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Antibiotics eradicate S. aureus colonization, prevent SSTI recurrence in children

13 Oct 2017

Use of systemic antibiotics, in conjunction with performance of incision and drainage, in the management of paediatric acute skin and soft tissue infection (SSTI) appears to reduce Staphylococcus aureus colonization and the likelihood of infection recurrence, a prospective study has found.

Researchers looked at a cohort of 383 children (median age 3 years; 56 percent female) with S. aureus SSTI for which an incision and drainage procedure was performed. Swab samples from the children revealed S. aureus colonization in the anterior nares, axillae or inguinal folds.

Guideline-recommended antibiotics were empirically prescribed to 355 (93 percent) patients, with 81 receiving more than one antibiotic class. Most received clindamycin (n=220) or trimethoprim-sulfamethoxazole (n=199), while the others were given vancomycin (n=19) beta-lactams (n=12). The remaining patients in the cohort were not prescribed systemic antibiotics.

Repeat colonization sampling was performed within 3 months (median 38 days) in 357 patients, and incidence of recurrent infection was ascertained for up to 1 year.

Results showed that children prescribed guideline-recommended empiric antibiotics had reduced likelihood of remaining colonized at follow-up sampling (adjusted hazard ratio [aHR] 0.49; 95 percent CI, 0.30 to 0.79) and of having recurrent SSTI (aHR, 0.57; 0.34, 0.94) compared with those who did not receive antibiotics for their SSTI.

Of note, remaining colonized at repeat sampling was associated with a more than twofold risk of infection recurrence over 12 months (aHR, 2.37, 95% CI 1.69, 3.31).

Clindamycin was particularly superior to trimethoprim-sulfamethoxazole in eradicating S. aureus colonization (44 vs 57 percent remained colonized; p=0.03) and preventing recurrent SSTI (31 vs 47 percent had recurrence; p=0.008).

The current findings establish the benefit of systemic antibiotics beyond the resolution of acute SSTI, researchers claimed, adding that they should inform continuing conversations about optimal clinical management of SSTI in the contemporary era.

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