Details

Autor(en) / Beteiligte

• Randolph, Adrienne G
• Xu, Ruifei
• Novak, Tanya
• Newhams, Margaret M
• Bubeck Wardenburg, Juliane
• Weiss, Scott L
• Sanders, Ronald C
• Thomas, Neal J
• Hall, Mark W
• Tarquinio, Keiko M
• Cvijanovich, Natalie
• Gedeit, Rainer G
• Truemper, Edward J
• Markovitz, Barry
• Hartman, Mary E
• Ackerman, Kate G
• Giuliano, John S
• Shein, Steven L
• Moffitt, Kristin L

Titel

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

Ist Teil von

• Clinical infectious diseases, 2019-01, Vol.68 (3), p.365-372

Ort / Verlag

US: Oxford University Press

Erscheinungsjahr

2019

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract 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. Influenza-methicillin-resistant Staphylococcus aureus (MRSA) coinfection is associated with high fatality in children. In this multicenter study, mortality was lower in critically ill children treated early with a second anti-MRSA antibiotic in addition to vancomycin compared to those who received vancomycin monotherapy.