Changing Susceptibility of Staphylococcus aureus in Children with Skin and Soft Tissue Infections: a Single Center Experience from 2010 to 2018

Yong-Sun Cho; Shin-Hye Lee; Taek-Jin Lee

doi:10.14776/piv.2019.26.e22

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Cho, Lee, and Lee: Changing Susceptibility of Staphylococcus aureus in Children with Skin and Soft Tissue Infections: a Single Center Experience from 2010 to 2018

Original Article

Pediatric Infection & Vaccine 2019; 26(3): 140-147.

Published online: 5 November 2019

DOI: https://doi.org/10.14776/piv.2019.26.e22

Changing Susceptibility of Staphylococcus aureus in Children with Skin and Soft Tissue Infections: a Single Center Experience from 2010 to 2018

Yong-Sun Cho

, Shin-Hye Lee

, Taek-Jin Lee

Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, the Republic of Korea.

Correspondence to Taek-Jin Lee. Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, the Republic of Korea. bjloveu@cha.ac.kr

Received 5 July 2019 Revised 15 October 2019 Accepted 21 October 2019

The Korean Society of Pediatric Infectious Diseases

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Staphylococcus aureus is a major cause of skin and soft tissue infections (SSTIs). This study aimed to determine the temporal trends in antibiotic susceptibility of S. aureus in SSTI patients aged <19 years.

Methods

This retrospective observational study was conducted in pediatric patients with SSTI caused by community-associated S. aureus. Microbiologic and demographic data were collected, and the trends of antibiotic susceptibility results were evaluated.

Results

From January 2010 to December 2018, a total of 807 S. aureus isolates were included. An overall increase in susceptibility of isolates to oxacillin was noted (P<0.001), with 75.0% of isolates being oxacillin-susceptible in 2018. S. aureus remained highly susceptible to trimethoprim/sulfamethoxazole and tetracycline, with 97.6% and 95.2% isolate susceptibility in 2018, respectively. Isolates from younger children aged 1 to 5 years had a significantly lower rate of susceptibility to oxacillin than older children aged 6 to 18 years (53.4% vs. 75.0%, P<0.001).

Conclusions

The proportion of methicillin-resistant S. aureus isolates appears to decrease in pediatric patients with community-associated SSTI caused by S. aureus. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens.

Keywords: Staphylococcus aureus, Staphylococcal skin infections, Methicillin-resistant

Figures and Tables

Fig. 1

Schematic diagram describing pediatric patients with skin and soft tissue infections included in the study.

^*Only the first isolate from each patient per hospital admission was included; ^†Three patients had history of surgery or hospitalization in the 12 months preceding the culture and had an invasive device at the time of evaluation.

Table 1

Demographic and clinical characteristics of pediatric patients with Staphylococcus aureus skin and soft tissue infections, 2010–2018

Characteristics		2010 (n=63)	2011 (n=76)	2012 (n=81)	2013 (n=115)	2014 (n=110)	2015 (n=97)	2016 (n=105)	2017 (n=76)	2018 (n=84)	P-value^*
Age group (%)											0.542
	1–5 yr	49.2	55.3	51.9	53.9	48.2	46.4	49.5	47.4	38.1
	6–18 yr	50.8	44.7	48.1	46.1	51.8	53.6	50.5	52.6	61.9
Gender (%)											0.001
	Male	58.7	56.6	53.1	45.2	52.7	51.5	58.1	40.8	63.1
	Female	41.3	43.4	46.9	54.8	47.3	48.5	41.9	59.2	36.9
Skin abscess present (%)		31.7	21.1	12.3	6.1	7.3	10.3	4.8	11.8	19.0	<0.001
Patient status (%)											0.005
	Inpatient	23.8	6.6	21.0	11.3	15.5	7.2	13.3	23.7	11.9
	Outpatient	76.2	93.4	79.0	88.7	84.5	92.8	86.7	76.3	88.1

^*Determined by using a χ² test.

Table 2

Antibiotic susceptibility of Staphylococcus aureus isolates among pediatric patients with skin and soft tissue infections, 2010–2018

Antibiotics	Susceptibility (%)									P-value^*
Antibiotics	2010 (n=63)	2011 (n=76)	2012 (n=81)	2013 (n=115)	2014 (n=110)	2015 (n=97)	2016 (n=105)	2017 (n=76)	2018 (n=84)	P-value^*
Ciprofloxacin	96.8	94.7	92.6	98.3	100	96.9	95.2	97.4	96.4	0.579
Clindamycin	58.7	67.1	56.8	52.2	52.7	59.8	64.8	59.2	67.9	0.281
Erythromycin	49.2	60.5	46.9	35.7	49.1	53.6	60.0	52.6	66.7	0.014
Gentamicin	77.8	72.4	70.4	58.3	62.7	72.2	71.4	75.0	86.9	0.052
Oxacillin	58.7	60.5	58.0	50.4	60.9	70.1	72.4	76.3	75.0	<0.001
Penicillin	7.9	3.9	4.9	2.6	3.6	4.1	2.9	7.9	7.1	0.697
Tetracycline	90.5	96.1	95.1	97.4	96.4	92.8	89.5	92.1	95.2	0.388
TMP/SMX	98.4	98.7	96.3	99.1	100	97.9	100	100	97.6	0.474
Fusidic acid	50.8	65.8	70.4	68.7	58.2	52.6	45.7	44.7	46.2	<0.001

Only the first S. aureus isolate per patient was included. Pediatric patients defined as being 1 to 19 years of age.

^*Determined by using the Mantel-Haenszel χ² test for trend from 2010 through 2018.

Abbreviation: TMP/SMX, trimethoprim/sulfamethoxazole.

Table 3

Antibiotic susceptibility of Staphylococcus aureus isolates among pediatric patients with skin and soft tissue infections by age group, 2010–2018

Antibiotics	Susceptibility (%)		P-value^*
Antibiotics	1–5 yr (n=395)	6–18 yr (n=412)	P-value^*
Clindamycin	51.1	67.5	<0.001
Oxacillin	53.4	75.0	<0.001
Tetracycline	93.7	94.2	0.764
TMP/SMX	99.5	98.1	0.065

^*Determined by using a χ² test.

Abbreviation: TMP/SMX, trimethoprim/sulfamethoxazole.

Notes

^{Conflict of Interest} No potential conflict of interest relevant to this article was reported.

^{Author Contributions}

Conceptualization: Lee TJ.
Data curation: Cho YS, Lee TJ.
Formal analysis: Cho YS, Lee TJ.
Investigation: Lee SH, Cho YS.
Supervision: Lee TJ.
Validation: Lee TJ.
Visualization: Cho YS, Lee SH.
Writing - original draft: Cho YS, Lee SH.
Writing - review & editing: Lee TJ.

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ORCID iDs

Yong-Sun Cho
https://orcid.org/0000-0002-0841-4617

Shin-Hye Lee
https://orcid.org/0000-0003-4122-9592

Taek-Jin Lee
https://orcid.org/0000-0002-8912-6982

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