Is methicillin-resistant Staphylococcus aureus involved in community acquired skin and soft tissue infections?: Experience from a tertiary care centre in Mumbai

• Main Authors: R S Phakade, G Nataraj, S K Kuyare, U S Khopkar, P R Mehta
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2012-01-01
• Series: Journal of Postgraduate Medicine
• Subjects: Community-acquired methicillin resistant Staphylococcus aureus; D-test; pyoderma
• Online Access: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2012;volume=58;issue=1;spage=3;epage=7;aulast=Phakade
• ISSN: 0022-3859; 0972-2823

Background: To improve the empiric antimicrobial therapy of community-acquired (CA) skin and soft tissue infections (SSTIs), it is necessary to generate data on the current spectrum and susceptibility profile of associated bacteria. CA methicillin-resistant Staphylococcus aureus (CA MRSA) is increasingly being reported in SSTIs in India and globally. Aims: The present study was undertaken to determine the bacterial profile of CA-SSTIs, to know the contribution of MRSA in these infections, to determine inducible clindamycin resistance in S. aureus and to compare the resistance patterns of isolates from hospital-acquired (HA) SSTIs. Materials and Methods: Eight hundred and twenty patients with CA SSTIs were prospectively studied. Pus samples were cultured and antimicrobial susceptibility pattern determined. Inducible clindamycin resistance was detected by D-test. Laboratory records were analyzed retrospectively to generate data on HA SSTIs. Results: 619 isolates were recovered in CA-SSTIs, of which S. aureus (73%) and Streptococci (12%) were the most common. Pseudomonas aeruginosa (28%) and Acinetobacter spp (18%) were the predominant HA-SSTI pathogens. Susceptibility of CA S. aureus to antibiotics tested was, penicillin (6%), co-trimoxazole (20%), ciprofloxacin (37%), cefazolin (100%), erythromycin (84%), clindamycin (97%), gentamicin (94%) and fusidic acid (95%). No MRSA was found in CA SSTIs whereas 45% of HA S. aureus strains were methicillin-resistant. HA strains demonstrated significantly higher resistance as compared to their CA counterparts (P<0.001). D test was positive in 22% of CA S. aureus tested. Conclusions: In CA SSTIs, methicillin-susceptible S. aureus is the predominant pathogen. Penicillinase-resistant penicillins, clindamycin and erythromycin in that order can be used as suitable antimicrobials for empiric therapy. D test should be carried out routinely. No CA MRSA was detected in the present series.