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zoom RSS MRSAによる小児耳鼻咽頭感染の急増/米国医療事情

<<   作成日時 : 2009/01/22 23:50   >>

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画像 米国で小児の耳鼻咽頭感染におけるMRSAの割合が最近6年間で11.8から 28.1%へと急増した。
 2001年1月から2006年12月までの間で小児の頭頸部ブドウ球菌感染を調査した。300施設、21,000人の感染が見られ、平均年齢は6.7才。60%の子どもは医療施設内ではなく外来受診で見つかっているので、コミュニティレベルで耐性菌が広がっていると推定される。
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MRSA Infections Spreading to Kids in Community
Antibiotic-resistant bacteria moving beyond hospital setting, study finds
By Alan Mozes, HealthDay Reporter
http://health.msn.com/medications/articlepage.aspx?cp-documentid=100231542

画像Antibiotic-resistant bacteria moving beyond hospital setting, study finds.

MONDAY, Jan. 19 (HealthDay News) -- Antibiotic-resistant infections around the head and neck are on the rise among American children, a new report indicates.

The finding suggests that tougher strains of the bacteria Staphylococcus aureus -- referred to as MRSA because of their resistance to the antibiotic methicillin -- are moving beyond the traditional confines of hospitals and into the community at large.

"We certainly found that the emergence of resistant staph head and neck infections in pediatric settings is on the rise," said study co-author Dr. Steven E. Sobol, director of the department of pediatric otolaryngology at the Emory University School of Medicine in Atlanta.

Sobol and his colleagues reported the findings in the January issue of the Archives of Otolaryngology Head & Neck Surgery.

The building threat to children compounds a trend toward more community-based MRSA infections previously observed among prison, nursing home, and chronically ill patient populations, the researchers noted.

In the latest study, the authors reviewed data concerning pediatric infections that had been collected between 2001 and 2006 in a national database that amasses anti-microbial drug resistance test results from labs working for more than 300 hospitals across the country.

The research team found that of the more than 21,000 infections that had occurred among children during the study period, almost 22 percent were resistant to the antibiotic methicillin. Overall, MRSA head and neck infection rates had more than doubled, from about 12 percent to just over 28 percent.

About one-third of MRSA infections affected the ears, while about 28 percent impacted the nasal and sinus regions. Head and neck MRSA infections accounted for about 14 percent of the total.

Sobol stressed, however, that the apparent rising MRSA risk to children is not yet cause for alarm.

"I don't want to generate panic," he said. "And really, there's no reason for parents and children to change their lives. Reducing risk for infection is all about common sense and practicing normal hygienic measures, such as encouraging children to wash their hands and avoid contact with other ill children in crowded situations."

"But it's also important that pediatricians recognize the importance of this and suspect the possibility among children who don't respond to normal measures taken to deal with a cold or infection," he said. "And certainly, when a normal infection or cold seems worse than a parent would expect it to be, then parents should seek medical attention from their pediatrician quickly. Don't panic. Just be aware."

"Meanwhile, the underlying cause for the rise in pediatric infections is the subject of ongoing study at our institution, because we don't yet know exactly why it's occurring," Sobol acknowledged. "But we suspect is that it's due to a combination of factors."

Dr. Philip Tierno, director of clinical microbiology and immunology at New York University Medical Center, agreed.

"On the one hand, it could be that physicians might be less cautious in their use of antibiotics when it comes to children," he noted. "This is even though the American Pediatric Association has really come out strongly for physicians to be careful with administration of antibiotics to children. It also could, in part, be that we're simply monitoring case trends better than we had in the past, and so we're finding it in greater numbers among children than before."

But Tierno hypothesized that MRSA is simply on the rise outside traditional hospital settings.

"I suspect," added Tierno, "that the primary reason children might be more likely to come down with a MRSA in the community is that the community is now a reservoir for antibiotic-resistant organism, whereas before it was primarily just the hospital. And so, children just reflect that shift as a significant part of the community."

More information

For more on MRSA, visit the U.S. Centers for Disease Control and Prevention.
SOURCES: Steven E. Sobol, M.D., director, department of pediatric otolaryngology, Emory University School of Medicine, Atlanta; Philip Tierno, M.D., Ph.D., director, clinical microbiology and immunology, New York University Langone Medical Center, and author, The Secret Life of Germs and Protect Yourself Against Bioterrorism; January 2009, Archives of OtolaryngologyHead & Neck Surgery

Copyright © 2009 ScoutNews, LLC. All rights reserved.

