Infectious Disease

Staph remains a leader at SSTI, says one expert

November 22, 2021

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Source:

Creech CB wound: The ever-changing Staphylococcus aureus. Presented at: Symposium on Infectious Diseases in Children; 20.-21. November 2021; New York (hybrid meeting).

Disclosure:
Creech reports that he has received grants from the CDC, Merck Vaccines and the NIH and has acted as an advisor to Altimmune, Astellas (data security and monitoring committee), GlaxoSmithKline, Horizon Pharma, Premier Healthcare and Vir. He also reports that he has received royalties from UpToDate.

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NEW YORK – Staphylococcus aureus remains the leading cause of skin and soft tissue infections, or SSTIs, according to a pediatric infectious disease expert.

C. Buddy Creech, Dr.

“One of the things to think about when dealing with children with recurring skin and soft tissue infections is that it is very difficult to stop people from carrying staph,” said Creech, who is also an editorial board for infectious diseases in children is a member. “If you have skin and a nose, you will carry staphylococci.”

However, Creech said his institution is seeing fewer and fewer cases of recurrent staph infections in the same patients.

“We drained about 2,500 abscesses a year in our emergency room, but now it’s only about 150,” Creech said. “Our emergency ambulance is seeing some of this, so I think there has been a small shift, but our pediatricians in the area have said they have seen fewer cases and as a result, they have made a small improvement in those with recurring infections to have.”

He mentioned several groups that would benefit greatly from an S. aureus vaccine, especially those with comorbidities.

“What we do know is that people with HIV, diabetes, people with hematologic or solid tumors – these [patients] It’s more likely that it’s not just a disease but a relapse, ”Creech said.

Creech also discussed research on antibiotic therapy for staph infections, citing a 2015 study that included 524 adults and children with uncomplicated skin infections including cellulitis, large abscesses (> 5 cm), or both. Patients underwent incision and drainage and were randomly assigned to ether-clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX). Clinical healing at the end of the 10-day treatment was similar – 90% in the clindamycin group and 88% in the TMP-SMX group – but only 84.7% of the patients in the TMP-SMIX group suffered after 1. no recurring infection month, compared with 91% in the clindamycin group.

“Why should that happen? Well, clindamycin showed in a study in the 1970s that it eradicated carriage [of S. aureus] in the nasal lining, ”said Creech. “So it may be that we actually eliminate this problematic strain for some people.”

Creech mentioned a second study published in 2017 that enrolled 786 adults and children with uncomplicated skin infections who had cellulitis or small abscesses (<5 cm), or both, and were treated with clindamycin, TMP-SMX, or a placebo. Although 83% of patients in the clindamycin group had symptoms resolved or cured, and a relatively few (7%) had a relapse after 1 month, 22% of the group experienced adverse events - most of the three groups.

Creech described it as a compromise: “There are more adverse events in the clindamycin group, but perhaps fewer relapses [of staph infections] in the same group. “

Crèche closed by advocating decolonization as a preventive measure against S. aureus and recommended mupirocin ointment for affected parts of the body as well as washing clothes and cleaning other household surfaces with chlorhexidine.

References:

DaumR, et al. N Engl J Med. 2017; doi: 10.1056 / NEJMoa1607033.

Miller, G. et al. N Engl J Med. 2015: doi 10.1056 / NEJMoa1403789.

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