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Keep a close eye.

STAPHYLOCOCCUS AUREUS Is one of the most common organisms isolated from children with health care-associated infections, regardless of whether these infections had their onset in the community or were acquired in the hospital. Thus, the initial empiric treatment of a skin or soft tissue infection or invasive infection in a child almost always includes an antibiotic effective against S. aureus.

However, over the years, clindamycin susceptibility among S. aureus isolates has declined, likely related to the increased use of this agent for empiric as well as definitive treatment of community-acquired (CA) MRSA infections, encouraging the transmission of the genes associated with clindamycin resistance.

What are the implications of the findings from the report by Sutter et al. with respect to the selection of empiric antibiotics for children with suspected S. aureus infections? Currently, considering the still substantial MRSA resistance rates that exceed the 10%-15% level suggested by many experts as the threshold above which agents effective against CA-MRSA isolates should be administered for empiric treatment, changes in the selection of empiric antibiotics are not warranted. If rates of MRSA among S. aureus isolates from otherwise normal children are documented to drop below the 10%-15% threshold in different communities, a modification of current recommendations should be considered. It would also be important to understand why methicillin resistance is declining among S. aureus isolates from CA infections; this information may provide clues for preventing CA-MRSA infections with the use of vaccines or other means. The epidemiology of S. aureus infections in children has been changing over the past 2 decades, which is why it is critical to keep a very close eye on this common pathogen.

These comments were excerpted from an accompanying commentary by Dr. Kaplan of the infectious disease service at Texas Children's Hospital in Houston (Pediatrics. 2016 Mar 1. doi: 10.1542/peds.2016-0101). Dr. Kaplan has received research funds from Pfizer, Forest Laboratories, and Cubist.

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Title Annotation:VIEW ON THE NEWS
Author:Kaplan, Sheldon L.
Publication:Pediatric News
Date:May 1, 2016
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