Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children
Background: Clindamycin resistance among community-associated methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA) complicates the management of a challenging infection. Little data exist to guide clinicians in the management of invasive clindamycin-resistant CA-MRSA infections i...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-01-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/14/1/107 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589323798577152 |
|---|---|
| author | Amanda E. Macias Grant Stimes Sheldon L. Kaplan Jesus G. Vallejo Kristina G. Hulten J. Chase McNeil |
| author_facet | Amanda E. Macias Grant Stimes Sheldon L. Kaplan Jesus G. Vallejo Kristina G. Hulten J. Chase McNeil |
| author_sort | Amanda E. Macias |
| collection | DOAJ |
| description | Background: Clindamycin resistance among community-associated methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA) complicates the management of a challenging infection. Little data exist to guide clinicians in the management of invasive clindamycin-resistant CA-MRSA infections in children and studies using oral regimens such as trimethoprim-sulfamethoxazole (TMP-SMX) and linezolid for treatment of these infections are limited. We sought to reevaluate antibiotic management among invasive CA-MRSA at a tertiary children’s hospital. Methods: Cases of invasive clindamycin-resistant MRSA infections in children were identified through an ongoing <i>S. aureus</i> surveillance study. Eligible cases were those occurring in otherwise healthy children from 2011–2021. Medical records were reviewed. Results: Thirty-four subjects met inclusion criteria. The most common diagnoses were osteomyelitis (n = 17) and deep abscess (n = 7). The median duration of IV therapy was 11.5 days (IQR 6–42 days) and total therapy (IV + oral) was 32 days (IQR 23–42). Overall, 50% of patients were transitioned to oral therapy. Definitive antibiotics used for treatment included vancomycin (n = 15), TMP/SMX (n = 9), linezolid (n = 7), ceftaroline (n = 2), and doxycycline (n = 1). Cure rates were similar across definitive antibiotic therapies (vancomycin-73.3%; TMP/SMX-88.9%; ceftaroline 50%; linezolid and doxycycline-100%). Three subjects died of MRSA disease; two definitively treated with vancomycin and one with ceftaroline. Conclusions: Vancomycin is the most commonly used agent in the treatment of invasive clindamycin-resistant CA-MRSA in children at our center. However, TMP/SMX and linezolid can be considered as oral options when completing treatment in select cases. Further work is needed to evaluate the optimal management of these infections. |
| format | Article |
| id | doaj-art-4d125a1ecc684e9ea6852d837d5b2ad1 |
| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-4d125a1ecc684e9ea6852d837d5b2ad12025-01-24T13:19:02ZengMDPI AGAntibiotics2079-63822025-01-0114110710.3390/antibiotics14010107Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in ChildrenAmanda E. Macias0Grant Stimes1Sheldon L. Kaplan2Jesus G. Vallejo3Kristina G. Hulten4J. Chase McNeil5Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADivision of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADivision of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADivision of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADivision of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADivision of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USABackground: Clindamycin resistance among community-associated methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA) complicates the management of a challenging infection. Little data exist to guide clinicians in the management of invasive clindamycin-resistant CA-MRSA infections in children and studies using oral regimens such as trimethoprim-sulfamethoxazole (TMP-SMX) and linezolid for treatment of these infections are limited. We sought to reevaluate antibiotic management among invasive CA-MRSA at a tertiary children’s hospital. Methods: Cases of invasive clindamycin-resistant MRSA infections in children were identified through an ongoing <i>S. aureus</i> surveillance study. Eligible cases were those occurring in otherwise healthy children from 2011–2021. Medical records were reviewed. Results: Thirty-four subjects met inclusion criteria. The most common diagnoses were osteomyelitis (n = 17) and deep abscess (n = 7). The median duration of IV therapy was 11.5 days (IQR 6–42 days) and total therapy (IV + oral) was 32 days (IQR 23–42). Overall, 50% of patients were transitioned to oral therapy. Definitive antibiotics used for treatment included vancomycin (n = 15), TMP/SMX (n = 9), linezolid (n = 7), ceftaroline (n = 2), and doxycycline (n = 1). Cure rates were similar across definitive antibiotic therapies (vancomycin-73.3%; TMP/SMX-88.9%; ceftaroline 50%; linezolid and doxycycline-100%). Three subjects died of MRSA disease; two definitively treated with vancomycin and one with ceftaroline. Conclusions: Vancomycin is the most commonly used agent in the treatment of invasive clindamycin-resistant CA-MRSA in children at our center. However, TMP/SMX and linezolid can be considered as oral options when completing treatment in select cases. Further work is needed to evaluate the optimal management of these infections.https://www.mdpi.com/2079-6382/14/1/107MRSAinvasiveclindamycin resistantchildren |
| spellingShingle | Amanda E. Macias Grant Stimes Sheldon L. Kaplan Jesus G. Vallejo Kristina G. Hulten J. Chase McNeil Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children Antibiotics MRSA invasive clindamycin resistant children |
| title | Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children |
| title_full | Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children |
| title_fullStr | Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children |
| title_full_unstemmed | Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children |
| title_short | Management and Outcome of Invasive Clindamycin-Resistant MRSA Community-Associated Infections in Children |
| title_sort | management and outcome of invasive clindamycin resistant mrsa community associated infections in children |
| topic | MRSA invasive clindamycin resistant children |
| url | https://www.mdpi.com/2079-6382/14/1/107 |
| work_keys_str_mv | AT amandaemacias managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren AT grantstimes managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren AT sheldonlkaplan managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren AT jesusgvallejo managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren AT kristinaghulten managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren AT jchasemcneil managementandoutcomeofinvasiveclindamycinresistantmrsacommunityassociatedinfectionsinchildren |