Health

Study notes continued MRSA upsurge in kids' ENT infections

The incidence of tissue infections from antibiotic-resistant bacteria doubled in five years, researchers found.

By Susan J. Landers — Posted Feb. 9, 2009

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Methicillin-resistant Staphylococcus aureus is continuing to take a toll on the nation's children, say researchers who reviewed data from more than 300 hospitals.

They found an "alarming" increase between 2001 and 2006 in the number of head and neck infections resistant to antibiotic treatment.

Their report is in the January Archives of Otolaryngology--Head & Neck Surgery.

Resistant forms of S. aureus have been responsible in recent years for large increases in the numbers of patients with skin and soft-tissue infections who land in physicians' offices and emergency departments.

A recent analysis of records from outpatient settings showed a doubling of the number of abscesses or cellulites, both of which are MRSA hallmarks, from 4.6 million to 9.6 million between 1997 and 2005. The highest rates were seen among children treated in urban emergency departments.

The researchers in the new study excluded skin infections from their analysis and focused on soft-tissue infections deeper in the ear, nose and throat. They found that while just 12% of these infections were resistant to antibiotics in 2001, 28% showed signs of resistance five years later.

The Archives study examined data from 21,009 pediatric head and neck S. aureus infections. Most were obtained from outpatient settings, suggesting, said the researchers, that infections were community-acquired. In past years, most MRSA infections had been acquired in the hospital.

"The take-home message for physicians is to be aware that when dealing with an infection of the ear, nose or throat area that doesn't seem to be responding to standard treatment, you have to think about resistance," said Steven Sobol, MD, director of pediatric otolaryngology at Emory University School of Medicine in Atlanta, and one of the study's authors.

The AMA and other physician organizations have advocated for judicious use of antibiotics to lower the odds that adaptable bacteria will become stronger and survive medications that once had killed them.

Additional resistance threat

One of those drugs, clindamycin, seemed in the new study to be less effective at defeating S. aureus than it had been. In past years, nearly all MRSA isolates had been susceptible to clindamycin. But in the new study, more than 46% of the isolates examined had become resistant.

"Clindamycin has been one of the drugs of choice for MRSA," Dr. Sobol said. "In our study, we found that resistance is increasing. So it is eliminating one of the antibiotics from our armamentarium."

In one positive note, the data show that the rate of increase in resistant infections may be slowing. This also was evident in other studies. "But there is no way of knowing whether the trend will increase upwards or remain where it is," Dr. Sobol said.

Of the three infection sites studied, researchers found, the highest proportion of MRSA was found in children with ear infections, followed by those with sinus infections and then infections of the throat area. The authors also recommended "expeditious culture of suspected head and neck infections leading to more appropriate antimicrobial drug selection ... to avoid further resistant patterns."

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ADDITIONAL INFORMATION

Ongoing rise and threat of MRSA

A new study found the number of children's head and neck infections resistant to treatment with certain antibiotics increased sharply between 2001 and 2006.

Infections 2001 2002 2003 2004 2005 2006
S. aureus 2,842 2,893 3,157 3,988 4,131 3,998
Methicillin-susceptible S. aureus 2,506 2,530 2,585 2,902 3,078 2,874
MRSA 336 363 572 1,086 1,053 1,124

Source: "Nationwide Trends in Pediatric Staphylococcus aureus Head and Neck Infections," Archives of Otolaryngology--Head & Neck Surgery, January (link)

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