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Published on: October 15, 2014
Antibiotic Susceptibility and Treatment Response in Bacterial Skin Infection
Ji Soo Lim1, Hyun-Sun Park1, Soyun Cho1
1Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.
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.
Insights
Community-acquired bacterial skin infections are often caused by Staphylococcus aureus. High antibiotic resistance and non-systemic antibiotic use were linked to poorer treatment outcomes in young patients.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Bacterial skin infections, frequently caused by Staphylococcus aureus and Streptococci, arise from compromised skin barriers or as primary infections like impetigo.
- Increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) poses a growing challenge.
Purpose of the Study:
- To characterize community-acquired bacterial skin infections in young outpatients.
- To analyze antibiotic susceptibility patterns of causative pathogens.
- To identify factors influencing treatment response.
Main Methods:
- Retrospective review of 197 outpatients under 30 years old (2010-2015).
- Analysis of skin swab cultures and antibiotic susceptibility testing results.
- Collection of clinical and microbiological data from medical records.
Main Results:
- Staphylococcus aureus was the most common pathogen (52.6%), with high resistance to penicillin (90.9%) and oxacillin (36.3%).
- 86.3% of patients achieved initial treatment response.
- Multivariable analysis revealed that resistance to multiple antibiotics, high bacterial load, and non-systemic antibiotic use were associated with lower treatment response.
- Methicillin resistance did not significantly impact treatment response.
Conclusions:
- Staphylococcus aureus is the predominant pathogen in bacterial skin infections among young patients.
- High-level antibiotic resistance and non-systemic antibiotic use correlate with reduced treatment efficacy.
- First-generation cephalosporins are recommended as effective first-line empirical treatment for outpatient bacterial skin infections, irrespective of methicillin resistance status.
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