Pediatric Pyoderma in Eastern India: Bacteriologic Profile and Antimicrobial Susceptibility Pattern

Pediatric Pyoderma in Eastern India: Bacteriologic Profile and Antimicrobial Susceptibility Pattern

Abstract \sBackground

A bacterial infection of the skin and its appendages is known as pyogenic skin infection (pyoderma). Scabies, pediculosis, wounds, insect bites, and eczema are examples of primary pyoderma, which is produced by a direct invasion of healthy skin, whereas secondary pyoderma is caused by a superimposed condition in sick skin, such as scabies, pediculosis, wounds, insect bites, and eczema. The goal of this study was to investigate the clinical patterns and risk factors of pyoderma in a paediatric population, as well as isolate and determine the susceptibility patterns of several pathogenic microorganisms.

Methodology

For one year (from August 2016 to July 2017), a prospective study was undertaken at the Medical College and Hospital in Kolkata, India, which included all children younger than 12 years old with pyoderma who visited the outpatient dermatology department (as the study was conducted among the paediatric population, only children below 12 years of age were included). Exudates or pus were collected aseptically from lesions and anterior nares with sterile cotton swabs, which were used for culture, identification, and antibiotic susceptibility testing of the pathogenic organisms.

Results

A total of 182 individuals were included in the study, with 121 (66.48 percent) having primary pyoderma and 61 (33.52%) having secondary pyoderma. On culture, 161 of the 182 patients had bacteria: 126 (78.26 percent) had Staphylococcus aureus, 18 (11.18 percent) had coagulase-negative staphylococci, 16 (9.94 percent) had Streptococcus pyogenes, and one (0.62 percent) had Pseudomonas aeruginosa. Vancomycin and linezolid were effective against all staphylococci.

Conclusions

S. aureus is the most common cause of pyoderma in children, albeit the prevalence of methicillin-resistant S. aureus in this institution was low. The management of these diseases necessitates proper identification and antibiogram.

Introduction

Pyoderma is a skin infection that is classified as a purulent infection. It is one of the most prevalent clinical disorders seen by dermatologists. Pyoderma is defined as either primary or secondary, with the former resulting from an infection of healthy skin and the latter from a pre-existing skin condition [1]. Impetigo, folliculitis, furunculosis, carbuncle, ecthyma, and sycosis are examples of primary pyoderma, whereas infected scabies, infected eczema, infected wounds, and infected trophic ulcers are examples of secondary pyoderma [2]. Overcrowding, poverty, malnutrition, poor hygiene, illiteracy, customs, low immunity, lifestyle habits, and other traumas, such as insect bites and thorn pricks, have all been linked to the development of pyoderma [3]. Pyoderma is a frequent illness in children, with Staphylococcus and Streptococcus being the most prevalent causal organisms.

Staphylococcus and Streptococcus are two types of bacteria [4].

The range of pyoderma-causing substances and their antibiotic susceptibility patterns is constantly evolving. Antibiotic resistance is increasing, making it more difficult to effectively manage such instances. Antibiotics with higher potencies should not be used on susceptible bacteria since they can spread antibiotic resistance. Precise information of pyoderma's clinical patterns, pathogenic bacteria, and current antibiotic susceptibility pattern is required for optimal treatment.

The goal of this research was to evaluate the clinical pattern and risk factors of pyoderma in children, as well as isolate, identify, and determine the antibiotic susceptibility pattern of the numerous pathogenic bacteria in primary and secondary pyoderma. The nasal carriage of Staphylococcus was also assessed in this investigation.

Materials and Procedures

After receiving ethical clearance from the Institutional Ethics Committee of Medical College Kolkata (MC/KOL/IEC/NON-SPON/104/10-2015 dated 13-10-2015), a prospective, cross-sectional study was conducted for a year (August 2016 to July 2017) at the Medical College and Hospital, Kolkata, a tertiary care centre in Eastern India. The trial included all children aged 12 and under who were treatment-naive who came with a pyogenic skin infection at an outpatient dermatology department. Patients who had previously received antibiotics for the condition, were beyond the age of 12, or had other infections (such as fungal infections) were excluded from the trial.

A detailed history of the patients' age, sex, living conditions, lesion morphology, illness duration, disease onset and progression, ingestion of any drugs, and associated metabolic disorders was recorded after obtaining informed consent from the patients' parents, and a thorough clinical examination was performed. Exudates or pus were collected aseptically from the lesions using sterile cotton swabs. The patients' lesions were sampled twice, and their anterior nares were sampled twice. The pustule was ruptured with a sterile needle and material was collected on two sterile swabs in the case of intact pustular lesions. Gram staining of the smear was done with one swab from each set (pus and anterior nares), and the other was immediately inoculated on blood agar, MacConkey's agar, and brain heart agar.

The infected media were stored at 37°C for 48 hours, with readings obtained after 24 and 48 hours according to conventional procedures.

Standard microbiological techniques, such as Gram staining, pertinent biochemical reactions, and the VITEK 2 Compact instrument, were used to detect organism development (bioMerieux Inc., France). The Kirby-Bauer disc diffusion method was used to evaluate antibiotic susceptibility on Mueller-Hinton agar plates, and the results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (2016 version) [4]. The Staphylococcus isolates were tested using the disc diffusion method with cefoxitin (30 g), ciprofloxacin (5 g), levofloxacin (5 g), erythromycin (15 g), clindamycin (2 g), trimethoprim-sulfamethoxazole (1.25/23.75 g), amikacin (30 g), gentamicin (10 g), doxycycline (30

The disc diffusion method was used with vancomycin and teicoplanin, while the E-strip method was used with vancomycin and teicoplanin. A D-test with erythromycin and clindamycin discs was used to detect inducible clindamycin resistance. All data was input and analysed in an Excel spreadsheet (Microsoft, Seattle, WA, USA).

Results

A total of 182 patients were included in the one-year trial (from August 2016 to July 2017). The kids ranged in age from two days to twelve years. There were 13 (7.15%) infants under the age of one year, 68 (37.36%) children aged one to four years, 52 (28.57%) children aged five to eight years, and 49 (26.92%) children aged nine to twelve years (mean age, 5.62 years). 97 (53.29 percent) of the 182 patients were men, 85 (46.71 percent) were women, 119 (65.38 percent) resided in a city, and 63 (34.62 percent) lived in the country.

Primary pyoderma affected 121 (66.48 percent) of the patients, while secondary pyoderma affected 61 (33.52%). Impetigo contagiosa (34.07 percent) was the most common type of primary pyoderma, followed by folliculitis (20.33 percent), which included both superficial and deep folliculitis, whereas scabies with secondary infection (14.84 percent) was more common than eczema with secondary infection among secondary pyoderma cases (11.54 percent ). The most prevalent clinical symptoms found in 118 (64.83 percent) cases were pain, fever, and discharge, followed by itching and fever in 18 (9.89 percent) instances. The head and neck region was more common in the lesion distribution in 61 (33.52%) instances, followed by the lower limbs in 36 (19.78%) cases. In 112 (61.54 percent) of the cases, pustules were the most common type of lesion, followed by crusting and erosion.

In 36 cases (19.78%), limbs were missing. In 112 (61.54 percent) of the cases, pustules were the most common kind of lesion, followed by crusting and erosion in 30 (16.48 percent) of the cases (Table 1).