Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy

• Published in: International journal of antimicrobial agents Vol. 22; no. 4; pp. 406 - 419
• Main Authors: Jones, Mark E., Karlowsky, James A., Draghi, Deborah C., Thornsberry, Clyde, Sahm, Daniel F., Nathwani, Dilip
• Format: Journal Article
• Language: English
• Published: London Elsevier B.V 01.10.2003; Amsterdam Elsevier; New York, NY
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial resistance; Bacterial diseases; Bacterial diseases of the skin; Biological and medical sciences; Drug Resistance, Bacterial; Enterococcus; Escherichia coli; Europe; Gram-Negative Bacteria - drug effects; Gram-Positive Bacteria - drug effects; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Microbial Sensitivity Tests; Pharmacology. Drug treatments; Pseudomonas aeruginosa; Skin Diseases, Bacterial - drug therapy; Skin soft tissue infection; Soft Tissue Infections - drug therapy; Staphylococcus; Staphylococcus aureus; Surveillance; United States; United States; Europe; America; Italy; France; North America; Germany; Spain; Skin soft tissue infection; Surveillance; Antimicrobial resistance; Human; Skin disease; Epidemiology; In vitro; Infection; Antibiotic; Sensitivity resistance; Bacteriosis; Soft tissue; Skin; Antibacterial agent; Clinical isolate
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/S0924-8579(03)00154-7

Susceptibility data for all organisms associated with a range of skin and soft tissue infections (SSTI) in hospitalised patients were studied. Data were reported by clinical laboratories in the USA, France, Germany, Italy and Spain during 2001 which participate in The Surveillance Network (TSN). Staphylococcus aureus, Enterococcus spp. and coagulase-negative staphylococci (CNS), Escherichia coli and Pseudomonas aeruginosa were the most prevalent pathogens in all countries. MRSA was detected in 44.4, 34.7, 12.4, 41.8 and 32. 4% of S. aureus in each country, respectively. The majority of MRSA were cross resistant to other compound classes tested except for vancomycin (100% susceptible) trimethoprim–sulphamethoxazole with range 1.7% (France) to 15.9% (Italy) resistant, and gentamicin with range 12.2% (France) to 87.0% (Italy) resistant. More than 99.0% of MSSA tested susceptible to ceftriaxone and >94.9% to trimethoprim–sulphamethoxazole. 87.2% (France) to 94.6% of MSSA (Germany) were ciprofloxacin susceptible; 73.2% (USA) to 86.6% (Spain) were erythromycin susceptible; 85.4% (Italy) to 99.2% (France) were gentamicin susceptible. MSSA were more frequently found and generally more antibiotic susceptible from out patients. Overall, 100% of Streptococcus agalactiae and Streptococcus pyogenes were susceptible to penicillin, ceftriaxone and cefotaxime. Macrolide resistance was common among S. agalactiae (20.7%, Germany to 10%, Italy and Spain), S. pyogenes (19.2%, France to 11.1%, USA) and viridans streptococci (25.7%, France to 14.1%, Germany). Vancomycin-resistant Enterococcus spp. were uncommon outside the USA (17.5%) and Italy (7.4%). For all countries susceptibility of E. coli was 100% to imipenem, >98.7% to amikacin, >96.0% to ceftriaxone and cefotaxime. Susceptibility of E. coli isolates to ciprofloxacin was 77.6% in Spain to 94.3% in Germany. Klebsiella spp., Proteus spp., Citrobacter spp. and Enterobacter spp. displayed varying susceptibilities between countries to drugs tested. Putative extended spectrum β-lactamase expression in E. coli remained rare comprising 4–5% of isolates in USA, Italy and Spain and in France and Germany <2%. For P. aeruginosa piperacillin–tazobactam, amikacin, imipenem and ceftazidime were the most active compounds tested irrespective of region. Surveillance data should be considered when selecting empirical therapy for treating SSTI.