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Children’s Staph Infections Increasingly Resistant to Drugs
http://www.nytimes.com/2009/01/21/health/research/21staph.html

By RONI CARYN RABIN
Published: January 20, 2009

Children are picking up more stubborn staph infections that don’t respond to common antibiotics, and the proportion their of ear, nose and throat infections resistant to standard drug treatment increased dramatically over a six-year period, a new study has found.

Methicillin-resistant Staphylococcus aureus infections, known as MRSA, accounted for 28.1 percent of children’s head and neck staph infections in 2006, up from just 11.8 percent in 2001, according to researchers at Emory University in Atlanta. It once was rare for an ear, nose and throat doctor to see MRSA infections, noted Dr. Steven E. Sobol, the paper’s senior author and director of pediatric otolaryngology at Emory University School of Medicine. “That was the impetus for the study,” he said.

The report was published in this week’s issue of Archives of Otolaryngology - Head and Neck Surgery.

“Over the past four or five years, we’ve seen an increased prevalence of these infections that used to be caused by other organisms that are now being caused by MRSA,” said Dr. Sobol. The researchers excluded from their analysis skin infections not caused by staph.

Though the study captured information from only a limited number of laboratories, the report’s authors said the overall trend is clear, concluding that there is “an alarming nationwide increase” in the prevalence of MRSA infections in children. The change parallels an increase in so-called community-acquired cases of MRSA among relatively healthy people who aren’t hospitalized or infirm.

The scientists analyzed 21,009 head and neck staph infections occurring among children from January 2001 to December 2006. The data came from a national electronic microbiology database that collects strain-specific drug resistance test results from labs affiliated with 300 hospitals around the country. The average age of the patients was 6.7 years old.

The proportion of drug resistant head and neck staph infections increased dramatically over the six-year period, the researchers found. Overall, 21.6 percent, or 4,534 samples, were methicillin-resistant, the greatest proportion of them involving the ear, nose and sinus and pharynx.

Only 11.8 percent of childhood head infections were resistant in 2001, but the figure jumped to 12.5 percent in 2002, 18.1 percent in 2003, and 27.2 percent in 2004.

The rate fell to 25.5 percent in 2005 and rose again to 28.1 percent in 2006, the researchers reported.

Almost 60 percent of the head and neck infections occurred among children who had not been in medical settings beforehand and were seeing doctors as outpatients, the researchers said, suggesting that children were exposed to resistant bacteria in the community.
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Nationwide Trends in Pediatric Staphylococcus aureus Head and Neck Infections

Iman Naseri, MD; Robert C. Jerris, PhD; Steven E. Sobol, MD, MSc

画像Arch Otolaryngol Head Neck Surg. 2009;135(1):14-16.

Objectives To evaluate the epidemiologic manifestations of pediatric Staphylococcus aureus head and neck infections nationwide and to identify possible trends in the antibiotic drug susceptibility of S aureus during a 6-year period.

Design Retrospective review of microbiologic data from a peer-reviewed national database.

Setting More than 300 hospitals nationwide.

Patients All pediatric patients with head and neck infections involving S aureus.

Main Outcome Measures Anatomic sites were divided into oropharynx/neck, sinonasal, and otologic infection categories. Demographic and antimicrobial drug susceptibility patterns were reviewed.

Results A total of 21 009 pediatric head and neck S aureus infections that occurred between January 2001 and December 31, 2006 were gathered from the database. Predominance was observed in the oropharyngeal/neck category (60.3%). For all sites, the mean patient age was 6.7 years (range, 0-18 years), with a 51.7% male predominance. There was a high occurrence in the North East Central region of the United States. Overall, methicillin-resistant S aureus was seen in 21.6% of all patient isolates (n = 4534), with rates of 11.8%, 12.5%, 18.1%, 27.2%, 25.5%, and 28.1% for 2001 through 2006, respectively. This represents a 16.3% increase in methicillin-resistant S aureus during these 6 years for all pediatric head and neck S aureus infections.

Conclusions There is an alarming nationwide increase in the prevalence of pediatric methicillin-resistant S aureus head and neck infections. Disparities in the treatment of various head and neck infections nationwide may contribute to the regional differences in the prevalence of such infections. Judicious use of antibiotic agents and increased effectiveness in diagnosis and treatment are warranted to reduce further antimicrobial drug resistance in pediatric head and neck infections.


Author Affiliations: Departments of Otolaryngology--Head and Neck Surgery (Dr Naseri) and Pediatric Otolaryngology (Dr Sobol), Emory University School of Medicine, Atlanta, Georgia; and Children's Healthcare of Atlanta, Egleston Hospital (Dr Jerris).

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