Background
The emergence of community-associated methicillin-resistant
Staphylococcus aureus
(CA-MRSA) resulted in the recommended use of clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) for suspected
S
.
aureus
infections. The objective of this study was to determine the resistance to methicillin, clindamycin, and TMP-SMX in
S
.
aureus
isolates during a 10-year period.
Methods
Retrospective review of the antimicrobial susceptibilities of all
S
.
aureus
isolates in the outpatient and inpatient settings at Nationwide Children’s Hospital from 1/1/2005 to 12/31/2014. Duplicate isolates from the same site and year and those obtained for MRSA surveillance or from patients with cystic fibrosis were excluded.
Results
Of the 57,788
S
.
aureus
isolates from 2005–2014, 40,795 (71%) were included. In the outpatient setting, methicillin resistance decreased from 54% to 44% (
p
<0.001) while among inpatient isolates, no significant change was observed. From 2009–2014, resistance to clindamycin among outpatient isolates increased from 16% to 17% (
p
= 0.002) but no significant trend was observed among inpatient isolates (18% to 22%). Similarly, TMP-SMX resistance increased in outpatient
S
.
aureus
isolates from 2005–2014 (0.9% to 4%,
p
<0.001) but not among inpatient isolates. Among both inpatient and outpatient isolates, methicillin-susceptible
S
.
aureus
(MSSA) exhibited higher resistance to both clindamycin and TMP-SMX than MRSA. In addition, resistance to methicillin, clindamycin and TMP-SMX varied widely according to the site of specimen collection.
Conclusion
In a decade where >40,000
S
.
aureus
isolates were identified at a large pediatric hospital, substantial changes in methicillin, clindamycin, and TMP-SMX resistance occurred. These findings highlight the importance of ongoing surveillance of the local antimicrobial resistance in
S
.
aureus
in order to guide empiric antimicrobial therapy.
Coronavirus disease 2019 (COVID-19) is an important cause of morbidity in children in the United States (U.S.). Moreover, the U.S. has witnessed significant disparities affecting American Indian/Alaska Native, Black, and Hispanic/Latino children, stemming from systemic racism and social-structural inequalities and not differences in innate biological susceptibility.
We review what is known on COVID-19 and health disparities in disease burden, access to care, pharmaceutical interventions, and clinical research in children, with a focus on the U.S. context. In addition, we propose strategies to communicate scientific data in ways that do not promote racism and biological susceptibility themes, and to address pediatric disparities in clinical infectious diseases research.
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