Characterization of Staphylococcus aureus cutaneous infections in a pediatric dermatology tertiary health care outpatient facility

Background: Epidemiology and patterns of antibiotic resistance for Staphylococcus aureus are changing in the United States. Objective: We sought to determine the epidemiology and antibiotic susceptibility profiles in S aureus cutaneous infections in a pediatric dermatology tertiary health care facility in North Carolina. Methods: We conducted a prospective observational study involving pediatric patients (n = 93, age<18 years) with signs of skin and soft tissue infections seen at a pediatric dermatology clinic between 2005 and 2007. Results: We analyzed 141 cultures from 93 pediatric dermatology patients. S aureus was recovered from 97 cultures, of which 32% were methicillin-resistant S aureus (MRSA). In the pediatric dermatology clinic, children with atopic dermatitis accounted for 66% of the cultures; however, the presence of atopy did not represent a risk factor to acquire MRSA infection (P = .190; odds ratio = 1.643 [95% confidence interval: 0.672-4.014]). In all, 97 cultures were tested for antibiotic susceptibility and demonstrated the following resistance patterns: penicillin (86%), erythromycin (46%), methicillin (32%), clindamycin (22%), gentamicin (3%), vancomycin (0%), and trimethoprim-sulfamethoxazole (0%). Of the pediatric dermatology outpatient MRSA infections, the resistance patterns were as follows: erythromycin (71%), clindamycin (16%), gentamicin (2%), and trimethoprim-sulfamethoxazole (0%). Limitations: This study addressed a select population of children in North Carolina and may not generalize to different clinical settings or regions. Conclusion: Cutaneous S aureus infections in an outpatient pediatric dermatology tertiary health care facility demonstrated less resistance than previously reported from inpatient and emergency department settings. In our population, clindamycin and tetracyclines are still effective antibiotic choices in the majority of MRSA infections. Local prevalence and susceptibility of community-acquired MRSA as well as individual risk factors should be considered for diagnosis and treatment.