Retrospective Study on Staphylococcus aureus Resistance Profile and Antibiotic Use in a Pediatric Population
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Inclusion Criteria
2.3. Collected Variables and Microbiological Studies
2.4. Primary and Secondary Aims
2.5. Statistical Analyses
- -
- A descriptive statistical analysis: calculated median and interquartile range for numeric variables and absolute and percentage frequencies for categorical variables;
- -
- An inferential statistical analysis;
- -
- Univariate analysis for comparison of the frequency of resistance to the investigated antibiotics between categories of categorical variables using the χ2 test (or Fisher’s exact test in the case of expected absolute frequencies in at least one of the cells of the contingency table less than 5);
- -
- Non-parametric Mann–Whitney test for the comparison of numerical variables with non-normal distribution between the investigated antibiotic-resistant and non-resistant groups;
- -
- Multivariate analysis using logistic regression for the calculation of the odds ratio and relative 95% confidence interval.
3. Results
3.1. Study Population
- -
- Newborns (0–28 days): 484 patients (40%);
- -
- Infants (29–90 days): 170 patients (14%);
- -
- Children (older than 90 days): 556 patients (46%).
- -
- Pharyngeal swab in 46% of cases;
- -
- Bronchoalveolar lavage (BAL) in 35% of cases;
- -
- Central venous catheter (CVC) in 13% of cases;
- -
- Urine in 4% of cases;
- -
- Other sites in 2% of cases.
3.2. Pattern of Antibiotic Resistance in S. aureus Isolates
- -
- Pharyngeal swab in 24.6% of cases (298 patients);
- -
- Broncho-alveolar lavage (BAL) in 8.6% of cases (104 patients);
- -
- Central venous catheter (CVC) in 0.5% of cases (6 patients);
- -
- Urine in 1.32% of cases (16 patients);
- -
- Other sites in 0.6% of cases (8 patients).
- -
- Pharyngeal swab in 15.2% of cases (184 patients);
- -
- Broncho-alveolar lavage (BAL) in 16.4% of cases (199 patients);
- -
- Central venous catheter (CVC) in 0.4% of cases (5 patients);
- -
- Urine in 0.6% of cases (8 patients);
- -
- Other sites in 0.5% of cases (6 patients).
- -
- Pharyngeal swab in 3.2% of cases (39 patients);
- -
- Broncho-alveolar lavage (BAL) in 5.6% of cases (68 patients);
- -
- Central venous catheter (CVC) in 7.2% of cases (87 patients);
- -
- Urine in 1.2% of cases (13 patients);
- -
- Other sites in 0.57% of cases (7 patients).
- -
- Pharyngeal swab in 2.3% of cases (36 patients);
- -
- Broncho-alveolar lavage (BAL) in 4.4% of cases (53 patients);
- -
- Central venous catheter (CVC) in 4.9% of cases (59 patients);
- -
- Urine in 0.91% of cases (11 patients);
- -
- Other sites in 0.25% of cases (3 patients).
3.3. Empiric and Targeted Antibiotics Used
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- Oxacillin or β-lactam therapy was initiated in 48% of cases;
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- 42% began therapy with aminoglycosides;
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- Cephalosporin therapy was initiated in 9% of cases;
- -
- Fluoroquinolones were initiated in 1% of cases;
- -
- No patients began therapy with glycopeptides.
