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Nodaras C, Kotsaki A, Tziolos N, Kontopoulou T, Akinosoglou K, Chrisanthakopoulou M, Kranidioti E, Kritselis I, Voloudakis N, Vittoros V, Gogkou A, Fillas I, Toutouzas KG, Bristianou M, Tsoutsos D, Christaki E, Adamis G, Kaziani K, Tsironis C, Lada M, Kokkinakis E, Sympardi S, Koutelidakis IM, Karkamanis A, Pantazi A, Bayram C, Alexiou Z, Mousoulis G, Gogos C, O'Hare M, Griffiths D, MacGowan A, Sambatakou H, Giamarellos-Bourboulis EJ. Microbiology of acute bacterial skin and skin-structure infections in Greece: A proposed clinical prediction score for the causative pathogen. Int J Antimicrob Agents 2019; 54:750-756. [PMID: 31479742 DOI: 10.1016/j.ijantimicag.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/20/2019] [Accepted: 08/23/2019] [Indexed: 01/03/2023]
Abstract
Although clinical definitions of acute bacterial skin and skin-structure infection (ABSSSI) are now well established, guidance of the prediction of likely pathogens based on evidence is missing. This was a large survey of the microbiology of ABSSSIs in Greece. During the period November 2014 to December 2016, all admissions for ABSSSI in 16 departments of internal medicine or surgery in Greece were screened to determine the likely bacterial aetiology. Samples were cultured on conventional media. Expression of the SA442, mecA/mecC and SCCmec-orfX junction genes was assessed. Following univariate and forward logistic regression analysis, clinical characteristics were used to develop scores to predict the likely pathogen with a target of 90% specificity. In total, 1027 patients were screened and 633 had positive microbiology. Monomicrobial infection by Gram-positive cocci occurred in 52.1% and by Gram-negative bacteria in 20.5%, and mixed infection by Gram-positive cocci and Gram-negative bacteria in 27.3%. The most common isolated pathogens were Staphylococcus aureus and coagulase-negative staphylococci. Resistance to methicillin was 57.3% (53.5-61.1%). Three predictive scores were developed: one for infection by methicillin-resistant S. aureus, incorporating recent hospitalisation, atrial fibrillation, residency in long-term care facility (LTCF) and stroke; one for mixed Gram-positive and Gram-negative infections, incorporating localisation of ABSSSI in lumbar area, fluoroquinolone intake in last 6 days, residency in LTCF and stroke; and another for Gram-negative infection, incorporating skin ulcer presentation, peptic ulcer and solid tumour malignancy. In conclusion, methicillin-resistant staphylococci are the main pathogens of ABSSSIs. The scores developed may help to predict the likely pathogen.
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Affiliation(s)
- Christos Nodaras
- 2nd Department of Internal Medicine, Thriasio General Hospital, Elefsis, Greece
| | - Antigoni Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Tziolos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theano Kontopoulou
- 3rd Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | | | | | - Ioannis Kritselis
- Department of Internal Medicine, Argos General Hospital, Argos, Greece
| | - Nikolaos Voloudakis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Vassilios Vittoros
- 1st Department of Internal Medicine, Thriasio General Hospital, Elefsis, Greece
| | - Agathoniki Gogkou
- 1st Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Ilias Fillas
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - Konstantinos G Toutouzas
- 1st Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimosthenis Tsoutsos
- Department of Plastic Surgery, Microsurgery and Burn Center 'J. Ioannovich', 'G. Gennimatas' Athens General Hospital, Athens, Greece
| | - Eirini Christaki
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Adamis
- 1st Department of Internal Medicine, 'G. Gennimatas' Athens General Hospital, Athens, Greece
| | - Katerina Kaziani
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Tsironis
- Department of Plastic Surgery, Microsurgery and Burn Center 'J. Ioannovich', 'G. Gennimatas' Athens General Hospital, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - Evangelos Kokkinakis
- 1st Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Styliani Sympardi
- 1st Department of Internal Medicine, Thriasio General Hospital, Elefsis, Greece
| | - Ioannis M Koutelidakis
- 2nd Department of Surgery, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | | | - Aikaterini Pantazi
- 2nd Department of Internal Medicine, Thriasio General Hospital, Elefsis, Greece
| | - Cihat Bayram
- 3rd Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital, Elefsis, Greece
| | - George Mousoulis
- 3rd Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | | | | | | | - Helen Sambatakou
- 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
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