title: Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period.
abstract: BACKGROUND
  Increasing resistance to commonly used antibiotics has been seen for patients with superficial skin wounds and leg ulcers.
  
  
  OBJECTIVE
  We sought to evaluate bacterial isolates from leg ulcers and superficial wounds for resistance to commonly used antibiotics and to compare current data with previous data.
  
  
  METHODS
  We performed a chart review for patients admitted to a tertiary care dermatology inpatient unit from January to December 2001. Comparison was made with 2 previous surveys of the same inpatient service from 1992 and 1996.
  
  
  RESULTS
  Bacterial isolates were cultured from 148 patients, 84% (72 of 86) with leg ulcers and 38% (76 of 202) with superficial wounds. Staphylococcus aureus and Pseudomonas aeruginosa were the most common bacterial isolates in both groups. For patients with leg ulcers, S aureus grew in 67% of isolates (48/72) of which 75% (36/48) were methicillin-resistant (MRSA). Of leg ulcers, 35% (25/72) grew P aeruginosa, which was resistant to quinolones in 56% of cultures (14/25). For patients with superficial wounds, S aureus was isolated in 75% (57/76) and 44% were MRSA (25/57). P aeruginosa grew in 17% of isolates (13/76) and was resistant to quinolones in 18%. We found a marked increase in antibiotic resistance for both leg ulcers and superficial wounds. Over time, MRSA increased in leg ulcers from 26% in 1992 to 75% in 2001. For superficial wounds, MRSA increased from 7% in 1992 to 44% in 2001. P aeruginosa resistance to quinolones in leg ulcers increased from 19% in 1992 to 56% in 2001, whereas for superficial wounds there was no resistance in 1992 and 18% resistance in 2001.
  
  
  CONCLUSIONS
  Rapid emergence of antibiotic-resistant bacteria continues and is a problem of increasing significance in dermatology. Common pathogenic bacteria, S aureus and P aeruginosa, showed increased resistance to commonly used antibiotics. Selection of antibiotics should be on the basis of local surveillance programs.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami, School of Medicine, Miami, Florida, USA.
authors.forename: Isabel C
authors.initials: IC
authors.lastname: Valencia
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Kerdel
mesh_terms: D024881:Drug Resistance, Bacterial; D006801:Humans; D007871:Leg Ulcer / Q000382:microbiology*; D016106:Methicillin Resistance; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D015363:Quinolones / Q000494:pharmacology; D012867:Skin / Q000293:injuries*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D014947:Wounds and Injuries / Q000382:microbiology*
chemical_list: D015363:Quinolones