16 Sep Atopic Dermatitis: Antibiotic Choice in Pediatric Superinfections
MedicalResearch.com Interview with:
Carrie C. Coughlin, MD
Member of the Society for Pediatric Dermatology
Assistant Professor, Dermatology
Departments of Medicine and Pediatrics
Washington University School of Medicine / St. Louis Children’s Hospital
Cristopher C. Briscoe, MD
Dermatology Resident, PGY-2
Washington University School of Medicine in St. Louis
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Briscoe: Superinfection of atopic dermatitis (AD) in pediatric patients is a common complication. Our study sought to determine the best empiric antibiotic choice for these patients while a bacterial culture is pending. We retrospectively analyzed 182 skin cultures from pediatric atopic dermatitis patients seen in the outpatient setting over five years and found that 170 (93.4%) grew Staphylococcus aureus. Of these, 130 (76.5%) grew methicillin-sensitive S. aureus (MSSA), 37 (21.8%) grew methicillin-resistant S. aureus (MRSA), and 3 (1.8%) grew both MSSA and MRSA. There was no statistically significant relationship between age, sex, race, or dilute bleach bath usage and MRSA infection. Interestingly, as compared to a separate group of pediatric atopic dermatitis patients seen in the emergency room, our patients had lower rates of MSSA susceptibility to doxycycline and MRSA susceptibility to TMP-SMX.
MedicalResearch.com: What should readers take away from your report?
Dr. Briscoe: The biggest takeaway from our study is that, in light of the high overall rate of MSSA found, first-generation cephalosporins remain a good choice for empiric treatment of superinfection in pediatric atopic dermatitis patients. For patients with a history of MRSA infection, or those suspected to have MRSA for some other reason, clindamycin, TMP-SMX, or tetracyclines could be considered. It is important to note that although recent studies have shown a declining rate of community-acquired MRSA in pediatric patients, there has been an increase of USA300 clones found in MSSA. The USA300 clone is associated with increased virulence in both MSSA and MRSA, and it therefore remains critical to treat any S. aureus infection, regardless of methicillin susceptibility.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Dr. Coughlin: Systemic therapy for pediatric atopic dermatitis is advancing. It will be important to see how these newer agents affect incidence and causative bacteria of bacterial superinfection.
Neither of the authors has a disclosure.
Briscoe, CC, Reich, P, Fritz, S, Coughlin, CC. Staphylococcus aureus antibiotic susceptibility patterns in pediatric atopic dermatitis. Pediatr Dermatol. 2019; 36: 482‐ 485. https://doi.org/10.1111/pde.13867
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