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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1210 Participants | N° of Patients |
---|---|
Male | 702 (58%) |
Female | 508 (42%) |
0–28 days | 484 (40%) |
29–90 days | 170 (14%) |
>90 days | 556 (46%) |
Neonatal ICU | 560 (46.2%) |
Pediatric ICU | 219 (18.1%) |
Comorbidities | 830 (68.6%) |
Devices | 814 (67.3%) |
Isolation Site: | Oxacillin | Cephalosporin | Aminoglycosides | Fluoroquinolones |
---|---|---|---|---|
PS (46%) | 24.6% | 15.2% | 3.2% | 2.3% |
BAL (35%) | 8.6% | 16.4% | 5.6% | 4.4% |
CVC (13%) | 0.5% | 0.4% | 7.2% | 4.9% |
Urine (4%) | 1.32% | 0.6% | 1.2% | 0.91% |
Other sites (2%) | 0.6% | 0.5% | 0.57% | 0.25% |
Oxacillin Resistance (MRSA) | |||||
---|---|---|---|---|---|
YES | NO | ||||
n | % | n | % | p-Value | |
Age (days) | |||||
0–28 | 235 | 72.53 | 89 | 27.47 | <0.001 |
29–90 | 327 | 76.22 | 102 | 23.77 | |
>90 | 280 | 61.26 | 177 | 38.73 | |
Sex | |||||
Male | 425 | 60.54 | 277 | 39.45 | 0.811 |
Female | 311 | 61.22 | 197 | 38.77 | |
ICU admission | |||||
No | 450 | 67.56 | 216 | 32.43 | <0.001 |
Yes | 219 | 40.25 | 325 | 59.74 | |
ICU type | |||||
Neonatal ICU | 144 | 59.01 | 100 | 40.98 | 0.997 |
Paediatric ICU | 177 | 59.00 | 123 | 41.00 | |
Previous admissions | |||||
No | 582 | 69.70 | 253 | 30.29 | <0.001 |
Yes | 221 | 58.93 | 154 | 41.06 | |
Comorbidity | |||||
No | 416 | 57.37 | 309 | 42.62 | <0.001 |
Yes | 214 | 44.12 | 271 | 55.87 | |
Type of comorbidity | |||||
Haematological | 80 | 56.33 | 62 | 43.66 | 0.707 |
Gastrointestinal | 60 | 42.25 | 55 | 38.73 | |
Infectious | 63 | 57.27 | 47 | 42.72 | |
Kidney | 39 | 48.14 | 42 | 51.85 | |
Other | 19 | 51.35 | 18 | 48.64 | |
Device | |||||
No | 285 | 47.49 | 304 | 52.50 | 0.001 |
Yes | 359 | 56.89 | 272 | 43.10 | |
Average days hospitalization | 3.7 | 3.7 | |||
Average emergency room access | 1.09 | 1.09 |
Cephalosporin Resistance | |||||
---|---|---|---|---|---|
YES | NO | ||||
n | % | n | % | p-Value | |
Age (days) | |||||
0–28 | 322 | 61.90 | 198 | 38.07 | <0.001 |
29–90 | 210 | 48.38 | 224 | 51.61 | |
>90 | 147 | 57.42 | 109 | 42.57 | |
Sex | |||||
Male | 446 | 63.53 | 256 | 36.46 | 0.304 |
Female | 308 | 60.62 | 200 | 39.37 | |
ICU admission | |||||
No | 384 | 56.38 | 297 | 43.61 | <0.001 |
Yes | 348 | 65.78 | 181 | 32.21 | |
ICU type | |||||
Neonatal ICU | 206 | 63.19 | 120 | 36.80 | 0.203 |
Paediatric ICU | 117 | 57.63 | 86 | 42.36 | |
Previous admissions | |||||
No | 402 | 56.30 | 312 | 43.69 | 0.206 |
Yes | 261 | 52.62 | 235 | 47.37 | |
Comorbidity | |||||
No | 467 | 60.72 | 302 | 39.27 | 0.027 |
Yes | 239 | 54.19 | 202 | 45.80 | |
Type of comorbidity | |||||
Haematological | 53 | 54.08 | 45 | 45.91 | 0.620 |
Gastrointestinal | 60 | 55.00 | 50 | 45.00 | |
Infectious | 67 | 62.03 | 41 | 37.96 | |
Kidney | 57 | 56.43 | 44 | 43.56 | |
Other | 16 | 66.60 | 8 | 33.30 | |
Device | |||||
No | 300 | 50.08 | 299 | 49.91 | <0.001 |
Yes | 395 | 64.64 | 216 | 35.35 | |
Average days hospitalization | 3.7 | 3.7 | |||
Average emergency room access | 1.09 | 1.09 |
Aminoglycosides Resistance | |||||
---|---|---|---|---|---|
YES | NO | ||||
n | % | n | % | p-Value | |
Age (days) | |||||
0–28 | 100 | 34.60 | 189 | 65.39 | 0.039 |
