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The Crisis of Antibiotic Resistance Has Come to the Surface

Arthur S. Colsky, PhD, MD; Robert S. Kirsner, MD; Francisco A. Kerdel, BSc, MBBS

Arch Dermatol. 1998;134:1006-1009.

Background  Results of an ongoing surveillance of antibiotic resistance in hospitalized dermatology patients are presented. Bacterial isolates cultured from patients with skin wounds admitted to a tertiary care dermatology inpatient unit from May 1995 through May 1996 were evaluated for resistance to commonly used antibiotics. Comparison was made with a previous survey of the same inpatient service from 1992. Our results show an alarming trend toward antibiotic resistance.

Observation  In superficial skin wounds, Staphylococcus aureus constituted 77% of isolates. In leg ulcers, the frequencies of S aureus and Pseudomonas aeruginosa were approximately equal, constituting 43% and 42% of cultures, respectively. Fifty percent of S aureus isolates from leg ulcers were resistant to oxacillin, with 36% of pseudomonad isolates resistant to ciprofloxacin. In superficial wounds, oxacillin resistance in S aureus approached 25%. A comparison of antibiotic resistance profiles using data collected in 1992 for patients admitted to the same inpatient service revealed a marked increase in oxacillin and ciprofloxacin resistance in S aureus and P aeruginosa in leg ulcers, respectively (from 24% to 50% oxacillin resistance in S aureus and from 9% to 24% ciprofloxacin resistance in P aeruginosa), and superficial wounds (24% to 36% ciprofloxacin resistance in P aeruginosa).

Conclusions  This study demonstrates the rapid emergence of antibiotic-resistant bacteria as a problem of growing significance in hospital dermatology and highlights the importance of local surveillance programs to aid in selecting antibiotic treatments.

From the Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Fla.

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