Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis

Vivian Wang; Matthew Keefer; Peck Y Ong

doi:10.1016/j.anai.2018.12.001

Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis

Ann Allergy Asthma Immunol. 2019 Mar;122(3):314-317. doi: 10.1016/j.anai.2018.12.001. Epub 2018 Dec 7.

Authors

Vivian Wang¹, Matthew Keefer², Peck Y Ong³

Affiliations

¹ Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
² Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
³ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: pyong@chla.usc.edu.

PMID: 30529713
DOI: 10.1016/j.anai.2018.12.001

Abstract

Background: Systemic antibiotics are commonly used in hospitalized patients with severe atopic dermatitis (AD) exacerbation. However, the antibiotic prescribing patterns are unclear.

Objective: To compare the prescribing patterns of antibiotics for children who were hospitalized for AD exacerbation and infectious complications.

Methods: Electronic medical records were reviewed for patients younger than 18 years who were hospitalized for AD exacerbation or infectious complications based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes from 2003 to 2018. The following information was obtained: history, physical examination findings, physician discharge summary, antibiotic treatments, serum tests, and wound cultures. The t test was used to compare clinical and laboratory features.

Results: A total of 174 patients with AD were included. Seventy patients had AD exacerbation and 104 had infectious complications, including cellulitis, abscesses, invasive infections, and eczema herpeticum. The differences between these 2 groups of patients were further verified by length of stay, serum total IgE level, and inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). A total of 56 of 70 patients (80%) with AD exacerbation were treated with a systemic antibiotic. Clindamycin and vancomycin together accounted for 88% of antibiotics on admission for both groups, whereas clindamycin and sulfamethoxazole-trimethoprim were prescribed at similar rates for both groups at discharge. Wound culture results showed that the methicillin-resistant Staphylococcus aureus (MRSA) rate was significantly lower in children with AD exacerbation (22%) vs infectious complications (39%).

Conclusion: Children were treated with a high frequency of anti-MRSA antibiotics for inpatient AD exacerbation and infectious complications. However, the rate of MRSA was significantly lower in children with AD exacerbation. Thus, empiric antibiotic choice for infectious complications may not be appropriate for AD exacerbation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Child
Child, Preschool
Dermatitis, Atopic / drug therapy*
Hospitalization
Humans
Infant
Infant, Newborn
Methicillin-Resistant Staphylococcus aureus*
Practice Patterns, Physicians'*
Staphylococcal Infections / drug therapy*

Substances

Anti-Bacterial Agents