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Updated: Feb 1, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis
Vivian Wang1, Matthew Keefer2, Peck Y Ong3
1Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
Insights
Antibiotic prescribing for hospitalized children with atopic dermatitis (AD) exacerbations often uses anti-MRSA drugs, despite lower MRSA rates in AD patients compared to those with infections. This suggests current empiric antibiotic choices may be inappropriate for AD exacerbations.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Pharmacology
Background:
- Systemic antibiotics are frequently prescribed for severe atopic dermatitis (AD) exacerbations in hospitalized children.
- Current antibiotic prescribing patterns for these patients are not well-understood.
Purpose of the Study:
- To compare antibiotic prescribing patterns in children hospitalized for atopic dermatitis (AD) exacerbation versus those hospitalized for infectious complications.
Main Methods:
- A retrospective review of electronic medical records for patients under 18 hospitalized between 2003-2018.
- Data collected included patient history, physical exam, discharge summaries, antibiotic treatments, and laboratory/culture results.
- Statistical analysis, including t-tests, compared clinical and laboratory features between groups.
Main Results:
- 174 patients were included: 70 with AD exacerbation and 104 with infectious complications.
- 80% of AD exacerbation patients received systemic antibiotics; clindamycin and vancomycin were common on admission.
- Methicillin-resistant Staphylococcus aureus (MRSA) rates were lower in AD exacerbation (22%) compared to infectious complications (39%).
Conclusions:
- Children with atopic dermatitis exacerbation and infectious complications often receive broad-spectrum antibiotics targeting MRSA.
- The lower prevalence of MRSA in AD exacerbation suggests that empiric antibiotic selection for infectious complications may not be optimal for AD exacerbation.
- Further research is needed to refine antibiotic guidelines for pediatric atopic dermatitis management.
Background:
Systemic antibiotics are commonly used in hospitalized patients with severe atopic dermatitis (AD) exacerbation. However, the antibiotic prescribing patterns are unclear.
Objective:
To compare the prescribing patterns of antibiotics for children who were hospitalized for AD exacerbation and infectious complications.
Methods:
Electronic medical records were reviewed for patients younger than 18 years who were hospitalized for AD exacerbation or infectious complications based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes from 2003 to 2018. The following information was obtained: history, physical examination findings, physician discharge summary, antibiotic treatments, serum tests, and wound cultures. The t test was used to compare clinical and laboratory features.
Results:
A total of 174 patients with AD were included. Seventy patients had AD exacerbation and 104 had infectious complications, including cellulitis, abscesses, invasive infections, and eczema herpeticum. The differences between these 2 groups of patients were further verified by length of stay, serum total IgE level, and inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). A total of 56 of 70 patients (80%) with AD exacerbation were treated with a systemic antibiotic. Clindamycin and vancomycin together accounted for 88% of antibiotics on admission for both groups, whereas clindamycin and sulfamethoxazole-trimethoprim were prescribed at similar rates for both groups at discharge. Wound culture results showed that the methicillin-resistant Staphylococcus aureus (MRSA) rate was significantly lower in children with AD exacerbation (22%) vs infectious complications (39%).
Conclusion:
Children were treated with a high frequency of anti-MRSA antibiotics for inpatient AD exacerbation and infectious complications. However, the rate of MRSA was significantly lower in children with AD exacerbation. Thus, empiric antibiotic choice for infectious complications may not be appropriate for AD exacerbation.
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