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MRSA infection prevalence declines among US pediatric population
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Antibiotic susceptibility trends suggested that the prevalence of Staphylococcus aureus infections caused by MRSA among children has declined during the last decade, according to recent research in Pediatrics.
“After several decades of increasing prevalence, the proportion of Staphylococcus aureus infections due to [MRSA] has been reported to be in decline in adults,” Deena E. Sutter, MD, of the department of pediatrics at San Antonio Military Medical Center, Fort Sam Houston, and colleagues wrote. “Whether this decrease is also occurring in children is not well-documented.”
The researchers retrospectively studied microbiology and demographic data from 39,207 pediatric patients who received care in the U.S. Military Health System from 2005 through 2014. To determine the association between clinical and S. aureus antibiotic susceptibility and population characteristics, demographic and clinical data were compared with susceptibility trends. Pediatric patients included in the study were nonactive beneficiaries aged younger than 18 years. The researchers collected 41,745 S. aureus isolates from participants for study inclusion.
Study results showed that S. aureus susceptibility to oxacillin decreased from 59.4% in 2005 to 53.6% in 2007 before increasing to 68.4% in 2014 (P < .0001), with 60% of isolates susceptible to this antibiotic by 2014. The researchers also found that susceptibility to erythromycin and gentamicin also increased. The susceptibility to clindamycin, however, decreased from 90.7% in 2005 to 86% in 2014 (P < .0001). This same declining trend in clindamycin effectiveness was noted in MRSA-susceptibility. Decreased susceptibility also was noted in ciprofloxacin and trimethoprim-sulfamethoxazole.
The researchers also wrote that results suggest methicillin-susceptible S. aureus (MSSA) clindamycin resistance is increasing.
“Although rates of resistance to other non-beta-lactam antibiotics remain low, clindamycin resistance is increasing among MSSA, with over 16% of isolates identified as resistant,” Sutter and colleagues wrote. “Clinicians should be aware of these trends and use caution when using clindamycin for empirical therapy.”
Sheldon L. Kaplan
In a related editorial, Sheldon L. Kaplan, MD, of the Infectious Disease Service at Texas Children’s Hospital, and an Infectious Diseases in Children Editorial Board member, asked what implications changing trends in MRSA infection among children have on pediatric antibiotic treatments.
“Currently, considering the still substantial MRSA resistance rates that exceed the 10% to 15% level suggested by many experts as the threshold above which agents effective against community acquired-MRSA isolates should be administered for empiric treatment, changes in the selection of empiric antibiotics are not warranted,” Kaplan wrote. “If rates of MRSA among S aureus isolates from otherwise normal children are documented to drop below the 10% to 15% threshold in different communities, a modification of current recommendations should be considered.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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