Secondary Skin Infections Research Articles

Scabies: current knowledge and future directions

Scabies is a global public health issue, with approximately 455 million new cases worldwide each year. Scabies is a parasitic skin disease caused by infestation with the mite Sarcoptes scabiei var. hominis that can lead to secondary skin infections such as impetigo. In 2017, scabies was added to the World Health Organization’s list of neglected tropical diseases renewing calls for effective management and control of the disease. Mass drug administration has emerged as an effective strategy to control scabies, especially in highly endemic settings. In this review, we detail scabies epidemiology and risk factors, clinical characteristics and diagnosis, as well as control options, and future areas for scabies research.

Exploring mechanisms of mupirocin resistance and hyper-resistance.

Mupirocin is a broad-spectrum antibiotic that acts predominantly against Gram-positive bacteria. It is produced by Pseudomonas fluorescens NCIMB 10586 and has been clinically used to treat primary and secondary skin infections and to eradicate nasal colonisation of methicillin-resistant Staphylococcus aureus strains. Mupirocin inhibits protein synthesis by blocking the active site of isoleucyl-tRNA synthetase (IleRS), which prevents the enzyme from binding isoleucine and ATP for Ile-tRNAIle synthesis. Two types of IleRS are found in bacteria - while IleRS1 is susceptible to mupirocin inhibition, IleRS2 provides resistance to cells. These two types belong to distinct evolutionary clades which likely emerged from an early gene duplication in bacteria. Resistance in IleRS2 is based on the loss of interactions that govern mupirocin binding to IleRS1, such as hydrogen bonding to the carboxylate moiety of mupirocin. IleRS2 enzymes with Ki in the millimolar range have recently been discovered. These hyper-resistant IleRS2 variants surprisingly have a non-canonical version of the catalytic motif, which serves as a signature motif of class I aminoacyl-tRNA synthetases to which IleRS belongs. The non-canonical motif, in which the 1st and 3rd positions are swapped, is key for hyper-resistance and can be accommodated without abolishing enzyme activity in IleRS2 but not in IleRS1. Clinical use of mupirocin led to the emergence of resistance in S. aureus. Low-level resistance arises by mutations of the housekeeping IleRS1, while high-level resistance develops by the acquisition of the resistant IleRS2 on a plasmid. There is no evidence that hyper-resistant variants have been found in clinical isolates.

Machine learning-based monkeypox virus image prognosis with feature selection and advanced statistical loss function

Recently, the monkeypox virus has gained paramount attention due to various complications entangled within it. These complications encompass pneumonia, eye problems, and secondary-skin infections. Current complications include swelling and sores within the rectum that would result in pain or complexity while urinating. Due to such complexities, it is crucial for monkeypox detection. Concurrently, with the evolvement of AI (Artificial Intelligence) based methods, existing works have tried to perform better detection of monkeypox and non-monkeypox. Nevertheless, these studies have been lagging in accuracy rate. As an enhancement, this study proposes RN-50-ZCA (Residual Network-50-Zero Phase Component Analysis) for feature extraction to attain enhanced classification performance. ZCA-whitening is utilized with RN-50, which assists in accurately identifying the features that agree with the image lesions. This approach incorporates data normalization and later linear transformation that has been considered to support lessening co-variance among the features. This also maintains the concrete variance. To fuse the features, PCA (Principal Component Analysis) is used. Finally, the research proposes MXGBoost (Modified eXtreme Gradient Boosting) based on statistical loss function for classifying monkeypox and non-monkeypox images (other viral samples, chickenpox samples, and smallpox samples) for acquiring effective prediction. Using MXGBoost with the loss function aids in extemporizing the prediction rate of the model by considering certain features of the issues being modelled. With such factors, the proposed loss function can support diminishing overfitting, thereby improvising the generalizability of the model. The performance of this study is assessed by comparison with three studies, and the analytical results exposed the better prediction rate of the proposed system.

