Hogan PG, et al. – The proposition under contemplation here was that the inclusion of systemic antibiotics in the management of S. aureus skin and soft tissue infection (SSTI), in conjunction with incision and drainage, would reduce S. aureus colonization and incidence of recurrent infection. It was deduced that systemic antibiotics affected the S. aureus colonization. This, in turn, led to a decreased incidence of recurrent SSTI. The mechanism by which clindamycin differentially influenced colonization and recurrent SSTI compared to TMP–SMX needed additional exploration.

Methods

• 383 children with S. aureus SSTI, requiring incision and drainage and S. aureus colonization in the anterior nares, axillae, or inguinal folds, were enrolled for this study.
• Systemic antibiotic prescribing at the point of care was recorded.
• Repeat colonization sampling was carried outwithin 3 months (median 38 days; IQR 22–50 days) in 357 enrollees.
• Incidence of recurrent infection was determined for up to one year.

Results

• Those who were prescribed guideline-recommended empiric antibiotics for purulent SSTI exhibited lesser tendency of remaining colonized at follow-up sampling (adjusted hazard ratio [aHR] 0.49, 95% CI 0.30, 0.79).
• They displayed less likelihood of recurrent SSTI (aHR 0.57, 95% CI 0.34, 0.94) than those not receiving guideline-recommended empiric antibiotics for their SSTI.
• The enrollees remaining colonized at repeat sampling were more likely to report a recurrent infection over 12 months (aHR 2.37, 95% CI 1.69, 3.31).
• Clindamycin was more effective than trimethoprim-sulfamethoxazole (TMP-SMX) in eradicating S. aureus colonization (44% vs. 57% remained colonized, p=0.03) and preventing recurrent SSTI (31% vs. 47% experienced recurrence, p=0.008).