dibekacin and Infant--Premature--Diseases

  Staphylococcal scalded skin syndrome (SSSS), caused by methicillin-resistant Staphylococcus aureus (MRSA) producing exfoliative toxin (ET), is a life-threatening infection for neonates in neonatal intensive care units (NICUs). SSSS in extremely low-birth-weight (ELBW) neonates is rare. A new class of MRSA (community-acquired MRSA, CA-MRSA) has been emerging in the community. The aim of this study was to characterize MRSA from an ELBW neonate with SSSS, and to develop rapid detection methods for SSSS-associated and emerging pediatric MRSA..   An ELBW infant in the NICU developed SSSS on day 16 after birth. Isolated MRSA was genetically characterized and compared with CA-MRSA from bullous impetigo (biCA-MRSA), which is positive for the ET and collagen-adhesin (CNA) genes in many cases, and the Panton-Valentine leucocidin (PVL) gene rarely. Specific primers and probes for five virulence genes (for ETA, ETB, ETD, PVL, CNA) were designed for multiplex polymerase chain reaction (PCR) and real-time PCR..   MRSA strain H5 from SSSS exhibited the genotype (ST91, spa416[t375], agr3, SCCmecIVa, CoaI), and possessed the ETB and CNA genes, similar to ST91 biCA-MRSA (albeit with a divergence). Multiplex PCR detected the ETB and CNA genes of strain H5, and real-time PCR detected strain H5 at as low as 10(2)  CFU/mL. The assays were 100% specific and 100% sensitive, for the five virulence genes..   ETB-positive ST91 MRSA, which was very similar to ST91 biCA-MRSA, was isolated from an ELBW infant with SSSS. The multiplex and real-time PCR assays specifically or quantitatively detected SSSS-associated and emerging pediatric MRSA.

Topics: Anti-Infective Agents; Dibekacin; Humans; Immunoglobulin G; Immunologic Factors; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin-Resistant Staphylococcus aureus; Polymerase Chain Reaction; Staphylococcal Scalded Skin Syndrome

Once a day of arbekacin (ABK) administrations based on a new object of peak concentration setting on 9-20 microg/mL were performed to 14 neonates. The gestational ages were 27.3 +/- 4.2 weeks. As to the preparing initial dosage, Therapeutic Drug Monitoring Program soft was used. Mean daily dose of 6.2 +/- 0.4 mg/kg bodyweight was administered every 24 to 48 h by 30 min intravenous infusion. Mean serum peak concentrations of ABK and those of trough concentrations were 15.2 +/- 4.3 microg/mL and 2.0 +/- 1.4 microg/mL respectively. The relationship between the measured values (y) and predicted values (x) showed the regression equation y = 0.969 + 0.931x (R2 = 0.769, n = 35), which suggested the usefulness of the dosage design. Overall clinical effectiveness was 78.9% (11/14). There were no obvious adverse effects including abnormal auto auditory brainstem responses and serum creatinine increase. Effectiveness rate and no adverse effects suggested that once a day of ABK therapy in neonate including extremely preterm infant was preferable regimen.

Topics: Anti-Infective Agents; Dibekacin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Dibekacin; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Vancomycin