29–90 | 172 | 41.05 | 247 | 58.94 | |
>90 | 220 | 43.82 | 282 | 56.17 | |
Sex | |||||
Male | 294 | 41.88 | 408 | 58.11 | 0.249 |
Female | 196 | 38.58 | 312 | 61.41 | |
ICU admission | |||||
No | 289 | 42.12 | 397 | 57.87 | 0.235 |
Yes | 203 | 38.74 | 321 | 61.25 | |
ICU type | |||||
Neonatal ICU | 204 | 72.59 | 77 | 27.40 | 0.014 |
Paediatric ICU | 152 | 62.55 | 91 | 37.44 | |
Previous admissions | |||||
No | 294 | 43.62 | 380 | 56.37 | 0.907 |
Yes | 232 | 43.28 | 304 | 56.71 | |
Comorbidity | |||||
No | 266 | 44.93 | 326 | 55.06 | 0.002 |
Yes | 223 | 36.08 | 395 | 63.91 | |
Type of comorbidity | |||||
Haematological | 34 | 29.56 | 81 | 70.43 | 0.087 |
Gastrointestinal | 49 | 35.25 | 90 | 64.74 | |
Infectious | 31 | 20.66 | 119 | 79.33 | |
Kidney | 36 | 26.08 | 102 | 73.91 | |
Other | 20 | 26.31 | 56 | 73.68 | |
Device | |||||
No | 357 | 56.04 | 280 | 43.95 | 0.578 |
Yes | 312 | 54.45 | 261 | 45.54 | |
Average days hospitalization | 3.7 | 3.7 | |||
Average emergency room access | 1.09 | 1.09 |
Fluoroquinolones Resistance | |||||
---|---|---|---|---|---|
YES | NO | ||||
n | % | n | % | p-Value | |
Age (days) | |||||
0–28 | 220 | 36.91 | 376 | 63.08 | 0.870 |
29–90 | 132 | 37.07 | 224 | 62.92 | |
>90 | 100 | 38.75 | 158 | 61.24 | |
Sex | |||||
Male | 289 | 41.16 | 413 | 58.23 | 0.623 |
Female | 202 | 39.76 | 306 | 60.23 | |
ICU admission | |||||
No | 273 | 39.85 | 412 | 60.14 | 0.491 |
Yes | 199 | 37.90 | 326 | 62.02 | |
ICU type | |||||
Neonatal ICU | 130 | 59.09 | 90 | 40.90 | 0.662 |
Paediatric ICU | 186 | 60.98 | 119 | 39.01 | |
Previous admissions | |||||
No | 217 | 30.13 | 503 | 69.86 | 0.006 |
Yes | 185 | 37.75 | 305 | 62.24 | |
Comorbidity | |||||
No | 222 | 32.31 | 465 | 67.68 | 0.364 |
Yes | 182 | 34.79 | 341 | 65.20 | |
Type of comorbidity | |||||
Haematological | 30 | 25.42 | 88 | 74.57 | 0.017 |
Gastrointestinal | 39 | 33.62 | 77 | 66.37 | |
Infectious | 49 | 44.95 | 60 | 55.04 | |
Kidney | 32 | 29.09 | 78 | 70.90 | |
Other | 19 | 27.14 | 51 | 72.85 | |
Device | |||||
No | 271 | 34.08 | 524 | 65.91 | <0.001 |
Yes | 265 | 63.85 | 150 | 36.14 | |
Average days hospitalization | 3.7 | 3.7 | |||
Average emergency room access | 1.09 | 1.09 |
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Share and Cite
Buonsenso, D.; Giaimo, M.; Pata, D.; Rizzi, A.; Fiori, B.; Spanu, T.; Ruggiero, A.; Attinà, G.; Piastra, M.; Genovese, O.; et al. Retrospective Study on Staphylococcus aureus Resistance Profile and Antibiotic Use in a Pediatric Population. Antibiotics 2023, 12, 1378. https://doi.org/10.3390/antibiotics12091378
Buonsenso D, Giaimo M, Pata D, Rizzi A, Fiori B, Spanu T, Ruggiero A, Attinà G, Piastra M, Genovese O, et al. Retrospective Study on Staphylococcus aureus Resistance Profile and Antibiotic Use in a Pediatric Population. Antibiotics. 2023; 12(9):1378. https://doi.org/10.3390/antibiotics12091378
Chicago/Turabian StyleBuonsenso, Danilo, Martina Giaimo, Davide Pata, Alessia Rizzi, Barbara Fiori, Teresa Spanu, Antonio Ruggiero, Giorgio Attinà, Marco Piastra, Orazio Genovese, and et al. 2023. "Retrospective Study on Staphylococcus aureus Resistance Profile and Antibiotic Use in a Pediatric Population" Antibiotics 12, no. 9: 1378. https://doi.org/10.3390/antibiotics12091378