Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) with a narrower antibiotic resistance pattern have emerged. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms.


METHODS
We analyzed clindamycin-susceptible MRSA organisms from children (1987 to 2000) along with clinical data. Antibiotic susceptibilities of organisms were tested, pulsed field gel electrophoresis (PFGE) was done and the linked resistance mechanism was detected by the D test.


RESULTS
An average of 11 clindamycin-susceptible MRSA per year were obtained from children since 1993. Of 88 isolates 33 (38%) were erythromycin-resistant. The latter were less often community-acquired (45% vs. 69%), more often from infants <1 month of age (24% vs. 4%) and less likely to be in the community acquisition-associated PFGE Group 1 (62% vs. 87%) than those that were susceptible. The D test was positive in 31 of 33 erythromycin-resistant isolates. A 9-month-old boy with pneumonia/empyema caused by a clindamycin-susceptible, erythromycin-resistant, D test-positive MRSA developed a PFGE-identical clindamycin-resistant isolate and clinical relapse during clindamycin treatment. In contrast a 12-year-old girl with abscesses caused by a similar MRSA developed another abscess after clindamycin therapy, but the organism was unchanged in susceptibility.


CONCLUSIONS
Erythromycin resistance was present in 38% of clindamycin-susceptible MRSA in children, and clindamycin resistance was detected during treatment in one child. Clindamycin remains a treatment option if the clinician is notified of the risk by the microbiology laboratory and the clinical situation is suitable.
Frank
Arthur L
AL
Department of Pediatrics, College of Medicine, University of Illinois at Chicago, USA.
Marcinak
John F
JF
Mangat
P Daisy
PD
Tjhio
Joyce T
JT
Kelkar
Swathi
S
Schreckenberger
Paul C
PC
Quinn
John P
JP
D000038:Abscess / Q000382:microbiology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D004591:Electrophoresis, Polyacrylamide Gel; D006801:Humans; D007223:Infant; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D002981:Clindamycin