Inflamed or Infected Molluscum Contagiosum Lesions: Pediatrician Perceptions and the Risk of Antibiotic Overuse.

Abstract

Background/objectives: Molluscum contagiosum (MC) is a common pediatric skin infection caused by the molluscum contagiosum virus. Lesions often become inflamed prior to self-resolving. This phenomenon can mimic bacterial superinfection, although true superinfection of MC lesions is thought to be rare.

Methods: We conducted a single-center retrospective study of MC patients 0-18 years of age who were diagnosed with MC and had a bacterial culture of one or more inflamed molluscum lesions over a 10-year period. Data collected included the prevalence of true infection on culture, specific pathogens that were implicated, and the prevalence of antibiotic usage. We also surveyed general pediatricians to better understand their beliefs and practices regarding MC superinfection.

Results: Fifty-one patients who were diagnosed with MC and underwent a bacterial culture were included. Most patients were diagnosed and treated by their pediatrician. Of 57 cultures collected from the 51 included patients, 7 (12%) isolated a pathogenic bacterial organism. Thirty-six (71%) patients were prescribed at least one topical antibiotic, and 32 (63%) patients were prescribed at least one systemic antibiotic to treat their MC or MC-related superinfection. Among the 217 pediatricians surveyed, 118 complete responses were received (54% response rate), with 47% of respondents reporting never culturing MC lesions suspected of being superinfected.

Conclusions: Our study reaffirms a low prevalence of MC superinfection, as evidenced by the low rate of culture positivity. However, antibiotics were routinely prescribed despite negative cultures. These findings suggest that using bacterial cultures for MC lesions suspected of being superinfected, and-when clinically appropriate-waiting briefly for preliminary results before treating with antibiotics could dramatically reduce unnecessary antibiotic use.