated early with a second anti-MRSA antibiotic in addition to vancomycin compared to those who received vancomycin monotherapy.
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影响因子：
8.8
作者：
Hall MW;Geyer SM;Guo CY;Panoskaltsis-Mortari A;Jouvet P;Ferdinands J;Shay DK;Nateri J;Greathouse K;Sullivan R;Tran T;Keisling S;Randolph AG;Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network PICFlu Study Investigators
通讯作者：
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network PICFlu Study Investigators
影响因子：
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影响因子：
5.2
作者：
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通讯作者：
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影响因子：
6.4
作者：
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通讯作者：
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影响因子：
2.6
作者：
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通讯作者：
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