Download bacterial-infection-of-vzv-treatment

Bacterial superinfection of
chicken pox:
Best antibiotic to use?
Joshua Burns & Megan Collins
Paediatric varicella hospitalisations in
France: a nationwide survey1
• 1575 patients hospitilised between March 2003 and July 2005
• From 200 paediatric wards across France
• Median age was 2 years, 87.5% were <5 years, and 2.7% were
neonates
• Based on national surveillance network data
Results
• Skin/soft tissue infection was most common complication (36.5%)
• Other common complications: Neurologic (8.1%), febrile seizures
(6.4%), bacterial pneumonia (3.1%), ENT (2.9%), varicella pneumonia
(2.4)
Results (continued)
• A pathogen was identified in 268 cases of skin/soft tissue superinfection
- 158 were Staphylococcus Aureus (59%)
- 88 were Group A Beta-haemolytic streptococci (33%)
- 14 were Staph. Aureus + Group A strep (5%)
• 97% cases were Staph. Aureus or Group A Strep.
Strengths
Weaknesses
• Correct demographics (age-range,
hospitilised)
• Retrospective study
• Sufficient sample size
• Methods for how organism was
determined are unclear in paper
• Recorded all complications
Disease manifestations and pathogenic
mechanisms of Group A Streptococcus2
• Narrative review
• American Society for Microbiology – Clinical Microbiology
Reviews
• ‘Group A Strep remains exquisitely and universally sensitive
to penicillin’
• Suggests use of beta-lactam antibiotics for group A strep
• Clindamycin, macrolides and cephalosporins all also
appropriate
Antimicrobial Activities of Ceftaroline and Comparator
Agents against Bacterial Organisms Causing Bacteremia in
Patients with Skin and Skin Structure Infections in U.S.
Medical Centers, 2008 to 20143
• Bacteria collected as part of Assessing Worldwide
Antimicrobial Resistance Evaluation (AWARE)
• Skin infections that have progressed to bacteraemia
• In adult population
• Included 670 Staph. Aureus and 138 Beta-haemolytic
Streptococci
Staphylococcus Aureus (670)
Antibiotic
% Susceptibility
Beta-haemolytic streptococci (138)
Antibiotic
% Susceptibility
Ceftaroline
97.9
Ceftaroline
100
Ceftriaxone
49.4
Ceftriaxone
100
Oxacillin
49.4
Penicillin
100
Clindamycin
82.4
Clindamycin
84.8
Daptomycin
99.7
Daptomycin
100
Erythromycin
39.0
Erythromycin
71.0
Levofloxacin
59.0
Levofloxacin
99.3
Linezolid
99.9
Linezolid
100
Tetracycline
95.8
Tetracycline
44.9
Tigecycline
100
Tigecycline
100
Vancomycin
100
Vancomycin
100
Skin and soft tissue infections in Latin American medical
centers: four-year assessment of the pathogen
frequency and antimicrobial susceptibility patterns4
• Antimicrobial susceptibility of isolates collected from skin and
soft tissue infections during the first 4 years (1997-2000) of the
SENTRY Antimicrobial Surveillance Program
• Staphylococcus Aureus in 32.8%
Staphylococcus Aureus (584)
Antibiotic
% Susceptibility
Penicillin
5.3
Co-amoxiclav
71.6
Tetracycline
71.2
Chickenpox in adults - Clinical management5
“Secondary bacterial infection with Staphylococcus aureus
or Group A Streptococci is a common complication of
chickenpox … treatment with appropriate antibiotics, such
as flucloxacillin, co-amoxiclav or a macrolide should be
considered.’’
Conclusions
• Superinfected chicken pox lesions most likely to be Group
A Streptococcus or Staphylococcus Aureus
• Literature consensus is that Group A strep. is susceptible to
penicillin antibiotics, including co-amoxiclav
• Co-amoxiclav seems to be good choice for most but not
all of Staph. Aureus strains
References
1
Grimprel E, Levy C, de La Rocque F, Cohen R, Soubeyrand B, Caulin E, Derrough T, Lecuyer A, d'Athis P,
Gaudelus J. Paediatric varicella hospitalisations in France: a nationwide survey. Clinical microbiology and
infection. 2007 May 1;13(5):546-9.
2
Walker MJ, Barnett TC, McArthur JD, Cole JN, Gillen CM, Henningham A, Sriprakash KS, Sanderson-Smith ML,
Nizet V. Disease manifestations and pathogenic mechanisms of group A Streptococcus. Clinical microbiology
reviews. 2014 Apr 1;27(2):264-301.
3 Sader
HS, Flamm RK, Mendes RE, Farrell DJ, Jones RN. Antimicrobial activity of ceftaroline and comparator
agents tested against bacterial organisms causing bacteremia in patients with skin and skin structure infections
in United States medical centers (2008-2014). Antimicrobial agents and chemotherapy. 2016 Feb 8:AAC-02794.
4
Sader HS, Jones RN, Silva JB, SENTRY Participants Group. Skin and soft tissue infections in Latin American
medical centers: four-year assessment of the pathogen frequency and antimicrobial susceptibility patterns.
Diagnostic microbiology and infectious disease. 2002 Nov 30;44(3):281-8.
5 Tunbridge
AJ, Breuer J, Jeffery KJ. Chickenpox in adults–Clinical management. Journal of Infection. 2008 Aug
31;57(2):95-102.