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ORIGINAL ARTICLE
Year : 2012  |  Volume : 57  |  Issue : 5  |  Page : 358-361
Bacteriological study of pyodermas in a tertiary care dermatological center


1 Department of Dermatology, Government Medical College, Amritsar, Punjab, India
2 Department of Microbiology, Government Medical College, Amritsar, Punjab, India

Date of Web Publication3-Sep-2012

Correspondence Address:
Suresh K Malhotra
Department of Dermatology HIG 943, Sector 3, Ranjit Avenue, Amritsar-143001, Punjab
India
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DOI: 10.4103/0019-5154.100475

PMID: 23112354

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   Abstract 

Background: Bacterial skin infection especially Pyoderma, commonly caused by Staphylococcus aureus and group A Streptococci, is quite common in Indian dermatology clinics. Despite a number of new antibiotics, the incidence of bacterial resistance is rising. Aim: To find out causative organisms and their latest antibiotic susceptibility patterns in pyodermas. Materials and Methods: All in-patients admitted in the Dermatology wards in Government Medical College, Amritsar were screened over 18 months and those with erosive skin lesions and/or purulent discharge were included in the study and swabs were sent for culture and sensitivity. Results: Majority 49/61 cases (80.33%) comprised of secondary pyodermas while primary pyodermas constituted only 12/61 cases (19.67%). Single organism was isolated in 49 cases (80.33%). More than one type of organism was isolated in 3 cases (4.92%) while none could be isolated from 9 (14.75%) cases. Staphylococcus aureus spp. was the commonest organism isolated in 36 (59.01%) cases and out of these, coagulase positive strains were found to be highly susceptible to amikacin (21cases-100%). Coagulase negative strains were sensitive to amikacin (7 cases-77.7%) and gentamycin (6 cases-66.6%) respectively. Conclusion: This study gives an indication of the present pattern of bacteriological profile of pyodermas in a tertiary care hospital in north-west India. In-vitro testing is essential as knowledge of the causative organisms and resistance patterns can help us select appropriate antibiotics without wasting time in using resistant drugs.


Keywords: Bacteriological profile, pyodermas, tertiary hospital


How to cite this article:
Malhotra SK, Malhotra S, Dhaliwal GS, Thakur A. Bacteriological study of pyodermas in a tertiary care dermatological center. Indian J Dermatol 2012;57:358-61

How to cite this URL:
Malhotra SK, Malhotra S, Dhaliwal GS, Thakur A. Bacteriological study of pyodermas in a tertiary care dermatological center. Indian J Dermatol [serial online] 2012 [cited 2014 Oct 20];57:358-61. Available from: http://www.e-ijd.org/text.asp?2012/57/5/358/100475

What was known? 1. Bacterial skin infection is quite common. 2. The incidence of bacterial resistance is rising



   Introduction Top


Pyodermas are quite common in India and constitute a major portion of the cases in dermatology clinics. Many cases these days do not respond to the antibiotics that were previously very effective in such cases. Perhaps, indiscriminate use of topical and systemic antibiotics has contributed to this situation. [1],[2],[3],[4] The emergence of antibiotic resistance has significantly eroded the utility of established antibiotics and poses a serious threat to public health worldwide. In order to successfully treat cases of pyodermas, detailed knowledge is necessary regarding the various causative organisms and their sensitivity patterns. Considering these aspects, the present study was an attempt to find out the causative organisms and their antibiotic susceptibility patterns in different cases of primary and secondary pyodermas admitted in the dermatology wards in a tertiary care hospital.


   Materials and Methods Top


All patients admitted in dermatology wards of a tertiary hospital in north-west India from January 2009 to August 2010 were screened for pyogenic skin infections of both primary and secondary types. Only those who had erosive skin lesions with exudative or purulent discharge were included in the study. Sixty-one patients of various ages and both sexes were identified for inclusion in the study; these included patients from urban as well as rural backgrounds. Sterile swabs were used to aseptically collect exudate or pus from the lesions. Care was taken that these samples were collected before the start of antibiotic therapy. The swabs were transported immediately to the microbiology laboratory for culture and sensitivity examination.


