Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness.

Autor:	Randolph AG; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.; Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Xu R; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Novak T; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Newhams MM; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Bubeck Wardenburg J; Department of Pediatrics, St. Louis Children's Hospital, Missouri., Weiss SL; Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania., Sanders RC; Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock., Thomas NJ; Division of Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Pennsylvania., Hall MW; Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio., Tarquinio KM; Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Georgia., Cvijanovich N; Department of Critical Care Medicine, University of California-San Francisco, Benioff Children's Hospital Oakland., Gedeit RG; Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee., Truemper EJ; Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Markovitz B; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, California., Hartman ME; Department of Pediatrics, St. Louis Children's Hospital, Missouri., Ackerman KG; Department of Pediatrics, Golisano Children's Hospital, Rochester, New York., Giuliano JS Jr; Department of Pediatrics, Yale-New Haven Children's Hospital, Connecticut., Shein SL; Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio., Moffitt KL; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.; Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Massachusetts.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 Jan 18; Vol. 68 (3), pp. 365-372.
DOI:	10.1093/cid/ciy495
Abstrakt:	Background: Coinfection with influenza virus and methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening necrotizing pneumonia in children. Sporadic incidence precludes evaluation of antimicrobial efficacy. We assessed the clinical characteristics and outcomes of critically ill children with influenza-MRSA pneumonia and evaluated antibiotic use. Methods: We enrolled children (<18 years) with influenza infection and respiratory failure across 34 pediatric intensive care units 11/2008-5/2016. We compared baseline characteristics, clinical courses, and therapies in children with MRSA coinfection, non-MRSA bacterial coinfection, and no bacterial coinfection. Results: We enrolled 170 children (127 influenza A, 43 influenza B). Children with influenza-MRSA pneumonia (N = 30, 87% previously healthy) were older than those with non-MRSA (N = 61) or no (N = 79) bacterial coinfections. Influenza-MRSA was associated with increased leukopenia, acute lung injury, vasopressor use, extracorporeal life support, and mortality than either group (P ≤ .0001). Influenza-related mortality was 40% with MRSA compared to 4.3% without (relative risk [RR], 9.3; 95% confidence interval [CI], 3.8-22.9). Of 29/30 children with MRSA who received vancomycin within the first 24 hours of hospitalization, mortality was 12.5% (N = 2/16) if treatment also included a second anti-MRSA antibiotic compared to 69.2% (N = 9/13) with vancomycin monotherapy (RR, 5.5; 95% CI, 1.4, 21.3; P = .003). Vancomycin dosing did not influence initial trough levels; 78% were <10 µg/mL. Conclusions: Influenza-MRSA coinfection is associated with high fatality in critically ill children. These data support early addition of a second anti-MRSA antibiotic to vancomycin in suspected severe cases.
Databáze:	MEDLINE
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