The impact of varicella vaccination: A 2005–2019 interrupted time series analysis

ABSTRACT Varicella is an acute, highly contagious disease in susceptible individuals and is preventable through vaccination. This study aimed to determine the impact of varicella vaccination on hospitalizations and complications at a pediatric reference hospital in Panama before and after the vaccine introduction. This descriptive ecological study analyzed clinical records of patients diagnosed with varicella through a retrospective and interrupted time series analysis. An autoregressive integrated moving average model was built to compare the incidence rates observed after vaccination with those expected rates derived from the model. A statistical model was fitted to the observed interrupted time series data by regression and used to predict future trends. The mean difference in varicella hospital discharges before and after the introduction of the varicella vaccine was 47%. The rate of hospitalizations for varicella decreased to 52.3%. A declining trend in varicella hospitalizations was observed from 2015 after vaccine introduction in 2014. Complications in vaccinated patients were secondary skin and soft tissue infection, possibly due to bacterial superinfection. The impact of varicella vaccination on reducing varicella hospital discharges reported at a pediatric reference hospital in Panama was confirmed.

Microbiological assessment of the effectiveness of standard therapy in atopic dermatitis

Background. Atopic dermatitis is an inflammatory skin disease characterized by recurrent lesions and intense pruritus. Nowadays there is a stepwise approach to the treatment of atopic dermatitis, which is defined by disease intensity and complications such as secondary skin infections. However, the current management of atopic dermatitis may not always lead to the expected outcome due to not only immune dysregulation of both adaptive and innate immunity but also imbalance of the skin microbiome.
 Aims. The aim of the study was to evaluate changes in the composition of the skin microbiome in both lesional and non-lesional skin in patients with atopic dermatitis during standard treatment.
 Materials and methods. Twenty patients with atopic dermatitis and twenty six healthy controls over 18 years old were included into the study. All microbiome samples were obtained from lesional and non-lesional skin sites of atopic dermatitis patients before and after therapy. Whereas samples from healthy controls were taken once from a flexor surface of the elbow. Species identification of clinical isolates were identified using MALDI Biotyper Sirius (Bruker Daltonics).
 Results. At baseline, the prevalence of S. aureus colonization among patients with atopic dermatitis was 34.20% in lesional skin and 32.50% in non-lesional skin. After treatment, there was a significant decrease in the prevalence of S. aureus carriage in both lesional and non-lesional skin areas (р 0.05). However, no significant difference was observed in the proportion of all other staphylococci (р 0.1). Interestingly, S. aureus was not found in healthy controls.
 Conclusions. The results of the study demonstrated the effectiveness of standard therapy for managing patients with atopic dermatitis as it had a positive impact on the skin microbial community and showed a decrease in S. aureus proportion after the treatment.

Skin microbiome and modern treatment options for complicated forms of atopic dermatitis

Currently, atopic dermatitis is considered a systemic multifactorial disease, and its development involves various factors, mainly genetic disorders, epidermal barrier impairment, microbiome changes, allergen sensitization, and nonspecific environmental factors.
 The microbial skin barrier in patients with atopic dermatitis has its characteristics due to changes in the species composition of the microflora toward contamination by conditionally pathogenic microorganisms, which have a significant effect on the disease course, leading to secondary skin infection and exacerbations. Microbes and allergens percutaneously penetrate the disrupted epidermal barrier, leading to sensitization to various proteins, including bacterial and fungal proteins, characterizing the t2 immune response.
 The treatment of atopic dermatitis aims at achieving long-term control over the disease through an integrated approach, including external and systemic therapy.

Monkeypox (mpox) in immunosuppressed patients

The World Health Assembly declared that smallpox had been completely eradicated from the human population in 1980. Monkeypox, a zoonosis native to damp forested regions in West and Central Africa, is the illness that is most comparable to smallpox clinically and immunologically. Both illnesses could be prevented by the smallpox vaccine. Although the monkeypox virus is a less effective human disease than the smallpox virus, it could now spread among human populations if smallpox had not been eradicated and population-wide immunity had not been developed. A health warning on severe monkeypox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advise does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as "having autoimmune disease with immunodeficiency as a clinical component". The documented severe signs of monkeypox include widespread rashes with secondary fungal or bacterial skin infections or tissue death (necrosis), intestine obstruction, and difficulties with the heart, lungs, urinary system, and nervous system. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, "of the people with severe monkeypox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression". The current article goes into great detail about monkeypox disease occurring in immunocompromised patients and preventive guidelines.

Is Vitamin D3 a Worthy Supplement Protecting against Secondary Infections in Dogs with Atopic Dermatitis?

