Abstract
The aim of this study was to identify the causative secondary bacterial infection in scabies and its susceptibility against systemic antimicrobials. We performed a cross-sectional descriptive study of 34 scabies patients clinically diagnosed by investigators through consecutive sampling in one District Hospital in West Java, Indonesia from January to March 2017. The secondary bacterial infection was confirmed by Gram staining. Bacterial culture was derived from intact pustules, then identified using Vitek® 2 system, including its susceptibility against 30 systemic antimicrobials. The result of bacterial identification consisted of 48.89% Group A Beta-Hemolytic Streptococcus (GABHS), 44.44% Staphyloccocus aureus (S. aureus), 4.44% Staphylococcus epidermidis (S. epidermidis) and 2.22% Klebsiella pneumoniae (K. Pneumoniae). All bacterias were sensitive to carbapenem group, however resistant to cephradine and kanamycin. The overall percentages of GABHS sensitivity to the tested antibiotics were as follows: 95.45% for chloramphenicol and ceftriaxone, 90.91% for amoxicillin/clavulanate, 86.36% for clindamycin, cloxacillin, cefotaxime, 72.27% for ciprofloxacin and methicillin. Sensitivity of S. aureus to the antibiotics were as follows: 100.00% for methicillin, 95.00% for clindamycin and cloxacillin, 90.00% for ciprofloxacin and levofloxacin, 85.00% for cotrimoxazole and 75.00% for ceftriaxone. The sensitivity of S. epidermidis to clindamycin, amoxicillin/clavulanate and methicillin were 100.00%. All of K. pneumoniae (100.00%) were sensitive to ciprofloxacin, cotrimoxazole, ampicillin/sulbactam, cefazolin, ceftriaxone, ceftazidime and cefepime. The most common etiology of secondary infection in scabies were GABHS and S. aureus with varying sensitivity and oral clindamycin is a drug of choice which can be given to pediatric or adults patients.
Highlights
Bacterial skin infections or pyodermas are still common in most developing countries (Hay et al, 2014)
Bacterial infection in scabies was marked by pustules at sites of predilection and was proved by Gram staining with the appearance of Gram-positive or Gram-negative cocci or rods
Group A Beta-Hemolytic Streptococcus (GABHS) accounted for 35.29% of these infection, followed by S. aureus (29.41%)
Summary
Bacterial skin infections or pyodermas are still common in most developing countries (Hay et al, 2014). Adults acquire pyoderma through close contact with infected children (Halpern and Heymann, 2008). One study in 2012 reported that among the various diseases that were found to be associated with primary pyodermas, scabies was the most common, seen in 8.50% cases (Gandhi et al, 2012). Most of pyodermas are caused by Gram positive bacteria, especially either S. aureus or GABHS (Bowen et al, 2015). S. aureus in pyoderma may cause serious complications, such as invading the bloodstream, producing bacteremia (Vanderkoo et al, 2011) and infective endocarditis (Twele et al, 2010). Acute Post-Streptococcal Glomerulonephritis (APSGN) in several studies (Streeton et al, 1995; White et al, 2001; Rodriguez-Iturbe and Haas, 2016), acute rheumatic heart disease (Edison et al, 2015) and death (Wong and Stevens, 2013) may follow GABHS infections
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