Staph remains leading SSTI, expert says

November 22, 2021

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Source/Revelations

Source:

Creech CB Wound: The Ever-Evolving Staphylococcus aureus. Presented at: Symposium Infectious Diseases in Children; Nov 20-21, 2021; New York (hybrid meeting).

disclosures:
Creech reports that he has received grants from the CDC, Merck Vaccines and the NIH, and has served as an advisor to Altimmune, Astellas (data safety and monitoring board), GlaxoSmithKline, Horizon Pharma, Premier Healthcare and Vir. He also reports receiving 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, MD, MPH, associate professor of pediatrics and director of the pediatric infectious diseases fellowship program at Vanderbilt University, presented on the topic at this year’s Infectious Diseases in Children Symposium.

“One of the things I want to think about when we’re dealing with kids with recurrent skin and soft tissue infections is that it’s very hard to stop people from carrying staph,” said Creech, who is also an editorial board for Infectious Diseases in Children. member. “If you have skin and if you have a nose, you’re going to wear staph.”

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

“We drained about 2,500 abscesses a year in our ER, but now it’s about 150,” Creech said. “Our outpatient emergency care looks like a few, so I think there’s been a little shift, but our pediatricians in the area have said they’ve seen fewer cases, and as a result, they’ve had a small improvement in those who have recurring have infections.”

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

“What we know is that people with HIV, diabetes, people with hematologic or solid tumor malignancies — who… [patients] are more likely to not only have disease, but also more likely to have recurrence,” Creech said.

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

“Why would that happen? Well, clindamycin was shown to eradicate carriage in a study in the 1970s [of S. aureus] in the nasal mucosa,” Creech said. “So we may actually be eradicating this problematic strain in some individuals.”

Creech cited 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. While 83% of patients in the clindamycin group experienced symptom resolution or cure and relatively few (7%) had a recurrence at 1 month, 22% of the group experienced adverse events - most of any of the three groups.

Creech described it as a trade-off: “There are more side effects in the clindamycin group, but perhaps fewer recurrences.” [of staph infections] in the same group.”

Creech closed by advocating decolonization as a preventative measure against S. aureus and recommended mupirocin ointment for affected areas of the body and washing linens and cleaning other household surfaces with chlorhexidine.

References:

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

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

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