Biomedical subjects

John F Marcinak

Publications and source records attributed to John F Marcinak.

5 recordsLinked to original sources

PubMed2006

Epidemiology and treatment of community-associated methicillin-resistant Staphylococcus aureus in children.

Similar to the epidemiology of methicillin-sensitive Staphylococcus aureus, community-associated methicillin-resistant S. aureus infections occur in children in different regions of the USA and throughout the world. Although minor skin and soft-tissue infections predominate, life-threatening invasive disease and death can result. The novel genetic elements, staphylococcal cassette chromosome mec IV and V, explain the narrow antibiotic resistance pattern, and suggest the mechanism of spread among staphylococci. Panton-Valentine leukocidin apparently plays a role in its pathogenesis. Clindamycin therapy is often effective for treatment, but inducible resistance can develop if the isolate exhibits macrolide resistance due to the erm mechanism. Other drugs displaying in vitro activity against community-associated methicillin-resistant S. aureus include trimethoprim-sulfamethoxazole, tetracyclines, quinolones, linezolid and vancomycin. While experience in pediatric patients is limited, daptomycin, ketolides, glycylcyclines, newer glycopeptides and beta-lactamase-stable cephalosporins may be useful in the future. Further research could include well-designed studies of mechanisms of virulence, continued surveillance of changes in pathogenicity and susceptibility, as well as treatment effectiveness.

Anti-Bacterial Agents↗

PubMed2004

Cellulitis.

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Anti-Bacterial Agents↗

PubMed2003

Treatment of community-acquired methicillin-resistant Staphylococcus aureus in children.

PURPOSE OF REVIEW: The concept of methicillin-resistant Staphylococcus aureus (MRSA) associated with broad resistance, nosocomial acquisition, and known risk factors has recently been expanded. A new type of MRSA that is resistant to fewer antibiotics has emerged in pediatric practice since the mid-1990s. These isolates are community acquired and have been reported from diverse geographic regions. Awareness of these organisms is important for appropriate treatment of S. aureus infections in children. RECENT FINDINGS: Community-acquired MRSA (CA-MRSA) isolates are similar in many respects to community-acquired methicillin-susceptible S. aureus (CA-MSSA). There are usually no differences in risk factors between children with CA-MRSA infections and those with CA-MSSA infections or their household contacts. In one study, however, multivariate analysis showed that age greater than 1 year and health care contact in the preceding month were significant risk factors for CA-MRSA. Skin and soft tissue infections are the most common manifestations, although serious invasive infections and death may occur. Pneumonia has been reported more often in children with CA-MRSA than in those with CA-MSSA. Clindamycin is an effective therapy for CA-MRSA, but there is a risk for development of clindamycin resistance during treatment of a CA-MRSA that is clindamycin susceptible and inducibly erythromycin resistant. Trimethoprim-sulfamethoxazole is likely to be effective, and linezolid is a new option for treatment. SUMMARY: The appearance of CA-MRSA has important implications for therapy of infections caused by S. aureus in children. Three specific issues are the development of resistance during clindamycin therapy, insufficient data on the use of trimethoprim-sulfamethoxazole in serious CA-MRSA infections, and the appropriate role for newer antibiotics such as linezolid.

Aged↗

PubMed2002

Chronic vulvovaginitis caused by antibiotic-resistant Shigella flexneri in a prepubertal child.

A 7-year 8-month-old girl was diagnosed with a prolonged course of vulvovaginitis caused by Shigella flexneri. The child was symptomatic with intermittent vaginal bleeding, dysuria and foul smelling vaginal discharge for a 3-year period. Initial attempts to resolve the infection with successive courses of antibiotic therapy using ampicillin, trimethoprim-sulfamethoxazole, cefixime and amoxicillin/clavulanic acid failed. The child's infection was finally resolved by a 14-day course of ciprofloxacin.

Anti-Infective Agents↗

PubMed2002

Clindamycin treatment of methicillin-resistant Staphylococcus aureus infections in children.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) with a narrower antibiotic resistance pattern have emerged. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms. METHODS: We analyzed clindamycin-susceptible MRSA organisms from children (1987 to 2000) along with clinical data. Antibiotic susceptibilities of organisms were tested, pulsed field gel electrophoresis (PFGE) was done and the linked resistance mechanism was detected by the D test. RESULTS: An average of 11 clindamycin-susceptible MRSA per year were obtained from children since 1993. Of 88 isolates 33 (38%) were erythromycin-resistant. The latter were less often community-acquired (45% vs. 69%), more often from infants <1 month of age (24% vs. 4%) and less likely to be in the community acquisition-associated PFGE Group 1 (62% vs. 87%) than those that were susceptible. The D test was positive in 31 of 33 erythromycin-resistant isolates. A 9-month-old boy with pneumonia/empyema caused by a clindamycin-susceptible, erythromycin-resistant, D test-positive MRSA developed a PFGE-identical clindamycin-resistant isolate and clinical relapse during clindamycin treatment. In contrast a 12-year-old girl with abscesses caused by a similar MRSA developed another abscess after clindamycin therapy, but the organism was unchanged in susceptibility. CONCLUSIONS: Erythromycin resistance was present in 38% of clindamycin-susceptible MRSA in children, and clindamycin resistance was detected during treatment in one child. Clindamycin remains a treatment option if the clinician is notified of the risk by the microbiology laboratory and the clinical situation is suitable.

Abscess↗