Pediatric Skin and Soft Tissue Infection Antibiogram and Antibiotics Prescription Pattern in the Pediatric Emergency and In-Patient Settings

Background
Antimicrobial resistance has posed significant challenge to effective treatment of pediatric skin and soft tissue infections (SSTIs) in the past two decades with significant demographic variations. The AAP Committee on Infectious Disease recommends tracking of local antibiotic resistance patterns, judicious use of empiric antibiotics in line with resistance patterns and antibiotic stewardship to combat this challenge.

Objectives
Characterization of pediatric SSTI antibiogram and antibiotic prescription pattern, with specific evaluation of MRSA prevalence, antibiotic resistance and prescription patterns.

Methods
We conducted a retrospective review of patients aged 0–21 years seen at the Emergency and In-patients units of the BronxCare Health System from Jan. 2013 to Dec. 2016. Study was IRB-approved and data was collected using ICD-9 and 10 codes for key words. Specific information about patient demographics, type of SSTI, empiric antibiotics prescribed, culture results and antibiotic sensitivities were obtained from the EHRs. Data was analyzed using SAS 9.3® with bivariate comparison tested at α = 0.05 significance level. The antibiogram was created with the WHONET software.

Results
Records for 2872 children were reviewed – 52% were females, mean age was 10 years, and 75% self-identified as Black or Hispanic. The majority (80%) presented with abscess or cellulitis with mean size of 4.0cm, predominantly affecting the extremities (31%), gluteal and groin regions (14%) and head and neck regions (10%). Seventy-one percent (71%, n = 574) of 811 cultures sent were positive, with Staphylococcus aureus and Group A Streptococcus reported in 83% and 5% of positive cultures, respectively. The prevalence of methicillin-resistant S. aureus (MRSA) was 28% (39% of positive cultures), with 18% of MRSA demonstrating inducible Clindamycin resistance. MRSA was 99.1% sensitive to TMP-SMX. During the period under review, there was a trend towards decreasing sensitivity of MRSA to clindamycin (from 93% to 75% with p = 0.071). Despite the observed pattern, clindamycin constituted 70% of all empiric antibiotics prescribed, with only 1.0% receiving TMP-SMX at their initial encounter.