加拿大學者的一項研究表明，近半數(shù)伴耐甲氧西林金黃色葡萄球菌（MRSA）感染的社區(qū)兒童接受過抗生素治療,，抗生素應用與MRSA風險升高顯著相關,。論文8月1日發(fā)表于《兒童與青少年醫(yī)學文獻》（Arch Pediatr Adolesc Med）。
此項基于人群的病例對照研究以年齡為1～19歲的兒童為受試者,。研究組為伴MRSA感染的門診患兒,，對照組為年齡和日常行為與之相匹配的兒童。以患者診斷日期作為索引日期,。主要暴露指標為索引日期前180～30天的抗生素開具情況,。在校正共患疾病、其他藥物應用和住院等指標之后,，利用條件Logistic回歸進行分析,。
結果顯示，MRSA感染率為每年4.5/10萬,。在297例患兒和9357例對照兒童中,，各有52.5%和13.6%的兒童在150天暴露時間窗內接受抗生素治療。與未接受抗生素治療的患兒相比,，所有接受抗生素治療的患兒MRSA感染風險升高[校正比值比（RR）=3.5],。RR隨處方開具數(shù)的增加而升高（1、2,、3和≥4張?zhí)幏降腞R分別為2.2,、3.3、11.0和18.2）,。不同種類抗生素的RR存在顯著差異,，喹諾酮類抗生素的RR顯著升至14.8。(生物谷 Bioon.com)
doi:10.1001/archpediatrics.2011.143
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Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children
Verena Schneider-Lindner, MD, MSc; Caroline Quach, MD, MSc; James A Hanley, PhD; Samy Suissa, PhD
Objective: To investigate in children the association between antibacterial drugs and subsequent diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Design: Population-based case-control study in children 1 to 19 years of age. Setting: Primary care, General Practice Research Database, United Kingdom, 1994-2007. Participants: Cases were children who had MRSA diagnosed as outpatients, and controls were individually matched on age and practice, with the matched case's diagnosis date as the index date for both. Main Exposures: Antibacterial agents prescribed 180 to 30 days prior to the index date, excluding prescriptions 30 days before the index date to prevent protopathic bias. Outcome Measures: Rate ratios (RRs) estimated from the odds ratios of exposure in cases compared with controls using conditional logistic regression, adjusted for comorbid conditions, other prescription drug use, and hospitalization. Results:The rate of MRSA was 4.5 per 100 000 per year. Of 297 cases and 9357 controls, 52.5% and 13.6%, respectively, received antibacterial drug prescriptions during the 150-day exposure window. The adjusted RR with any antibacterial drug was 3.5 (95% confidence interval [CI], 2.6-4.8). The RRs increased with the number of prescriptions (2.2 [95% CI, 1.5-3.2], 3.3 [95% CI, 1.9-5.6], 11.0 [95% CI, 5.6-21.6], and 18.2 [95% CI, 9.4-35.4] for 1, 2, 3, and ≥4 prescriptions, respectively). The RR was particularly elevated for quinolones at 14.8 (95% CI, 3.9-55.8), with wide variation among antibacterial classes. Conclusion: While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults.
