Antibiotics, S aureus Colonization, and Recurrent Skin Infections

Abstract

Research Article| February 01 2018 Antibiotics, S aureus Colonization, and Recurrent Skin Infections AAP Grand Rounds (2018) 39 (2): 16. https://doi.org/10.1542/gr.39-2-16 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antibiotics, S aureus Colonization, and Recurrent Skin Infections. AAP Grand Rounds February 2018; 39 (2): 16. https://doi.org/10.1542/gr.39-2-16 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: microbial colonization, skin diseases, infectious, staphylococcus aureus, skin and soft tissue infections, clindamycin Source: Hogan PG, Rodriguez M, Spenner AM, et al. Impact of systemic antibiotics on Staphylococcus aureus colonization and recurrent skin infection [published online ahead of print August 24, 2017. Clin Infect Dis. doi: https://doi.org/10.1093/cid/cix754 Investigators from Washington University, St. Louis, MO, and Southern Illinois University, Springfield, IL, assessed the effect of systemic antibiotics prescribed at the time of incision and drainage (I&D) for Staphylococcus aureus skin and soft tissue infections (SSTI) on rates of future colonization and recurrent infections in children. The investigators combined data from a series of prospective studies, conducted in patients <21 years old with S aureus SSTI since 2008. At the time of I&D (baseline), swabs of the anterior nares, inguinal folds, and axillae of study participants were obtained. For the current study, only children who had S aureus colonization at one or more of these sites were included. Additional data collected at baseline included demographics, decolonization measures (intranasal mupirocin, dilute bleach, or chlorhexidine body washes), whether the infecting S aureus was methicillin-sensitive (MSSA) or resistant (MRSA), and whether the child received antibiotics recommended by the Infectious Diseases Society of America (eg, clindamycin or trimethoprim-sulfamethoxazole [TMP-SMZ]).1 Repeat swabs to determine colonization status were done up to 3 months after baseline. In addition, follow-up data were collected for up to a year after baseline to assess for recurrent SSTI. Cox regression was used to assess the association between use of a guideline-recommended antibiotic at baseline on future colonization or recurrent SSTI, after adjusting for age, race, SSTI isolate (MRSA or MSSA), and number of anatomic sites colonized at baseline. Data were analyzed on 383 children with a median age of 3 years. Overall, 81% of baseline SSTI were caused by MRSA. Baseline colonization was most often detected in inguinal folds, followed by anterior nares; 46% of study participants were colonized at multiple sites. At the time of I&D, 93% of children were prescribed a guideline-recommended antibiotic (clindamycin or TMP-SMZ). Follow-up colonization data were collected on 357 participants. The risk of S aureus colonization at follow-up was significantly lower for children receiving recommended antibiotics compared to those receiving non-recommended or no antibiotics at baseline (colonization rates 48% and 77%, respectively, adjusted hazard ratio [aHR] 0.49, 95% CI 0.30, 0.79). Children receiving clindamycin at baseline were significantly less likely to be colonized at follow-up than those receiving TMP-SMZ (44% and 57%, respectively; P = .03). Recurrent SSTI occurred in 40% of children receiving a recommended antibiotic at baseline vs 64% of those receiving a non-recommended or no antibiotic (aHR = 0.57, 95% CI 0.34, 0.94). The authors conclude that use of clindamycin or TMP-SMZ at the time of I&D in children with an SSTI caused by S aureus reduces the risk of future colonization and rates of recurrent SSTI. Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The results of this study join others supporting... You do not currently have access to this content.