Ann Dermatol.  2018 Apr;30(2):186-191. 10.5021/ad.2018.30.2.186.

Antibiotic Susceptibility and Treatment Response in Bacterial Skin Infection

• Lim JS
• Park HS
• Cho S
• Yoon HS

• KMID: 2414680
• DOI: http://doi.org/10.5021/ad.2018.30.2.186

Abstract

BACKGROUND
Bacterial skin infections occur secondarily in conditions involving a vulnerable skin barrier such as atopic eczema, as well as primarily such as impetigo. They are mainly caused by Staphylococcus aureus and Streptococci. Recently, the prevalence of methicillin-resistant S. aureus has been increasing.
OBJECTIVE
To determine the characteristics of community-acquired bacterial skin infections, to observe their antibiotic susceptibility patterns, and to evaluate factors contributing to the treatment response.
METHODS
We retrospectively reviewed outpatients under 30 years old from 2010 to 2015, from whom we had taken skin swabs for antibiotic susceptibility testing. We collected clinical and microbiological characteristics from the medical records.
RESULTS
We evaluated the culture results of 197 patients and reviewed their medical records. Overall, 86.3% (n=170) of the patients responded to the initial treatment regimen. S. aureus was the most commonly isolated pathogen (52.6%) and showed a high resistance rate to penicillin (90.9%) and oxacillin (36.3%). In the multivariable logistic regression analysis, resistance to 3 or more antibiotics (p=0.044), culture amounts described as "many" (p=0.040), and non-systemic antibiotic use (p < 0.001) were significantly associated with lower treatment response. However, methicillin resistance was not associated with lower treatment response both in univariable and multivariable analyses.
CONCLUSION
Among young patients, S. aureus was the most predominant pathogen present in bacterial skin infections. Resistance to high numbers of antibiotics and the use of non-systemic antibiotics were associated with lower treatment response. First-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings, regardless of methicillin resistance.

Keyword

Antibiotic susceptibility; Bacterial skin infection; Infectious skin diseases; Methicillin resistance

MeSH Terms

Anti-Bacterial Agents
Cephalosporins
Dermatitis, Atopic
Humans
Impetigo
Logistic Models
Medical Records
Methicillin Resistance
Outpatients
Oxacillin
Penicillins
Prevalence
Retrospective Studies
Skin Diseases, Infectious
Skin*
Staphylococcus aureus
Anti-Bacterial Agents
Cephalosporins
Oxacillin
Penicillins

Reference

1. Daum RS, Miller LG, Immergluck L, Fritz S, Creech CB, Young D, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med. 2017; 376:2545–2555. PMID: 28657870.

2. Ellis MW, Lewis JS 2nd. Treatment approaches for community-acquired methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis. 2005; 18:496–501. PMID: 16258322.

3. Odell CA. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections. Curr Opin Pediatr. 2010; 22:273–277. PMID: 20386450.

4. Chen AE, Carroll KC, Diener-West M, Ross T, Ordun J, Goldstein MA, et al. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. 2011; 127:e573–e580. PMID: 21339275.

5. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014; 59:147–159. PMID: 24947530.

6. Leung DYM, Eichenfield LF, Boguniewicz M. Atopic dermatitis (atopic eczema). In : Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw-Hill;2012. p. 165–182.

7. Boguniewicz M, Leung DY. Recent insights into atopic dermatitis and implications for management of infectious complications. J Allergy Clin Immunol. 2010; 125:4–13. quiz 14-15. PMID: 20109729.

8. Lowy FD. Staphylococcal infections. In : Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison's principles of internal medicine. 19th ed. New York: McGraw-Hill;2014. p. 954–962.

9. Lepainteur M, Royer G, Bourrel AS, Romain O, Duport C, Doucet-Populaire F, et al. Prevalence of resistance to antiseptics and mupirocin among invasive coagulase-negative staphylococci from very preterm neonates in NICU: the creeping threat? J Hosp Infect. 2013; 83:333–336. PMID: 23414707.

10. Walraven CJ, Lingenfelter E, Rollo J, Madsen T, Alexander DP. Diagnostic and therapeutic evaluation of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections in the emergency department. J Emerg Med. 2012; 42:392–399. PMID: 21524884.

11. Lee HJ, Choi SI, Ahn SK. A statistical study of dermatoses in Wonju (2005~2009). Korean J Dermatol. 2010; 48:460–467.

12. Gehrig KA, Warshaw EM. Allergic contact dermatitis to topical antibiotics: epidemiology, responsible allergens, and management. J Am Acad Dermatol. 2008; 58:1–21. PMID: 18158924.

13. Parish LC, Jorizzo JL, Breton JJ, Hirman JW, Scangarella NE, Shawar RM, et al. Topical retapamulin ointment (1%, wt/wt) twice daily for 5 days versus oral cephalexin twice daily for 10 days in the treatment of secondarily infected dermatitis: results of a randomized controlled trial. J Am Acad Dermatol. 2006; 55:1003–1013. PMID: 17097398.

14. Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, et al. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ. 2016; 354:i3410. PMID: 27378578.

15. Napolitano LM. Early appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. Surg Infect (Larchmt). 2008; 9(Suppl 1):s17–s27. PMID: 18844471.

16. Kim MS, Chung BS, Choi KC. A study of antibiotic susceptibility of Staphylococcus aureus in bacterial skin infections. Korean J Dermatol. 2006; 44:805–810.

17. Jung MY, Chung JY, Lee HY, Park J, Lee DY, Yang JM. Antibiotic susceptibility of Staphylococcus aureus in atopic dermatitis: current prevalence of methicillin-resistant Staphylococcus aureus in Korea and treatment strategies. Ann Dermatol. 2015; 27:398–403. PMID: 26273155.

18. Kim WJ, Lee KR, Lee SE, Lee HJ, Yoon MS. Isolation of the causative microorganism and antimicrobial susceptibility of impetigo. Korean J Dermatol. 2012; 50:788–794.

19. Park JH, Byun JY, Lee DY, Lee JH, Yang JM, Lee ES. Trends of the bacterial skin infections of dermatology outpatients in 1996, 2001 and 2006. Korean J Dermatol. 2009; 47:690–695.

20. Prabhu K, Rao S, Rao V. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. J Lab Physicians. 2011; 3:25–27. PMID: 21701659.

21. Woods CR. Macrolide-inducible resistance to clindamycin and the D-test. Pediatr Infect Dis J. 2009; 28:1115–1118. PMID: 19935273.

22. Ong PY, Leung DY. Bacterial and viral infections in atopic dermatitis: a comprehensive review. Clin Rev Allergy Immunol. 2016; 51:329–337. PMID: 27377298.

23. Choi JH, Seo HS, Lim SY, Park K. Cutaneous immune defenses against Staphylococcus aureus infections. J Lifestyle Med. 2014; 4:39–46. PMID: 26064853.

24. Huebner J, Goldmann DA. Coagulase-negative staphylococci: role as pathogens. Annu Rev Med. 1999; 50:223–236. PMID: 10073274.

25. Becker K, Heilmann C, Peters G. Coagulase-negative staphylococci. Clin Microbiol Rev. 2014; 27:870–926. PMID: 25278577.

26. Archer GL. Alteration of cutaneous staphylococcal flora as a consequence of antimicrobial prophylaxis. Rev Infect Dis. 1991; 13(Suppl 10):S805–S809. PMID: 1754789.