Revista de la Sociedad Boliviana de Pediatría
versão impressa ISSN 1024-0675
PREGO, Javier et al. Infections of skin and soft tissue in outpatients. Rev. bol. ped. [online]. 2006, vol.45, n.2, pp. 132-139. ISSN 1024-0675.
Introduction: the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), without classics risk factors, with different antibiotic susceptibility patterns of community-acquired, have increased dramatically in the last decade. In 2001 the ﬁrst CA-MRSA infections of skin and soft tissue in Uruguay were reported at Pereira Rossell Hospital Center (CHPR). Objectives: 1) Analyse clinical characteristics, and etiology of outpatients with skin and soft tissues. 2) Report prevalence and antibiotic susceptibility of CA-MRSA. Methods: this was a prospective, descriptive study in children presenting to the Pediatric Emergency Department (DEP) of CHPR with skin and soft tissues infection communityacquired, from March 24, 2004, through July 31, 2004. Outpatients received antibiotic therapy before culture results. Children presenting to the DEP with impetigo, furuncles, abscesse, cellulites, paronychia, burn and wound infections were included. Patients demographics, MRSA risk factors, clinical characteristics and culture results from Bacteriology Laboratory CHPR, were reported. Results: 297 patients were included. The spectrum of disease observed was: impetigo 122 (48,4%), furuncles 29 (11,5%), cellulitis 19 (7,5%), abscesse 30 (11,9%), paronychia 8 (3,2%), burn and wound infections 6 (2,4%) and twice of the last disease 38 (15%). Staphylococcus aureus was isolated in 71,8% alone or with Streptococcus pyogenes. CA-MRSA belong to 47%. CAMRSA was isolated in 73% of furuncles, abscesse and cellulites, 10% impetigo (p<0,001). In surface infections 75% Streptococcus pyogenes was isolated. No signiﬁcant risk factors for CA-MRSA were identiﬁed, and no signiﬁcant differences in children with susceptible SA (p>0,10). All CA-MRSA were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) and vancomycin. One case was gentamicin resistance. Inducible resistance was found in: macrolids, lincosamides and streptogramines (MLS) (54%). Clindamycin constitutive resistance was not found. Conclusions: in surface skin infections Streptococcus pyogenes was the microorganisms most frequently isolated, although SA was in deep infections. All of the skin infections SA alone or associated was the most frequently. CA-MRSA belong to 47% of skin infections, 73% were deep infections. One case was gentamicin resistance. All were susceptible to TMP-SMX and vancomycin. Clindamycin constitutive resistance was not found. 54% inducible resistence to MLS group.
Palavras-chave : Staphylococcal Skin Infections; Soft Tissue Infections; Staphylococcus aureus; Methicillin resistance.