ABSTRACT
Resumen Objetivo: Estimar la resistencia del Staphylococcus aureus frente a diferentes antibióticos usados para el manejo ambulatorio de piodermias. Métodos: Se realizaron análisis descriptivos y de tendencias mediante modelos de regresión segmentada. Resultados: La mayor resistencia se presentó a la oxacilina, con mediana de 54,3% (RIQ: 43 - 58,8), seguido de eritromicina con el 20%, (RIQ: 15,4 - 26,5), clindami cina con el 14% (RIQ: 7,9 - 20), gentamicina con el 7,5% (RIQ: 0 -10), trimetoprima/sulfametoxazol (SXT) con el 5,5% (RIQ: 4 - 11), y ciprofloxacina con 2,1% (RIQ: 2 - 8.4). La tendencia de la resistencia del S. aureus a la oxacilina fue creciente con un cambio anual porcentual no significativo de (0,07) (IC 95%: -3,7; 3,9). Para eritromicina, clindamicina, ciprofloxacina, trimetoprima/sulfametoxazol, y gentamicina hubo decrecimiento. Conclusiones: La resistencia del S. aureus a oxacilina fue ligeramente creciente para el periodo 2010 al 2019 y francamente creciente en los últimos 3 años, superando en promedio a lo reportado a nivel país y Latinoamérica. Los antibióticos con menor resistencia fueron ciprofloxacina, SXT, clindamicina para uso sistémico, y ácido fusídico, mupirocina para manejo tópico y descolonización. Es pertinente articular la vigilancia del S. aureus en la atención ambulatoria a la red de vigilancia nacional.
Abstract Objective: To estimate the resistance trend of Staphylococcus aureus (S. aureus) against different antibiotics in a reference dermatology outpatient center in Colombia. Methods: Descriptive and trend analyzes were performed using segmented regression models for the period 2010 to 2019. Results: The greatest resistance was presented to oxacillin, with a median of 54.3% (RIQ: 43 - 58.8), followed by erythromycin with 20%, (RIQ: 15.4 - 26.5), then clindamycin with 14% (RIQ: 7.9 - 20), gentamicin with 7.5% (RIQ: 0 -10), trimethoprim / sulfamethoxazole (SXT) with 5.5% (RIQ: 4 - 11), and ciprofloxacin with 2.1% (RIQ: 2 - 8.4). The trend of S. aureus resistance to oxacillin from 2010 to 2019 was increasing with a non-significant Annual Percent Change (APC) of (0.07) (95% CI -3.7, 3.9). APC for erythromycin (-1.2) (95% CI: -11.3; 10), clindamycin (-1.7) (95% CI: 11; -12.9), ciprofloxacin (-25.4) (95% CI: -44.6; 0.5) and trimethoprim / sul famethoxazole (-20.7) (95% CI: -43.5; 11.2), were decreasing not significant. For gentamicin the trend was decreasing and significant (-44.2) (95% CI: -19.9; -61.1). Conclusions: The resistance of S. aureus to oxacillin exhibited a slightly increasing trend for the period 2010 to 2019 and increasing in the last 3 years, exceeding on average that reported at the country level and the world average. Antibiotics for outpatient management of skin and soft tissue pyoderma with less resistance were ciprofloxacin, SXT, clindamycin for systemic use, and fusidic acid, mupirocin for topical management and decolonization. It is important to articulate surveillance of S. aureus in outpatient care to the national surveillance network.
