title: Antibiogram testing of pediatric skin infections in the era of methicillin-resistant Staphylococci aureus: an Egyptian University Hospital-based study.
abstract: BACKGROUND
  Community-associated methicillin-resistant Staphylococci aureus (CA-MRSA) pediatric skin infections have been reported worldwide. However, little is known about pathogens' implications in Egyptian children, and beta-lactams are still the empiric antimicrobials prescribed. This warrants Egyptian studies on antibiogram testing of pediatric skin infections.
  
  
  OBJECTIVE
  To determine antibiotic susceptibility patterns of bacterial isolates from Egyptian pediatric skin infections to find out if we need reconsideration of the empiric beta-lactam antimicrobial therapy.
  
  
  METHODS
  Throughout an eight-month cross-sectional study, antibiogram testing was conducted on bacterial isolates from pediatric skin infections. Determination of inducible resistance to clindamycin using D-test was performed for isolates susceptible to clindamycin and resistant to erythromycin.
  
  
  RESULTS
  One-hundred and 21 children (mean age 6.9 years ± 3 SD) presented with pyogenic skin infections. Methicillin-sensitive Staphylococci aureus (MSSA) were isolated from 114 children, associated with group A Streptococci (GAS) in four of them, while GAS were the only isolates in three patients. A diagnosis of CA-MRSA was fulfilled in four children. Antibiotic susceptibilities differed between isolated organisms but with no statistically significant differences between susceptibility patterns of isolates from primary skin infections and those from secondary infection of skin diseases. Positive D-test was detected in five MSSA isolates.
  
  
  CONCLUSIONS
  CA-MRSA skin infections are not common among Egyptian children and, therefore, beta-lactams are still effective empiric antimicrobial therapy for most infections. Antibiogram testing from suppurative skin lesions are, however, better to be recommended to guide individual therapy. Clindamycin should not be considered for susceptible isolates unless they are erythromycin susceptible or D-test negative.
authors.affiliation: Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. nermeensamy2000@yahoo.com
authors.forename: Nermeen S A
authors.initials: NS
authors.lastname: Abdel Fattah
authors.forename: Yasser W
authors.initials: YW
authors.lastname: Darwish
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000494:pharmacology; D003430:Cross-Sectional Studies; D004534:Egypt / Q000453:epidemiology; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007169:Impetigo / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests / Q000379:methods*; D010044:Outpatient Clinics, Hospital; D011159:Population Surveillance; D015995:Prevalence; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D018440:beta-Lactam Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D004917:Erythromycin