   Results and Observation Top


The demographic characteristics of the patients enrolled in the study are shown in [Table 1].
Table 1: Demographic characteristics of the study cases (n=61)


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Primary bacterial skin infections (primary pyoderma) accounted for 12 (19.67%) cases while 49 (80.33%) cases were of secondary pyoderma. Among the primary pyodermas, impetigo was the commonest entity seen (nine cases-14.75%); among the secondary pyodermas, secondarily infected pemphigus vulgaris was the commonest, being seen in 24 cases (39.34%) [Table 2].
Table 2: Distribution of cases of primary and secondary pyoderma


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A single infecting organism was isolated from 49 (80.33%) cases, more than one type of organism from three cases (4.92%) and no organism from nine cases (14.75%). Coagulase positive methicillin-sensitive (MS) Staphylococcus was isolated from 21 (34.4%) cases, coagulase positive methicillin resistant (MR) Staphylococcus in five (8.2%) cases, coagulase negative MS Staphylococcus in nine (14.75%) cases, coagulase negative MR Staphylococcus in one (1.64%) case. Thus, overall there were 36 (59%) cases of Staphylococcus spp., which included six (9.84%) cases of methicillin resistant Staphylococcus (MRSA). Out of these 36 cases, coagulase positive Staphylococcus accounted for 26 (42.62%) cases and coagulase negative Staphylococcus accounted for 10 cases (16.39%). The second most common organism isolated was Klebsiella Spp. (three-4.91%), Streptococcus, Enterococcus and E.coli+Enterococcus were isolated in two patients (3.28%) each [Table 3].
Table 3: Pattern of microorganisms isolated from cases of pyodermas


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Among the S. aureus strains, susceptibility to antibiotics was as follows: amikacin- (21 strains-100%), gentamycin-(14 strains-66%), ciprofloxacin-(11 strains-52.4%) and gatifloxacin (9 strains-42.8%) [Table 4].
Table 4: Antibiotics susceptibility and resistance pattern of organisms isolated


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   Discussion Top


In all, we had 61 cases of pyoderma in this study. There were 12 (19.67%) cases of primary pyoderma, of which 9 cases were of impetigo. Impetigo formed the largest group followed by carbuncle and folliculitis. Similar high incidence of impetigo has been reported by others. [1],[5] In our study, primary pyoderma constituted only 19.67% cases. This low incidence of primary pyoderma was probably because our study included only those patients who were admitted as inpatients for treatment of some other problem, and also because a large number of patients of primary pyoderma reporting in the outpatient department were not included in the study. Males were affected more than females in this study, as has also been reported by others. [4],[6],[7],[8],[9] Among the secondary pyodermas, infected pemphigus vulgaris was the commonest diagnosis, followed by  Stevens-Johnson syndrome More Details (SJS). Infected pemphigus (vulgaris + foliaceus), with a total of 24 cases (39.34%) was the commonest diagnosis among all cases of pyoderma; second commonest diagnosis was impetigo- nine cases (14.75%) and this was followed by SJS (eight cases-13.11%).

In bacteriological analysis, we observed that Staphylococcus spp. (36 cases-59.01%) were the most common organisms to be isolated; this included MRSA- which was isolated in six cases (9.83%). A similar high incidence of MRSA has been reported in other studies. [2],[3],[6],[8],[10] Among the Staphylococcal strains isolated 26 (42.62%) were coagulase positive and 10 (16.39%) were coagulase negative. A high incidence of coagulase positive Staphylococcus in pyoderma has been reported by several workers. [2],[3],[4] Coagulase negative strains have also been reported to be etiological agents. [3],[11] S. aureus and Streptococci are considered to be the main etiological agents of cutaneous bacterial infections [12] and these have been isolated in different proportions of cases in studies in India and abroad. [2],[6],[7],[9],[10],[13],[14] The other organisms isolated in this study were Klebsiella in three (4.92%) patients, Streptococcus, Enterococcus and Proteus in two patients each (3.27% each) and Citrobacter and E.coli in one patient each (1.64%). A combination of Staphylococcus + Streptococcus was found in one case (1.64%), and combinations of Staphylococcus + Enterococcus and E. coli + Enterococcus in two patients each (3.28% each). Culture results were negative in nine patients (14.75%), which is similar to the studies by Baslas et al (negative culture results in 14.9%) and Rahul et al (negative culture results in 16.3%). [8],[15]

The antibiotic susceptibility patterns of the various isolates is shown in [Table 4] and comparisons between different studies are shown in [Table 5].
Table 5: Overview of different organisms isolated and their sensitivity patterns in various studies


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In this study most of coagulase positive strains of Staphylococcus were susceptible to amikacin (21 cases-100%), gentamycin (14 cases-66%) and ciprofloxacin (11 cases-52.4%). Coagulase negative Staphylococci were largely susceptible to amikacin (seven cases-77.7%) and gentamycin (six cases-66.6%) but showed relatively low susceptibility to ampicillin (five cases-55.5%), erythromycin (four cases-44.4%) and gatifloxacin (three cases-33.3%). Klebsiella was sensitive to amikacin (three cases-75%), gentamycin (two case-50%), ciprofloxacin (two cases-50%), and cefotaxime (two cases-50%) but showed relatively low susceptibility to gatifloxacin (one case-25%) and cephlexin (one case-25%). Most of the strains were found to be resistant to one or more antibiotics. [2],[3],[6],[8],[11] Most of the coagulase positive Staphylococcus strains were resitant to erythromycin and gatifloxacin (eight cases each-38.1%), ampicillin (seven cases-33%) and cephalexin (six cases-28%). Klebsiella spp. were resistant to ceftriaxone, ciprofloxacin, cefotaxime and cephalexin [two cases (50%) each]. Streptococci were sensitive to ampicillin, erythromycin, cephalexin, ciprofloxacin, gatifloxacin, linezolid in two cases (100%) each while sensitivity to gentamycin and amikacin was seen in one case (50%) each. Most of organisms were highly sensitive to the newer antibiotics while showing low susceptability or resistance to the conventional antibiotics. [2],[8],[10],[14],[16]


