title: Fusidic acid and clindamycin resistance in community-associated, methicillin-resistant Staphylococcus aureus infections in children of Central Greece.
abstract: BACKGROUND
  In Greece, fusidic acid and clindamycin are commonly used for the empiric therapy of suspected staphylococcal infections.
  
  
  METHODS
  The medical records of children examined at the outpatient clinics or admitted to the pediatric wards of the University General Hospital of Larissa, Central Greece, with community-associated staphylococcal infections from January 2003 to December 2009 were reviewed.
  
  
  RESULTS
  Of 309 children (0-14 years old), 21 (6.8%) had invasive infections and 288 (93.2%) skin and soft tissue infections (SSTIs). Thirty-five patients were ≤30 days of age. The proportion of staphylococcal infections caused by a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolate increased from 51.5% (69 of 134) in 2003-2006 to 63.4% (111 of 175) in 2007-2009 (P = 0.037). Among the CA-MRSA isolates, 88.9% were resistant to fusidic acid, 77.6% to tetracycline, and 21.1% to clindamycin. Clindamycin resistance increased from 0% (2003) to 31.2% (2009) among the CA-MRSA isolates (P = 0.011). Over the 7-year period, an increase in multidrug-resistant CA-MRSA isolates was observed (P = 0.004). One hundred and thirty-one (93.6%) of the 140 tested MRSA isolates were Panton-Valentine leukocidin-positive. Multilocus sequence typing of 72 CA-MRSA isolates revealed that they belonged to ST80 (n = 61), ST30 (n = 6), ST377 (n = 3), ST22 (n = 1), and ST152 (n = 1). Resistance to fusidic acid was observed in ST80 (58/61), ST30 (1/6), and ST22 (1/1) isolates.
  
  
  CONCLUSIONS
  In areas with high rate of infections caused by multidrug-resistant CA-MRSA isolates, predominantly belonging to the European ST80 clone, fusidic acid and clindamycin should be used cautiously as empiric therapy in patients with suspected severe staphylococcal infections.
authors.affiliation: Department of Pediatrics, University of Thessaly, Medical School, Biopolis, 411 10 Larissa, Greece.
authors.forename: George D
authors.initials: GD
authors.lastname: Katopodis
authors.forename: Ioanna N
authors.initials: IN
authors.lastname: Grivea
authors.forename: Angeliki J
authors.initials: AJ
authors.lastname: Tsantsaridou
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.forename: Efi
authors.initials: E
authors.lastname: Petinaki
authors.forename: George A
authors.initials: GA
authors.lastname: Syrogiannopoulos
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005672:Fusidic Acid / Q000627:therapeutic use*; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010641:Phenotype; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D005672:Fusidic Acid