392. Epidemiology and Antibiotic Prescribing Trends of Community Acquired Staphylococcal Skin and Soft Tissue Infections at a Tertiary Care Children’s Hospital
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • MRSABaystateIDWweek2013.pdf (504.5 kB)
  • Background: Staphylococcus aureus (SA) is the most frequent cause of skin and soft tissue infections (SSTI). Methicillin resistant Staphylococcus aureus (MRSA) infections have increased in most geographic areas of the United States.  Antibiotic use in these communities may be associated with changes in the epidemiology of these infections.

    Methods:   The epidemiologic pattern of SA-SSTI, antibiotic prescribing patterns and treatment modalities at our pediatric institution were examined. A retrospective chart review by diagnosis and billing codes of all SSTI in children 0 to 18 years of age from January 2005 through December 2009 was performed. Patient demographics, length of hospital stay (LOS) if admitted, microbiologic information, and antibiotics prescribed were collected. Poisson regression model was used to evaluate the significance of changes over time.

    Results: 2,411 children were screened; complete information and diagnosis were available for 553 subjects (23%). The annual number of proven of SA - SSTI increased steadily from 52 cases in 2005, to a peak of 174 cases in 2008 (p < 0.001).  The proportion of cases attributable to MRSA increased steadily to a peak of 72% of cases in 2009. The highest incidence occurred in teenagers aged >14 years (32%), and in toddlers ages 2-5 years (26%).  Seasonality was demonstrated by peak incidence in summer months every year of the study.  LOS decreased by 0.2 days per year over the study period (p<0.001). Clindamycin susceptibility of pediatric isolates in this study was higher than the predicted susceptibility using our hospital antibiograms (Figure 1). Initial antibiotic prescribing showed coverage for only MSSA 60% of the time at the beginning of the study, with a significant trend toward empirical coverage for MRSA in greater than 80% of cases over time (p<0.001).

    Conclusion: MRSA SSTI in pediatric patients increased in our community over the study period. A concomitant rise in use of antibiotics appropriate for MRSA was seen. Clindamycin susceptibility in all SA fluctuated during the study. Provider education about the trends of antibiotic resistance should be continually provided to enhance appropriate antibiotic use.

    Donna Fisher, M.D., Pediatrics, Baystate Children's Hospital, Baystate Health, Inc. Tufts University School of Medicine, Springfield, MA, Anna Eboch, Pediatrics, Baystate Children's Hospital, Springfield, MA and Katherine Ewall, M.D., Pediatrics and Medicine, Baystate Children's Hospital, Baystate Health, Inc, Springfield, MA


    D. Fisher, None

    A. Eboch, None

    K. Ewall, None

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