EVALUATING THE CHANGING TRENDS IN EMERGENCE OF MULTIDRUG RESISTANCE AMONG GRAM POSITIVE ORGANISMS ISOLATED FROM SKIN AND SOFT TISSUE INFECTIONS FROM A TERTIARY CARE HOSPITAL, JHARKHAND

Abstract

Drug resistance among gram positive aerobic cocci poses a significant problem in management of patients with skin and soft tissue infections (SSTI's). S. aureus is the most common organism that causes mild skin and soft tissue infections to serious infections such as sepsis and toxic shock syndrome. Enterococcus and Streptococcus species have also emerged as a cause of skin and soft tissue infections and health care associated infections (HAI's). SSTI's is an inflammatory microbial invasion of epidermis, dermis and subcutaneous tissue. It is classified according to the layer of infection, severity of infection and microbiologic etiology. The practice guidelines of the Infectious Disease Society of America (IDSA) for the diagnosis and management of skin and soft tissue infection classifies SSTI's into five categories comprising superficial and complicated infections which include impetigo, erysipelas, cellulitis, necrotizing fasciitis, surgical site infection. Risk factors associated with development of SSTI's include poor hygiene, overcrowding, co- morbidities like diabetes, immunocompromised state, overuse of antibiotics, prolonged hospital stay, burn patients etc. Prompt recognition, timely surgical debridement or drainage with appropriate antibiotic therapy is the mainstay treatment for SSTI's. Empirical therapy includes penicillin, cephalosporins, clindamycin and cotrimoxazole. Multi-Drug resistance is of major concern commonly caused by MRSA (Methicillin resistant staphylococcus aureus) which includes CA-MRSA (Community acquired methicillin resistant Staphylococcus aureus), HA-MRSA (hospital acquired methicillin resistant Staphylococcus aureus), VRSA (vancomycin resistant staphylococcus aureus) & VRE (vancomycin resistant Enterococci). HA-MRSA is generally susceptible to clindamycin, vancomycin, Linezolid & trimethoprim- sulfamethoxazole. In contrast, CA-MRSA is usually sensitive to these former antibiotics as well as broader range of oral antimicrobial agents like clindamycin, linezolid, quinolones, daptomycin, tigecycline etc. These empirical therapeutic agents provide coverage for both S. aureus, Streptococcus species and Enterococcus species. Therefore, demographic knowledge of antimicrobial agents and their resistance pattern plays a significant role in management of SSTI's.