MRSA Infection

Knowing clindamycin susceptibilities is key to treating MRSA

Knowing clindamycin susceptibilities is key to treating MRSA.

In hospitalized children with complicated skin and soft-tissue infections, vancomycin remains the gold standard, according to recently published guidelines by the Infectious Diseases Society of America (IDSA). Sheldon Kaplan, MD, an Infectious Diseases in Children Editorial Board member who also helped author the IDSA guidelines, discussed the guidelines today during the American Academy of Pediatrics 2011 National Conference and Exhibition held here. Sheldon Kaplan Sheldon Kaplan Kaplan noted that for skin and soft-tissue infections (SSTI), incision and drainage are the recommended primary treatment. He said the guidelines recommend antibiotics only for those in “extremes of age,” and he recommended those children younger than 12 months of age should probably get antibiotics, because there are data to suggest antibiotics may decrease recurrent infections. He also cited data that suggested recurrences were less in one study with clindamycin when compared with trimethoprim-sulfamethoxazole. However, Kaplan said, “if you are going to use clindamycin, you have to know what the clindamycin susceptibilities are in your area.” He noted levels of resistance at about 7% in Philadelphia, 9% in Baltimore, and as high as 22% in certain areas of Chicago.

Bactrim not needed against MRSA if resistance low in community

Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections.

The burden of pediatric skin and soft-tissue infections (SSTIs) is increasing, largely as a result of the widespread community emergence of methicillin-resistant Staphylococcus aureus (MRSA). Optimal antimicrobial management strategies for SSTIs in the era of community-associated MRSA remain unclear. These findings, from a cohort of nearly 50 000 children with incident SSTIs, bring into question the use of trimethoprim-sulfamethoxazole for treatment of purulent SSTIs in community-associated MRSA–prevalent regions in which clindamycin resistance remains low. β-Lactams, however, may still be effective for nonpurulent SSTIs. (Read the full article

Cephalexin a Viable Option for Children's MRSA Skin Infections

Cephalexin a Viable Option for Children's MRSA Skin Infections - Skin & Allergy News.

Cephalexin and clindamycin have comparable effectiveness for the treatment of uncomplicated pediatric skin and soft tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus, findings from a randomized double-blind study of 200 patients suggest.

Clindamycin failing against Community MRSA in Greece

Fusidic acid and clindamycin resistance incommunity-associated, methicillin-resistant Staphylococcus aureus infections in children of Central Greece.

Of 309 children (0-14 years old), 21 (6.8%) had invasive infections and 288 (93.2%) skin and soft tissue infections (SSTIs). Thirty-five patients were less than or equal to 30 days of age. The proportion of staphylococcal infections caused by a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolate increased from 51.5% (69 of 134) in 2003-2006 to 63.4% (111 of 175) in 2007-2009 (P=0.037). Among the CA-MRSA isolates, 88.9% were resistant to fusidic acid, 77.6% to tetracycline, and 21.1% to clindamycin. Clindamycin resistance increased from 0% (2003) to 31.2% (2009) among the CA-MRSA isolates (P=0.011). Over the 7-year period, an increase in multidrug-resistant CA-MRSA isolates was observed (P=0.004). One hundred and thirty-one (93.6%) of the 140 tested MRSA isolates were Panton-Valentine leukocidin-positive. Multilocus sequence typing of 72 CA-MRSA isolates revealed that they belonged to ST80 (n=61), ST30 (n=6), ST377 (n=3), ST22 (n=1), and ST152 (n=1). Resistance to fusidic acid was observed in ST80 (58/61), ST30 (1/6), and ST22 (1/1) isolates. Conclusion: In areas with high rate of infections caused by multidrug-resistant CA-MRSA isolates, predominantly belonging to the European ST80 clone, fusidic acid and clindamycin should be used cautiously as empiric therapy in patients with suspected severe staphylococcal infections.

Resistance Patterns & CA MRSA

Link: HighWire Press -- Medline Abstract.

This study compares in vitro antimicrobial resistance development between strains of Staphylococcus aureus including newly described community-acquired methicillin-resistant strains (CA-MRSA). High-level resistance developed in all strains of S. aureus after exposure to rifampicin and gentamicin and in some strains after fusidic acid exposure, independent of methicillin resistance phenotype. Resistance did not develop after exposure to clindamycin, cotrimoxazole, ciprofloxacin, linezolid, or vancomycin. These results have important implications for therapy of CA-MRSA infections.