Canine atopic dermatitis (CAD) is a common, chronic, inflammatory skin disease in dogs worldwide. This disease often predisposes for secondary organisms overgrowth and skin infections with pathogens, such as Staphylococcus pseudintermedius and Malassezia pachydermatis. Unfortunately, the causes of this disease in both humans and animals are not fully understood; therefore, the only possible option is a lifelong, symptomatic treatment. The management of CAD is mainly based on limiting contact with allergens and antipruritic therapy, most often with glucocorticoids and antihistamines. A serious problem in this situation is the fact, that long-term administration of glucocorticoids leads to side effects like polyuria, alopecia, increased susceptibility to infection, muscle atrophy, and many others. For this reason, great emphasis is placed on the development of replacement and supportive therapies. It is a well-documented fact that reduced concentrations of serum vitamin D3 contribute to the severity of atopic dermatitis symptoms in humans. Moreover, unlike the most commonly used therapeutic methods, of which the main goal is to ameliorate inflammation and pruritus, namely the symptoms of AD, vitamin D3 supplementation affects some underlying factors of this disease. Therefore, in this review, we summarize the current state of knowledge regarding the role of vitamin D3 in CAD, its protective effect against secondary bacterial and fungal infections, and the potential of its supplementation in dogs.

Intersecting HIV and mpox epidemics: more questions than answers.

Intersecting HIV and mpox epidemics: more questions than answers.

Physical Development and Puberty in Related Patients with Kindler Epidermolysis Bullosa: Case Study

Background. Kindler epidermolysis bullosa is orphan, autosomal recessive disease and it is one of the variants of congenital epidermolysis bullosa. Its severe course is characterized by high risk of multifactorial malnutrition, chronic inflammation due to recurrent secondary skin infections, and also bone metabolism disorders, what can lead to disorders in physical development and puberty in children. However, the effect of Kindler epidermolysis bullosa on patients’ physical development and puberty remains unexplored.Clinical case description. Family case of Kindler epidermolysis bullosa was presented in 13 and 12 years old patients, third degree of kinship (maternal, uncle — nephew) with typical clinical manifestations for this disease. The diagnosis was confirmed in both patients via Sanger sequencing and revealing identical pathogenic variants in the FERMT1 gene (two deletions in the compound-heterozygous state — c.778del, p.Q260Kfs*21 and c.1088del, p. L363Wfs*39). Reduced concentrations of testosterone and 25(OH)D were revealed, whereas, increased concentration of adrenocorticotropic hormone — only in the older patient. The concentrations of luteinizing hormone, follicle-stimulating hormone and estradiol in both patients were within the reference values. The younger patient had prepubertal sizes and volume of testicles. Both patients had specific features of psychoemotional state: mood swing with rapid increase in anxiety level in the older patient and difficulties in emotional-volitional regulation in younger one.Conclusion. Patients with Kindler epidermolysis bullosa have high risk of physical development and puberty delay due to its systemic chronic pathological process. Thus, these patients require dynamic follow-up by pediatrician and pediatric endocrinologist.

A Review of the Recent Monkeypox Outbreak in 2022.

The coincidence of the monkeypox outbreak with the coronavirus disease 2019 (COVID-19) pandemic raises a global concern about a potential new pandemic and the possible consequences. As the World Health Organization declared the international monkeypox outbreak a global emergency, there is apprehension about the complications and mortality of monkeypox infection.The monkeypox virus is a zoonosis: a disease that is transmitted from animals to humans. It is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus. Human-to-human transmission occurs with close contact with respiratory secretions, sores on an infected person's skin, or contaminated items like clothing.Monkeypox is endemic in regions of Africa, however, because of smallpox eradication and a decrease in vaccination efforts, this led to an outbreak in the United States of America in 2003 and a new world outbreak in 2022.Most patients experience prodromal sickness with fever, malaise, and enlarged lymph nodes before developing a rash. In addition to skin lesions, individuals may also experience secondary skin and/or soft tissue infection, pneumonitis, ocular problems, and encephalitis. There is an increased risk of infection among men who have sex with men and human immunodeficiency virus infection (HIV) patients. The polymerase chain reaction is the gold standard for diagnosis. Management is usually supportive but some cases may require tecovirimat. This is a comprehensive review of monkeypox virus epidemiology, clinical features, and the most up-to-date, effective management and prevention.

