title: Usefulness of antibiogram surveillance for methicillin-resistant Staphylococcus aureus in outpatient pediatric populations.
abstract: We assessed the impact of distributing an outpatient age-specific methicillin-resistant Staphylococcus aureus (MRSA) antibiogram on physician knowledge of MRSA prevalence and choice of empiric therapy. Questionnaires were given to 125 physicians at outpatient pediatric clinics in Monroe County, NY, before and after antibiogram distribution (response rates, 42% and 24%, respectively). The median physician-estimated MRSA prevalence (among S. aureus skin infections) was 15% before they received the antibiogram and 20% after. According to the antibiogram, the true 2005 prevalence was 25% among skin infections. When asked to select empiric therapy for a pediatric outpatient with a skin abscess, while assuming varying levels of MRSA prevalence, most selected cephalexin when the prevalence was assumed to be 20% or less, and trimethoprim-sulfamethoxazole when the prevalence was assumed to be 30% or greater. These data suggest that antibiograms may improve empiric therapy decision making by increasing knowledge of local outpatient prevalence of antibiotic resistance.
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
authors.forename: Jessina C
authors.initials: JC
authors.lastname: McGregor
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
authors.forename: Aida E
authors.initials: AE
authors.lastname: Casiano-Colón
authors.forename: Pei-Jean
authors.initials: PJ
authors.lastname: Chang
authors.forename: R Monina
authors.initials: RM
authors.lastname: Klevens
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002506:Cephalexin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D010045:Outpatients; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000382:microbiology*; D011795:Surveys and Questionnaires; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002506:Cephalexin