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Prolonged treatment common for acute bacterial skin, skin structure infections
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Prolonged treatment durations and antibiotics with a broad spectrum of gram-negative activity are often administered to pediatric patients hospitalized with acute bacterial skin and skin structure infection, according to recent study findings published in The Pediatric Infectious Disease Journal.
“We found it noteworthy that not a single pediatric case involved Infectious Diseases consultation, a sharp contrast to adult cases where Infectious Diseases consultation is common,” the researchers wrote. “This suggests that the vast majority of pediatric cases were uncomplicated and responded rapidly to treatment, supporting the assertion that antibiotic use might be safely reduced in this population.”
Timothy C. Jenkins, MD, of Denver Health Medical Center, and colleagues evaluated 102 children aged 18 years or younger (median age, 5 years) hospitalized for acute bacterial skin and skin structure infection (ABSSSI) to determine opportunities to decrease broad-spectrum antibiotic use and shorten treatment duration.
Timothy C. Jenkins
Forty-two percent of patients had non-purulent cellulitis followed by cutaneous abscess (39%) and wound infection or purulent cellulitis (19%). Fifteen percent of cases had prior skin infections. Lower extremities (44%) and the head or neck (23%) were the most common sites of infection.
Among 55 cases where a microorganism was identified, Staphylococcus aureus was identified in 69%, with similar rates for methicillin-susceptible S. aureus (32%) and MRSA (34%). Ninety-five percent of cases had Gram-positive organisms identified while 8% had gram-negative organisms. According to researchers their findings do not support use of antibiotics for broad Gram-negative activity and call for better education of providers “regarding the microbiology of ABSSSI and to develop interventions to promote the appropriate spectrum of therapy.”
A combination of antibiotics was used in 21% of cases during hospitalization. Sixty-seven percent of the initial regimens included clindamycin and 20% included vancomycin. Twenty-five percent of patients were treated with antibiotics with broad Gram-negative activity. The median duration of therapy was 11 days, while 61% were treated longer than 10 days. Only 3% of patients were treated for 7 or fewer days.
“In summary, pediatric patients hospitalized with ABSSSI are frequently exposed to antibiotics with a broad spectrum of gram-negative activity or prolonged treatment durations,” the researchers wrote. “Antibiotic use in such cases could potentially be reduced through prescription of shorter durations of antibiotics with gram-positive activity, although the greatest opportunity appears to lie in reducing treatment durations. These findings highlight the need for studies to determine the shortest effective duration of therapy in pediatric patients hospitalized with ABSSSI.”
Timothy C. Jenkins, MD, can be reached at Denver Health, 660 Bannock Street, Denver, CO 80204; email: timothy.jenkins@dhha.org.
Disclosure: The study was funded in part by the National Institute of Allergy and Infectious Diseases and the NIH. The researchers report no relevant financial disclosures.
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