加拿大学者的一项研究表明，近半数伴耐甲氧西林金黄色葡萄球菌（MRSA）感染的社区儿童接受过抗生素治疗，抗生素应用与MRSA风险升高显著相关。论文8月1日发表于《儿童与青少年医学文献》（Arch Pediatr Adolesc Med）。
此项基于人群的病例对照研究以年龄为1～19岁的儿童为受试者。研究组为伴MRSA感染的门诊患儿，对照组为年龄和日常行为与之相匹配的儿童。以患者诊断日期作为索引日期。主要暴露指标为索引日期前180～30天的抗生素开具情况。在校正共患疾病、其他药物应用和住院等指标之后，利用条件Logistic回归进行分析。
结果显示，MRSA感染率为每年4.5/10万。在297例患儿和9357例对照儿童中，各有52.5%和13.6%的儿童在150天暴露时间窗内接受抗生素治疗。与未接受抗生素治疗的患儿相比，所有接受抗生素治疗的患儿MRSA感染风险升高[校正比值比（RR）=3.5]。RR随处方开具数的增加而升高（1、2、3和≥4张处方的RR分别为2.2、3.3、11.0和18.2）。不同种类抗生素的RR存在显著差异，喹诺酮类抗生素的RR显著升至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.