Formulation and evaluation of anti-fungal and anti-bacterial novel herbal cream using Senna alata, Wrightia tinctoria and Datura metel

The main intention of these studies was to formulate and evaluate a novel herbal cream which includes Senna alata,Wrightia tinctoria and Datura metel for the treatment of secondary skin infections. The most suitable route for skin infection is topical. The development of topical drug transport systems designed to have systemic results appears to be useful for a number of drugs as a result of the numerous advantages over traditional routes of drug administration. In this study a novel herbal cream formulation consisting of Senna alata,Wrightia tinctoria and Datura metel was prepared. This study was subjected to in-vitro diffusion method. Microbiological studies were carried out the safety of materials used inside the formulation. The formulated cream was found to be safe and effective for the treatment of skin infection.

Ekbom syndrome: a case report

IntroductionEkbom syndrome is a clinical term for delusional parasitosis, a condition characterized by the belief that one’s skin is infested by invisible parasites. Despite having no medical evidence, patients strive to prove their illness and interpret different sensations and symptoms as infestation with parasites.ObjectivesOur objective was to present a case report of a patient with Ekbom syndrome with detailed clinical information and treatment complications.MethodsWe included patient’s history, psychiatric evaluation, complete diagnostic work-up, therapy and follow-up.ResultsA 60-years old female patient was admitted to her first hospital treatment in our psychiatric clinic. Upon admittance, she was extremely tense, preoccupied with the idea that bed bugs have infested her body. She showed extensive medical documentation, including numerous dermatologic reports regarding her condition, interpreting them in accordance with her delusions. In attempt to help herself and “release” the bugs, she harmed herself causing multiple skin lesions across her body and face. The treatment was complicated with secondary skin infections, ulcers, cellulitis and oedemas. Initial treatment with olanzapine was switched to risperidone due to side-effects (sedation, increase of appetite, weight gain). Gradually, with pharmacological treatment, psychoeducation and support, remission was achieved, but poor insight to her previous condition and psychiatric symptoms remained.ConclusionsEkbom syndrome presents a serious disorder that can be complicated with secondary somatic complications, often requiring involvement of different medical specialists. Moreover, lack of insight into the need for psychiatric treatment can lead to therapy discontinuation and relapse of symptoms.DisclosureNo significant relationships.

Altta yatan Komorbiditeleri Olan Çocuklarda Herpes Zoster: 10 Yıllık Retrospektif Tek Merkez Deneyiminin Değerlendirilmesi

Aim: It was aimed to evaluate the complications and prognosis of pediatric patients diagnosed with Herpes zoster(HZ) with an underlying comorbidity. Materials and Methods: Between 01.01.2011-01.01.2021 in our clinic; patients aged 0-18 years, with underlying comorbidities and diagnosed with HZ, who were followed up and treated, were evaluated retrospectively. Sociodemographic characteristics, clinical findings, treatments applied during hospitalization, complications developed during follow-up and prognosis were obtained from hospital file archive records. Results: The mean age was 9.25±4.79 years, and 53.4% of patients were male. The most common symptom was rash, followed by pain and itching. Most commonly, 23 (51.1%) patients had thoracic dermatome involvement. Dissemination did not develop in any of the patients. 8.9% of the patients had chickenpox, 4.4% had varicella vaccine, and 48% had no history of varicella-zoster virus transmission. Acute leukemia and having had a bone marrow transplant were the most common co-existing conditions. Median time between onset of symptoms and diagnosis was 3 (min-max=1-10) days. Median length of hospitalization was 7 (min-max=3-21) days, and the mean total treatment time was 9.33±3.58 days. It was determined that only 4 patients developed secondary skin infection, 44 patients were cured, and 1 patient died due to the primary disease. Conclusion: While HZ is rare in healthy children, it can progress with serious complications in those with an underlying disease. To consider HZ in differential diagnosis of vesicles in immunocompromised patients, to start treatment with early diagnosis; It is of great importance in terms of complications and prognosis that may develop.

