Clinical And Microbiological Study Of Pyoderma In Children With Special Reference To Communityacquired Methicillin-Resistant Staphylococcus Aureus

Abstract

Background- Cutaneous bacterial infections in pediatric age group constitute a major portion of the dermatological disorders. Staphylococcus aureus and Streptococcus pyogenes are the common causative agents. The prevalence of methicillin-resistant Staphylococcus aureus strains is reported to be increasing. MRSA, once thought to be as a nosocomial pathogen, is being increasingly reported in the community. A knowledge of the antimicrobial resistance of Staphylococcus aureus is important in the selection of antimicrobials for treatment. Objectives- To study the different clinical types and bacterial agents causing pyoderma in children. To determine the incidence of community-acquired methicillin-resistant Staphylococcus aureus in childhood pyodermas. Methods- It is a hospital based, cross-sectional, descriptive analytical study. Ninety seven children (<12 years) with pyoderma were recruited from dermatology out-patient department. Their demographic data regarding name, age, sex, occupation of parents/guardians, monthly income and address were recorded in the proforma. A detailed history of the illness regarding duration, onset, evolution, symptoms, other associated illness and recurrence were recorded. A complete clinical examination of the skin, nails, hair and mucous membrane was performed. After cleaning the surface pus is collected with two swabs from the depth of the lesion. Specimens were taken to the laboratory within two hours of collection and further processing was done in the department of microbiology. Gram staining, culture and antibiotic sensitivity was done for all pus samples. Methicillin resistance was detected using cefoxitin (30mcg) discs by disc diffusion method.

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Results- Out of 97 cases of pyoderma, 67 were boys and 29 were girls with a male: female ratio of 2.34:1. Incidence of pyoderma was highest among school going children (n=60, 61.85%). Among 97 cases, 56 (57.7%) were primary pyodermas and 41 (42.3%) were secondary pyodermas. Among primary pyodermas, non-bullous impetigo (39.3%) was the commonest clinical type, followed by folliculitis (23.2%) and furuncles (12.5%). Scabies with secondary infection (46.4%) was the commonest clinical type seen in secondary pyodermas, followed by infective eczema (29.3%) and atopic dermatitis with pyogenic infection (12.2%). Staphylococcus aureus (49.5%) was the commonest pathogen isolated from pyodermas. MRSA was seen in 6.25% of cases. Conclusion- Most of the pyodermas was caused by Staphylococcus aureus. Incidence of CA MRSA is less in this region of India. The findings of this study need further confirmation from larger prospective studies in multiple settings in this geographic area.