   Conclusions Top


This study gives an indication of present pattern of bacterial infections in pyodermas. Multidrug resistance has become a clinical challenge. Most of the bacterial strains were found to be resistant to one or more antibiotics. With knowledge of the likely causative organisms and their resistance patterns, the most suitable antibiotic therapy can be started without waiting for anti biogram results, and thus help avoid unnecessary medication with ineffective drugs.

 
   References Top

1.Verma KC, Chugh TD, Bhatia KK. Streptococci in pyoderma. Indian J Dermatol Venereol Leprol 1981;47:202-7.  Back to cited text no. 1
    
2.Mathews MS, Garg BR, Kanungo R. A clinico-bacteriological study of primary pyodermas in children in Pondicherry. Indian J Dermatol Venereol and Leprol 1992;58:183-7.  Back to cited text no. 2
    
3.Ramani TV, Jaykar PA. Bacteriological study of 100 cases of pyodermas with special reference to stapylococci, their antibiotic sensitivity and phage pattern. Indian J Dermatol Venereol Leprol 1980;46:282-6.  Back to cited text no. 3
    
4.Khare AK, Bansal NK, Dhruv AK, A clinical and bacteriological study of pyodermas. Indian J Dermatol Venereol Leprol 1988;54:192-5.  Back to cited text no. 4
    
5.Ghadage DP, Sali YA. Bacteriological study of pyoderma with special reference to antibiotic susceptibility to newer antibiotics. Indian J Dermatol Venereol Leprol 1999;65:177-81.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Sachdev D, Amladi S, Natraj G, Baveja S, Kharkar V, Mahajan S, et al. An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in dermatology indoor patients. Indian J Dermatol Venereol Leprol 2003;69:377-80.  Back to cited text no. 6
    
7.Kandhari KC, Omprakash, Singh G. Bacteriology of pyodermas. Indian J Dermatol Venereol 1962;28:125.  Back to cited text no. 7
    
8.Patil R, Baveja S, Nataraj G, Khopkar U. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol 2006;72:126-228.  Back to cited text no. 8
[PUBMED]    
9.Tan HH, Tay YK, Goh CL. Bacterial skin infections at a tertiary dermatological centre. Singapore Med J 1998;39:353-6.  Back to cited text no. 9
[PUBMED]    
10.Chopra A, Puli R, Mittal RR. A clinical and bacteriological study of pyodermas. Indian J Dermatol Venerol Leprol 1994;60:200-2.  Back to cited text no. 10
    
11.Bhaskaran CS, Syamsundara Rao P, Krishnamurty T. Bacteriological study of pyoderma. Indian J Dermatol Venereol Leprol 1979;45:162-9.  Back to cited text no. 11
    
12.Collee JG, Fraser AG, Marmion BP, Simons A, Editors. Mackie and McCartney. Practical Medical Microbiology. 14th ed. Philadelphia: Churchill Livingstone; 1996. p. 131.  Back to cited text no. 12
    
13.Asati DP, Sharma VK, Khandpur S, Khilani GC, Kapil A. clinical and bacteriological profi le and outcome of sepsis in dermatology ward in tertiary care centre in New Delhi. Indian J Dermatol Venereol Leprol 2011;77:141-7.  Back to cited text no. 13
    
14.Pasricha A, Bhujwala RA, Shriniwas. Bacteriological study of pyoderma. Indian J Path Bact 1972;15:131-7.  Back to cited text no. 14
[PUBMED]    
15.Baslas RG, Arora SK, Mukhija RD, Mohan L, Singh UK. Organisms causing pyoderma and their susceptibility patterns. Indian J Dermatol Venereol Leprol 1990;56:127-9.  Back to cited text no. 15
  Medknow Journal  
16.Kar PK, Sharma NP, Shah BH. Bacteriological study of pyoderma in children. Indian J Dermatol Venereol Leprol 1985;51:325-7.  Back to cited text no. 16
  Medknow Journal  

What is new? 1. Present pattern of infection is outlined. 2. Multidrug resistance is a serious clinical challenge.



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 Clinico-bacteriological studies on pyoderma in Gulbarga region (Karnataka state) emphases to Methicillin resistant Staphylococcus aureus
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International Journal of Pharma and Bio Sciences. 2013;
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