WANITA 62 TAHUN DENGAN MALNUTRISI BERAT DAN TOXIC EPIDERMAL NECROLYSIS

Malnutrition and skin problems are interrelated; therefore malnutrition will reduce the function of innate and adaptive immunity. The skin contains immune cells that is crucial for host defense. A 62-year-old female patient was diagnosed with Toxic Epidermal Necrolysis (TEN) due to an unknown drug allergy and severe malnutrition. The patient has a history of inadequate intake for 1 year ago and has worsened in the last 2 weeks due to blisters all over the skin, especially in the labium oris area after taking an unknown analgetic medication. Nutrition therapy had given with a target of 1900 kcal/day gradually increased to 2200 kcal/day through enteral and parenteral with a protein of 1.5 grams/kgIBW/day. Because of patients has history of aversion to food types such as chicken, eggs, fish, cow's milk, and dairy products, so patient had given soy-based polymeric formula and Parenteral Nutrition Supplement to achieve nutrition requirement. Supplementations administered were zinc, vitamin A, vitamin B complex, and vitamin C. At the end of the treatment period there were metabolic improvement such as wound healing without secondary skin infection and improvement of albumin serum from 2,3 g/dL to 3,3 g/ dL. Patients experienced side effects due to systemic corticosteroids in the form of moon face, severe muscle wasting, hyperglycemia, and hypertension. However, the use of systemic corticosteroids should pay attention to whether the benefits outweigh the disadvantages.
 Keywords: toxic epidermal necrolysis, malnutrition, corticosteroid, aversion

Prevention and correction of radiation dermatitis with basic skin care: doctor and patient consensus

External beam radiation therapy is widely used by doctors around the world as one of the most common form of cancer treatment. The radiotherapy can help reduce the treatment aggression as compared with the surgical intervention in a large number of clinical situations, which ensures that the patient's quality of life will be decreased to a lesser extent in the after-treatment period. However, like the vast majority of anticancer treatments, the radiation therapy has a number of side effects, which are classified into acute radiation reactions and post-radiation injuries. Among them is radiation dermatitis, which is one of the most common adverse reactions to the radiotherapy. This complication manifests as erythema, as well as hyperpigmentation, dry and itchy skin, hair loss. In addition to the obvious negative impact on the patient's quality of life, some of the above factors can result in the development of a secondary skin infection. As one of the most frequent post-radiation complications, radiation dermatitis places radiotherapists before a challenge to reduce the incidence rates of this side effect, as well as to decrease the intensity of its clinical manifestations if it occurs. This challenge suggests the search for targeted drugs aimed to prevent and treat clinical symptoms. To date, dermatocosmetic products that are used to relieve skin manifestations of radiation treatment complications is an alternate option of the effective solution to the problem of radiation dermatitis. In the described clinical case, we assess the experience of using some of the dermatocosmetic products in a patient with a florid form of radiation dermatitis.

Atopic dermatitis and skin infections are a poorly documented crisis in Canada's Indigenous pediatric population: It's time to start the conversation.

Canadian Indigenous youth continue to face higher rates of health disparities than their non-Indigenous counterparts. In dermatology, this includes a high burden of atopic dermatitis, as well as secondary skin and soft tissue infections. Unfortunately, numerous barriers to treatment exist, including systemic and institutional racism, poverty, crowded housing conditions on reserves, access and cost of basic skin care regimens, and clean water access. As per the Truth and Reconciliation Commission, Canadian dermatologists have been called upon to train more First Nations, Metis, and Inuit physicians to ensure we are providing high-quality, anti-racist, culturally appropriate care to Indigenous peoples.

Impact of six years of routine varicella vaccination on the disease-related hospitalizations at Minas Gerais, Brazil

IntroductionThe varicella vaccine was first introduced into the Brazilian immunization schedule in September 2013 as a single dose for children aged 15 months. In 2018, a second dose was recommended for individuals between 4 and 6 years old. This study aims to assess the impact of routine varicella vaccination on the number and profile of hospitalized varicella patients during the single dose period, as well as in the first two years after the adoption of the second dose. MethodsAn observational retrospective study was conducted in an infectious disease pediatric hospital, in Minas Gerais, Brazil. Clinical as well as epidemiological data from patients hospitalized due to varicella between 2010 and 2019 were collected. Patients were split into groups based on the vaccine introduction: pre-vaccine period, single dose and two-dose period. They were compared by age, sex, reason for admission, illness-related complications and clinical outcome. ResultsThere were 1193 admissions due to varicella during the studied period. When compared with the pre-vaccine period, the number of hospitalizations decreased in 61.5% during the single-dose regime, reaching 95.2% in the two-dose period. Hospitalization rates decreased in all age groups, including non-vaccinated individuals such as those younger than 12 months (92.1%). As for reasons of admission, secondary bacterial skin infections were perceived to be the most common cause (>70%). A reduction was also seen in admission of immunocompromised or HIV positive patients (84.8%). ConclusionThe collected data shows a significant impact in the number of hospital admissions due to varicella after six years of the implementation of the vaccine, positively affecting both vaccinated and non-vaccinated individuals. Further reduction was seen after the second dose was initiated, but its true impact will only be understood fully after a longer period of continuous vaccination.

