Empirical treatment decisions should not be altered yet,” Dr. Kaplan said. “The frequency of CA-MRSA still is high enough that this organism needs to be covered by the empiric treatment options.”

“The epidemiology of S. aureus infections in children is in flux and continuous surveillance of S. aureus infections is critical so physicians faced with making these empiric choices can do so with the most up-to-date information,” he concluded. “The increase in clindamycin resistance is obviously a good example of this.”

Dr. Stephanie A. Fritz, an expert in S. aureus infections from Washington University School of Medicine, St. Louis, Missouri, told Reuters Health by email, “I think for the pediatric community in general, it’s extremely important to be aware of the increasing prevalence of clindamycin resistance, particularly in MSSA isolates, as this has become in recent years, our ‘go to’ antibiotic for skin infections, as well as for stable patients with invasive infection (given its coverage for MRSA and MSSA and Group A Strep in the past).”

“The increasing resistance to ciprofloxacin is also notable, although this drug is less frequently used in pediatrics,” she said. “The finding that SSTI isolates were less likely to be oxacillin susceptible (i.e., more likely to be MRSA) than other infection types is intriguing.”

I think the important take-home message, considering empiric antibiotic coverage, is the importance of being familiar with the local antibiogram (this is also highlighted by the authors within the article) and use this data to inform the choice of empiric antibiotic therapy,” Dr. Fritz concluded. “If the prevalence of clindamycin-resistant S. aureus strains is high in the region, clinicians should consider the use of TMP/SMX in patients . . . for whom antibiotics are indicated.”

The authors reported no funding or disclosures.