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
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Methicillin-resistant Staphylococcus aureus (MRSA) is common in hospitals
and is increasingly reported in the community.
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This emerging resistant organism generally affects younger and healthier
individuals, including children.
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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
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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.
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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.
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Results
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We identified 297 cases and 9357 matching controls.
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52.5% of cases vs 13.6% of controls had received 1 or more antibacterial
drug prescriptions in the 150-day exposure window.
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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).
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Results
• The MRSA risk increased with increasing numbers of
antibacterial prescriptions.
40
Adjusted Rate Ratio
for MRSA Diagnosis
35
30
25
18.2
20
15
11.0
10
5
0
0
3.3
2.2
1
1
2
3
Prescriptions, No.
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4
Results
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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
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Comment
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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
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The findings should be confirmed in other data sources.
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Causality for antibacterial drug prescriptions with subsequent MRSA
infections in children remains to be established.
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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
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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
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Dr Schneider-Lindner was the recipient of a fellowship from the Canadian
Institutes for Health Research.
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