Antibiotic Susceptibility and Treatment Response in Bacterial Skin Infection
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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.
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.
참고문헌 (26)
- Daum RS, "A placebo-controlled trial of antibiotics for smaller skin abscesses", N Engl J Med, 376, pp.2545~2555 (2017)[DOI]
- Ellis MW, "Treatment approaches for community-acquired methicillin-resistant Staphylococcus aureus infections", Curr Opin Infect Dis, 18, pp.496~501 (2005)[DOI]
- Odell CA, "Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections", Curr Opin Pediatr, 22, pp.273~277 (2010)[DOI]
- Chen AE, "Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections", Pediatrics, 127, pp.e573~e580 (2011)[DOI]
- Stevens DL, "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, 59, pp.147~159 (2014)[DOI]
- Leung DYM, "Atopic dermatitis (atopic eczema);Fitzpatrick's dermatology in general medicine. 8th ed.", pp.165~182 (2012), McGraw-Hill
- Boguniewicz M, "Recent insights into atopic dermatitis and implications for management of infectious complications", J Allergy Clin Immunol, 125, pp.4~13 (2010)[DOI]
- Lowy FD, "Staphylococcal infections;Harrison's principles of internal medicine. 19th ed.", pp.954~962 (2014), McGraw-Hill
- Lepainteur M, "Prevalence of resistance to antiseptics and mupirocin among invasive coagulase-negative staphylococci from very preterm neonates in NICU: the creeping threat?", J Hosp Infect, 83, pp.333~336 (2013)[DOI]
- Walraven CJ, "Diagnostic and therapeutic evaluation of communityacquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections in the emergency department", J Emerg Med, 42, pp.392~399 (2012)[DOI]
- 이해진, "원주지역 피부질환의 통계적 고찰(2005∼2009)", 대한피부과학회지, 48(6), pp.460~467 (2010), 대한피부과학회
- Gehrig KA, "Allergic contact dermatitis to topical antibiotics: epidemiology, responsible allergens, and management", J Am Acad Dermatol, 58, pp.1~21 (2008)[DOI]
- Parish LC, "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, 2006, pp.55, 1003~1013
- Gulliford MC, "Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records", BMJ, 354, pp.i3410~ (2016)
- Napolitano LM, "Early appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus", Surg Infect (Larchmt), 9(Suppl 1), pp.s17~s27 (2008)[DOI]
- 김민성, "세균성 피부 질환에서 황색 포도구균의 항생제 감수성에 관한 연구", 대한피부과학회지, 44(7), pp.805~810 (2006), 대한피부과학회
- 정미영, "Antibiotic Susceptibility of Staphylococcus aureus in Atopic Dermatitis: Current Prevalence of Methicillin- Resistant Staphylococcus aureus in Korea and Treatment Strategies", Annals of Dermatology, 27(4), pp.398~403 (2015), 대한피부과학회
- 김우중, "농가진의 원인 균주 및 항생제 감수성에 관한 연구", 대한피부과학회지, 50(9), pp.788~794 (2012), 대한피부과학회
- 박지혜, "지난 11년간 5년 간격으로 살펴본 피부과 외래 환자의 피부 세균 감염의 변화 추세", 대한피부과학회지, 47(6), pp.690~695 (2009), 대한피부과학회
- Prabhu K, "Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples", J Lab Physicians, 3, pp.25~27 (2011)[DOI]
- Woods CR, "Macrolide-inducible resistance to clindamycin and the D-test", Pediatr Infect Dis J, 28, pp.1115~1118 (2009)[DOI]
- Ong PY, "Bacterial and viral infections in atopic dermatitis: a comprehensive review", Clin Rev Allergy Immunol, 51, pp.329~337 (2016)[DOI]
- Choi JH, "Cutaneous immune defenses against Staphylococcus aureus infections", J Lifestyle Med, 4, pp.39~46 (2014)[DOI]
- Huebner J, "Coagulase-negative staphylococci: role as pathogens", Annu Rev Med, 50, pp.223~236 (1999)[DOI]
- Becker K, "Coagulase-negative staphylococci", Clin Microbiol Rev, 27, pp.870~926 (2014)[DOI]
- Archer GL, "Alteration of cutaneous staphylococcal flora as a consequence of antimicrobial prophylaxis", Rev Infect Dis, 13(Suppl 10), pp.S805~S809 (1991)[DOI]