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Changing Trends

Richard H. Johnigan, MD; Kevin D. Pereira, MD, MS(Orl); Michael D. Poole, MD, PhD

Arch Otolaryngol Head Neck Surg. 2003;129:1049-1052.

Objective  To identify current trends in antibiotic sensitivity patterns of community-acquired methicillin-resistant Staphylococcus aureus (CA MRSA) infections of the head and neck in children and adolescents and evaluate outcomes after therapy.

Design  Retrospective review of cases consisting of a medical record review with telephone follow-up.

Setting  Two tertiary university medical referral centers.

Patients  Pediatric patients (age <18 years).

Main Outcome Measures  Number of cases, sensitivities of cultured organisms, treatments used, and outcome of treatments.

Results  Seven patients were identified with CA MRSA in a 4-month period. Superficial abscesses (3 patients [43%]) and suppurative lymphadenitis (3 patients [43%]) were the most common causes. An erythromycin-resistant, clindamycin-sensitive pattern was observed in 6 (86%) of the 7 isolates. All infections resolved with prescribed treatments; there were no complications.

Conclusions  A high prevalence of erythromycin-resistant, clindamycin-sensitive CA MRSA was noted. This new resistance pattern is indicative of inducible macrolide-lincomycin-streptogramin-B resistance. Basic science data suggest that these strains of bacteria could develop resistance to clindamycin during therapy despite appearing susceptible on initial laboratory testing. In our small series, clindamycin was used alone and effectively in 2 such cases. This appears to support its continued use as initial, empiric therapy in suspected cases of CA MRSA.

From the Department of Otolaryngology–Head and Neck Surgery, University of Texas Health Science Center, Houston. The authors have no relevant financial interest in this article.

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