Neighborhood Variation in Antibiotic Susceptibility Among Pediatric MRSA and MSSA Skin and Soft Tissue Infections in Chicago

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ID: 327334
2026
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Abstract
Abstract Background Staphylococcus aureus is the leading cause of pediatric skin and soft tissue infections (SSTIs). Yet, antibiotic resistance surveillance typically relies on single-antibiotic antibiograms, which overlook higher-order resistance patterns and the variation in resistance phenotypes across neighborhoods. Inspired by our previous work in association-mining methods used to uncover multidrug resistance phenotypes in Atlanta, we applied a spatial analytic framework to Chicago pediatric SSTI isolates to evaluate (1) neighborhood-level variation in S. aureus resistance and (2) signals of phenotype clustering. We hypothesized that clindamycin resistance and related phenotype patterns would demonstrate heterogeneous spatial distribution across Chicago. Methods We conducted a retrospective cohort study of pediatric SSTIs (ages 0–18 years) from 2016–2024 at a large urban academic medical center in Chicago. Wound cultures yielding MRSA or methicillin-susceptible S. aureus (MSSA) were included. Antibiotic susceptibility profiles were extracted for clindamycin, erythromycin, trimethoprim–sulfamethoxazole (TMP-SMX), and additional agents routinely tested. Non-susceptibility was defined as resistant or intermediate. ZIP code–level analyses were restricted to ZIP codes with ≥5 isolates per organism to ensure stability. Descriptive statistics were used to characterize the frequencies of phenotypes, and spatial heterogeneity in clindamycin resistance (a marker of evolving community-associated strains) was assessed as the primary outcome. This analysis represents the first phase of a larger study designed to identify phenotypic associations and assess higher-order resistance patterns over time and space. Results A total of 398 isolates met the inclusion criteria: 155 (38.9%) MRSA and 239 (60.1%) MSSA. MRSA demonstrated 100% non-susceptibility to methicillin and cefazolin, while MSSA remained >99% susceptible (0.4% non-susceptible). Across all isolates, clindamycin non-susceptibility was 11.6% (18/155) for MRSA and 16.3% (39/239) for MSSA; erythromycin non-susceptibility was 81.3% (126/155) vs. 34.3% (82/239); TMP-SMX non-susceptibility remained low (1.9% vs. 2.9%). ZIP codes 60636 and 60609 (southwest and south side of Chicago, respectively) demonstrated the highest MRSA clindamycin non-susceptibility (28.6%–33.3%), while ZIP 60629 (southwest side of Chicago) showed the highest MSSA non-susceptibility (40%). Conclusion Pediatric S. aureus antibiotic resistance in Chicago shows significant variation across neighborhoods, with distinct spatial patterns in clindamycin, erythromycin, and multidrug-resistant phenotypes. This ZIP-level approach provides a basis for using association mining to identify complex resistance relationships over time. Combining spatial analyses with pattern discovery may improve detection of emerging community-associated resistance profiles and inform targeted antimicrobial stewardship.
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Authors Sadia Chowdhury, Lilly Cheng-Immergluck, Abdolreza Mozaddegh, Chaohua Li, Samuel Owusu, Xiting Lin, Traci Leong, Declan Quinn, Robert C. Jerris, Peter Baltrus
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.020
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S10/70833171/piag070.020.pdf
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