Is methicillin-resistant Staphylococcus aureus involved in community acquired skin and soft tissue infections? Experience from a tertiary care centre in Mumbai.
TLDR
In CA SSTIs, methicillin-susceptible S. aureus is the predominant pathogen and penicillinase-resistant penicillins, clindamycin and erythromycin in that order can be used as suitable antimicrobials for empiric therapy.Abstract:
Background: To improve the empiric antimicrobial therapy of community-acquired (CA) skin and soft tissue infections (SSTIs), it is necessary to generate data on the current spectrum and susceptibility profile of associated bacteria. CA methicillin-resistant Staphylococcus aureus (CA MRSA) is increasingly being reported in SSTIs in India and globally. Aims: The present study was undertaken to determine the bacterial profile of CA-SSTIs, to know the contribution of MRSA in these infections, to determine inducible clindamycin resistance in S. aureus and to compare the resistance patterns of isolates from hospital-acquired (HA) SSTIs. Materials and Methods: Eight hundred and twenty patients with CA SSTIs were prospectively studied. Pus samples were cultured and antimicrobial susceptibility pattern determined. Inducible clindamycin resistance was detected by D-test. Laboratory records were analyzed retrospectively to generate data on HA SSTIs. Results: 619 isolates were recovered in CA-SSTIs, of which S. aureus (73%) and Streptococci (12%) were the most common. Pseudomonas aeruginosa (28%) and Acinetobacter spp (18%) were the predominant HA-SSTI pathogens. Susceptibility of CA S. aureus to antibiotics tested was, penicillin (6%), co-trimoxazole (20%), ciprofloxacin (37%), cefazolin (100%), erythromycin (84%), clindamycin (97%), gentamicin (94%) and fusidic acid (95%). No MRSA was found in CA SSTIs whereas 45% of HA S. aureus strains were methicillin-resistant. HA strains demonstrated significantly higher resistance as compared to their CA counterparts (P<0.001). D test was positive in 22% of CA S. aureus tested. Conclusions: In CA SSTIs, methicillin-susceptible S. aureus is the predominant pathogen. Penicillinase-resistant penicillins, clindamycin and erythromycin in that order can be used as suitable antimicrobials for empiric therapy. D test should be carried out routinely. No CA MRSA was detected in the present series.read more
Citations
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Asha C. Bowen,Asha C. Bowen,Asha C. Bowen,Steven Y. C. Tong,Mark D. Chatfield,Jonathan R. Carapetis,Jonathan R. Carapetis +6 more
TL;DR: While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where impetigo is severe and prevalent.
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Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics.
Hoe Nam Leong,Asok Kurup,Mak Yong Tan,Andrea L. Kwa,Andrea L. Kwa,Kui Hin Liau,Mark H. Wilcox +6 more
TL;DR: Strategies involving iv-to-oral switch, de-escalation to narrow-spectrum antibiotics, and dose optimization have an impact on the overall improvement of cSSTI therapy outcomes, especially in countries like Singapore that has a high disease burden.
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Community-associated methicillin-resistant Staphylococcus aureus case studies.
TL;DR: The globally polygenetic background of CA-MRSA is explored with a special emphasis on generally less characterized populations, using four case studies to highlight a wide range of the clinical presentations and challenges of the disease.
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High Prevalence of Ciprofloxacin Resistance in Community Associated Staphylococcus aureus in a Tertiary Care Indian Hospital
TL;DR: This is the first report on the mechanism of ciprofloxacin resistance among the most prevalent Indian CA-MRSA, and single mutation in the gyrA gene, Ser-84→Leu, was sufficient for the high resistance.
References
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