Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children
Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children
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DOI：
10.1097/00006454-200206000-00010
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发表时间：
2002-06-01
影响因子：
3.6
通讯作者：
Quinn, JP
中科院分区：
文献类型：
--
作者：
Frank, AL;Marcinak, JF;Quinn, JP
背景耐甲氧西林金黄色葡萄球菌（MRSA）的抗生素耐药模式较窄已经出现。克林霉素治疗红霉素耐药MRSA感染时存在出现耐药的风险，因为存在相关的耐药机制。我们分析了克林霉素敏感的MRSA微生物从儿童（1987年至2000年）沿着的临床数据。采用脉冲场凝胶电泳（PFGE）技术检测细菌对抗生素的敏感性，D检验法检测细菌的连锁耐药机制。自1993年以来，平均每年从儿童中获得11株克林霉素敏感的MRSA。在88株分离株中，33株（38%）对红霉素耐药。与易感人群相比，后者较少发生社区获得性（45%对69%），更常见于1个月以下的婴儿（24%对4%），并且不太可能出现在社区获得相关PFGE组1（62%对87%）中。33株红霉素耐药菌株中31株D试验阳性。一名9个月大的男孩因克林霉素敏感、红霉素耐药、D试验阳性MRSA引起肺炎/脓胸，在克林霉素治疗期间出现PFGE相同的克林霉素耐药分离株和临床复发。与此相反，一个12岁的女孩与脓肿所造成的类似的MRSA克林霉素治疗后发展另一个脓肿，但生物体的易感性不变。红霉素耐药存在于38%的克林霉素敏感的MRSA的儿童，克林霉素耐药检测在治疗过程中的一个孩子。如果微生物实验室通知临床医生风险，并且临床情况合适，克林霉素仍然是一种治疗选择。
Background. Methicillin-resistant Staphylococcus aureus (MRSA) with a narrower antibiotic resistance pattern have emerged. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms.Methods. We analyzed clindamycin-susceptible MRSA organisms from children (1987 to 2000) along with clinical data. Antibiotic susceptibilities of organisms were tested, pulsed field gel electrophoresis (PFGE) was done and the linked resistance mechanism was detected by the D test.Results. An average of 11 clindamycin-susceptible MRSA per year were obtained from children since 1993. Of 88 isolates 33 (38%) were erythromycin-resistant. The latter were less often community-acquired (45% vs. 69%), more often from infants < 1 month of age (24% vs. 4%) and less likely to be in the community acquisition-associated PFGE Group 1 (62% vs. 87%) than those that were susceptible. The D test was positive in 31 of 33 erythromycin-resistant isolates. A 9-month-old boy with pneumonia/empyema caused by a clindamycin-susceptible, erythromycin-resistant, D test-positive MRSA developed a PFGE-identical clindamycin-resistant isolate and clinical relapse during clindamycin treatment. In contrast a 12-year-old girl with abscesses caused by a similar MRSA developed another abscess after clindamycin therapy, but the organism was unchanged in susceptibility.Conclusions. Erythromycin resistance was present in 38% of clindamycin-susceptible MRSA in children, and clindamycin resistance was detected during treatment in one child. Clindamycin remains a treatment option if the clinician is notified of the risk by the microbiology laboratory and the clinical situation is suitable.