Clinical Context-Specific Staphylococcus aureus Susceptibilities May Differ Substantially and Be Obscured by Aggregate Antibiograms

Aggregate data in institutional antibiograms may not accurately represent major pathogens' antibiotic susceptibility patterns in important clinical scenarios. In this analysis of Staphylococcus aureus isolates between 2013 and 2016 at the Women and Children's Hospital of Buffalo, methicillin and clindamycin susceptibility rates of S. aureus differed significantly from aggregate data when stratified by wound specimen and osteoarticular infection (OAI) isolates. Clindamycin susceptibility of methicillin-resistant S. aureus (MRSA) in wound specimens was higher than published antibiograms, whereas the proportion of MRSA and total clindamycin susceptibility in OAI was relatively lower, which impacts empiric antibiotic decision-making. With S. aureus antibiotic susceptibility patterns shifting and differences by infection type, as well as geographic location, pediatric facilities are encouraged to perform local reviews and emphasize specimen and clinical-context rather than aggregate antibiograms.