Microbiological analysis of skin and soft tissue infections in children presenting to a paediatric tertiary care centre in Sri Lanka

Abstract

Introduction: Skin and soft tissue infections (SSTIs) are a common cause of hospitalisation in children. They are diverse in spectrum, ranging from impetigo and abscesses to life threatening necrotising infections. The main pathogens associated with SSTIs are Staphylococccus aureus and Streptococcus pyogenes. Emergence of community acquired methicillin resistant S. aureus (CA-MRSA) is of major concern when antibiotics are required, and it is important to know the prevalence of these pathogens in different geographic locations. This study was done with the aim of identifying and characterising the common bacterial pathogens implicated in SSTIs in children presenting to Sirimavo Bandaranaike Children’s Hospital (SBSCH), Peradeniya, Sri Lanka, which is one of the two paediatric referral hospitals in Sri Lanka.Method: A retrospective, descriptive study analysed data gathered from request forms accompanying pus and tissue sent for culture from patients with SSTIs to the SBSCH microbiology laboratory during a period of 13 months from January 2021 to January 2022.Results: Two hundred and ninety samples were received from suspected SSTIs of which 197 (67.9%) were positive for bacterial growth, with S. aureus present in 163 (83%). Methicillin resistant S. aureus (MRSA) was isolated from 113 (57%) and methicillin sensitive S. aureus (MSSA) from 50 (25%). The frequency of coliforms, Pseudomonas spp., and Group A streptococcus were 31 (16%), 3 (1.5%) and 4 (2%) respectively. Sensitivity of MRSA isolates to cotrimoxazole, clindamycin, ciprofloxacin and erythromycin were 97%, 86%,72% and 29% respectively. Among MSSA isolates, 94% were sensitive to cotrimoxazole, while sensitivity to clindamycin, ciprofloxacin and erythromycin were 74%, 67% and 40% respectively.Conclusion: MRSA was the most frequent pathogen associated with purulent SSTIs in children, followed by MSSA. One fourth of MSSA were resistant to ciprofloxacin and clindamycin. Ciprofloxacin and clindamycin resistance in MRSA was 15% and 28% respectively.