Transcript Slide 1
Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children
Schneider-Lindner V, Quach C, Hanley JA, Suissa S. Antibacterial drugs and the risk of community-associated methicillin-resistant
Staphylococcus aureus
in children.
Arch Pediatr Adolesc Med
. Published online August 1, 2011. doi:10.1001/archpediatrics.2011.143.
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Introduction
• Methicillin-resistant
Staphylococcus aureus
(MRSA) is common in hospitals and is increasingly reported in the community.
• This emerging resistant organism generally affects younger and healthier individuals, including children.
• The association of antibacterial agents with later MRSA diagnoses has been demonstrated for adults, but data on children are lacking.
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Methods
•
Study Design:
Population-based case-control study in children 1 to 19 years of age from the General Practice Research Database, United Kingdom, 1994-2007.
•
Participants:
Cases were children who had MRSA diagnosed as outpatients; controls were individually matched on age and practice, with the matched case’s diagnosis date as the index date for both.
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Methods
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Data Analysis:
Antibacterial agents prescribed 180 to 30 days prior to the index date were identified, excluding prescriptions 30 days before the index date to prevent protopathic bias. Using conditional logistic regression, adjusted rate ratios were estimated from the odds ratios of antibacterial exposure in cases compared with controls.
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Limitations:
– Children younger than 1 year were excluded because follow-up time for exposure and covariate information were required.
– Asymptomatic colonization could not be distinguished from clinically severe infection. Copyright restrictions may apply
Results
• We identified 297 cases and 9357 matching controls.
• 52.5% of cases vs 13.6% of controls had received 1 or more antibacterial drug prescriptions in the 150-day exposure window.
• Accounting for differences in sex, comorbid conditions, and hospitalizations, this difference translated to a more than 3-fold higher risk of MRSA diagnosis in children with any prior antibacterial drug prescription compared with those without (adjusted rate ratio = 3.5; 95% CI, 2.6-4.8). Copyright restrictions may apply
Results
• The MRSA risk increased with increasing numbers of antibacterial prescriptions.
40 15 10 5 0 35 30 25 20
0 1 11.0
1 2.2
3.3
2 3 Prescriptions, No.
18.2
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•
Results
The MRSA risk varied with prior exposure to different antibacterial drug classes.
Association of Different Classes of Antibacterial Drugs with Ca-MRSA Diagnoses in Children, General Practice Research Database, United Kingdom, 1994-2007 Copyright restrictions may apply
Comment
• The results support efforts to minimize unnecessary antibacterial drug prescribing, particularly of second-line agents, to children in the community.
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Comment
• The findings should be confirmed in other data sources.
• Causality for antibacterial drug prescriptions with subsequent MRSA infections in children remains to be established.
• Antibacterial use, particularly related to unnecessary prescribing to children, as well as MRSA incidence in the community require ongoing monitoring.
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Contact Information
• If you have questions, please contact the corresponding author: – Samy Suissa, PhD, Centre for Clinical Epidemiology, Sir Mortimer B. Davis –Jewish General Hospital, 3755 Côte Ste-Catherine, Ste H4, Montreal, QC H3T 1E2, Canada ([email protected]).
Funding/Support
• Dr Schneider-Lindner was the recipient of a fellowship from the Canadian Institutes for Health Research.
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