Determination of nasal carriage and skin colonization, antimicrobial susceptibility and genetic relatedness of Staphylococcus aureus isolated from patients with atopic dermatitis in Szczecin, Poland

BackgroundAtopic dermatitis (AD) is one of the most frequent chronic and inflammatory skin condition. AD is characterized by damaged epidermal barrier, xerosis and pruritus of eczematous skin lesions which tend to flare. The duration and frequency of exacerbation of AD symptoms markedly affects the quality of patient life. AD results from the interplay between host genetics, immunity, and environmental factors, however the detailed pathogenesis of this disease is still not entirely cleared. Furthermore, disturbances of the skin microbiota and skin functional impairment predispose to secondary skin infections. Staphylococcus aureus colonizes skin and mucous membranes of 20 to 80% of healthy individuals and of 90% of patients with AD in whom this bacterium is accounted as an important AD exacerbating factor. It is also proven, that S. aureus nasal carriage significantly increases the risk for self-transmission and endogenous infection. In the current study the presence of S. aureus either in nasal vestibule and on lesioned skin of 64 patients with AD enrolled in 10-year autovaccination program was determined. The genetic relatedness of 86 S. aureus isolated from patients nose and skin using Pulsed Field Gel Electrophoresis (PFGE) and antimicrobial susceptibility of all strains to methicillin, erythromycin, clindamycin, mupirocin, gentamicin, amikacin, tetracycline, chloramphenicol and cotrimoxazole was also evaluated.ResultsIn total 23 PFGE genotypes and 24 unique patterns were distinguished. 34 patients were S. aureus nasal carriers. Simultaneous presence of S. aureus in nose and on affected skin was found in 16 carriers colonized by indistinguishable or potentially related S. aureus vs 2 carriers colonized with non-related S. aureus in nasal vestibule and on skin.4 isolates were methicillin resistant (MRSA) among which 3 showed constitutive MLSB resistance phenotype and remaining one was resistant to tetracycline and chloramphenicol.In 4 isolates inducible MLSB resistance phenotype was found, one of them was additionally resistant to tetracycline. 7 S. aureus were mupirocin resistant among them 3 - isolated from one patient, were resistant simultaneously to tetracyclines and chloramphenicol. 7 strains demonstrated resistance to chloramphenicol and susceptibility to all tested antimicrobial agents. The susceptibility to gentamicin, amikacin and cotrimoxazole among all examined S. aureus was confirmed.ConclusionThe obtained results indicated non-clonal structure of S. aureus circulating in AD patients. PFGE results showed the clonal-structure of vast majority of S. aureus isolated from nose and skin from nasal carriers what may prove the autoinfection in these patients. All examined patients the moderate or strong severity of AD was reported. Susceptibility to most antibiotics among isolated strains was also observed.

Study of the Bacteriological Profile and Their Antimicrobial Susceptibility Pattern in Patients with Skin Infections

The study group consisted of 150 patients both male and female between 1 – 80 years, with primary and secondary skin infections who attended the out- patient department of Dermatology and surgery at Sree Balaji medical college and hospital a tertiary care hospital in Chennai, Tamilnadu, South India. Patients admitted as in patients in the above two department were also taken for this study. 28 out of 150 cases had primary bacterial and 122 had secondary bacterial skin infections. In this study the prevalence of Methicillin resistant Staphylococcus aureus (MRSA) (40.8%) and Extended spectrum beta-lactamases (ESBL) (40.5%) producers among Enterobacteriaceae was higher. Estimation of MRSA and ESBL has to be done in tertiary care hospital to prevent and curtail further spread of these strains in hospital acquired infections. These isolates pose a serious threat for use of routine groups of antimicrobials.