Subject(s)
Humans , Male , Adult , Middle Aged , Dermatology , Methicillin-Resistant Staphylococcus aureus , Staphylococcus aureus , Sulfamethoxazole , Gentamicins , Ciprofloxacin , Fusidic Acid , Anti-Bacterial AgentsABSTRACT
A restauração da barreira cutânea é o primeiro passo para o controle da dermatite atópica (DA) em todas as suas formas. O tratamento da DA grave ou refratária em crianças apresenta alguns desafios, devido principalmente aos efeitos colaterais das drogas imunossupressoras. Como alternativa, as técnicas "Wet Wraps" e "Soak and Smear" são intervenções seguras e eficazes em casos em que a xerose é fator determinante de agravamento da doença. Relata-se o caso de um menino de 5 anos com DA grave (SCORAD = 54) não controlada, com prurido intenso e distúrbio do sono. Houve tratamento prévio com corticoide tópico e sistêmico, diversos emolientes, uso repetido de antibióticos tópicos e sistêmicos, e restrição de leite de vaca, sem resultado. As comorbidades incluíam rinite alérgica (sensibilizado para ovo, leite, epitélio de cão e ácaros) e transtorno do espectro autista. Foi realizado tratamento tópico com ácido fusídico e corticoide de média potência, além de otimização das técnicas de restauração de barreira cutânea. Após um mês, o paciente retornou com melhora quase completa das lesões, SCORAD de 17 (leve), referindo intensa melhora na qualidade de vida, com resolução do distúrbio do sono. Este caso demonstrou a efetividade das técnicas "Wet Wraps" e "Soak and Smear" em criança com DA grave. A boa adesão e a correta execução são fundamentais para o resultado, ressaltando a importância da atenção médica quanto à educação da equipe e dos pais sobre o tratamento. Essas técnicas são bem estudadas e podem ser realizadas como resgaste na DA grave, mesmo em crianças com alterações comportamentais, e, se adequadamente utilizadas, podem evitar a prescrição de imunossupressores.
Skin barrier repair is the first step to control all forms of atopic dermatitis (AD). Treatment of severe or refractory AD in children poses some challenges, mainly due to the side effects of immunosuppressive drugs. As an alternative treatment, "Wet Wraps" and "Soak and Smear" techniques are safe and effective interventions when xerosis is an aggravating factor of the disease. We report the case of a 5-year-old boy with severe AD (SCORAD = 54), showing severe pruritus and sleep disorder. Prior treatment involved topical and systemic corticosteroids, several emollients, repeated use of topical and systemic antibiotics, and restriction to cow's milk, without any positive result. Comorbidities included allergic rhinitis (sensitized to egg, milk, dog epithelium and mites) and autism spectrum disorder. Topical treatment with fusidic acid and medium-potency corticoid was performed, in addition to optimization of skin barrier repair techniques. After one month, the patient returned with clinical improvement, SCORAD of 17 (mild), reporting a strong improvement in quality of life and no sleep disorder. This case demonstrates the effectiveness of the "Wet Wraps" and "Soak and Smear" techniques when applied to children with severe AD. Good adherence and correct execution are fundamental to outcomes, stressing the importance of medical care in the education of team and parents about the treatment. These techniques are well studied and can be performed as rescue therapy in severe AD, even in children with behavioral disorders, and, if properly used, may avoid prescription of immunosuppressants.
Subject(s)
Humans , Male , Child, Preschool , Skin Absorption , Medical Care , Dermatitis, Atopic , Emollients , Autism Spectrum Disorder , Patients , Pruritus , Quality of Life , Skin , Sleep Wake Disorders , Therapeutics , Pharmaceutical Preparations , Adrenal Cortex Hormones , Milk , Prescriptions , Fusidic Acid , Methods , Anti-Bacterial Agents , MitesABSTRACT
La tricomicosis es una infección superficial causada por Corynebacterium flavescens, que afecta por lo regular pelos axilares, en menor grado los púbicos, los escrotales e interglúteos y excepcionalmente los de la cabeza o tricomicosis capitis (TC). Esta infección se caracteriza por formación de nódulos pilosos. Clínicamente se confunde con infecciones como piedra blanca y pediculosis. El diagnóstico se realiza por microscopia y dermatoscopia de masas bacterianas y confirmado por cultivo. OBJETIVO: Presentar un caso de TC en un infante, y mostrar las características microscópicas, dermatoscópicas y ultraestructurales. CASO CLÍNICO: Niño sano de 6 meses de edad, con dermatosis que afectó los pelos de la cabeza en forma de múltiples nódulos-pilosos amarillentos. Se comprobó TC mediante fluorescencia amarilla a la luz de Wood; a la dermatoscopia se observaron cadenas blanco-amarillentas, como "rosarios de piedras cristalinas"; al examen directo se distinguieron masas bacterianas y al cultivo se identificó Corynebacterium flavescens. A la microscopia electrónica se observó infección superficial, sin perforación de los pelos. Se realizó tratamiento con aplicación de ácido fusídico por 3 semanas y se obtuvo curación clínica y microbiológica. CONCLUSIÓN: La TC es una entidad rara que se presenta en niños, y que suele confundirse con otros padecimientos del pelo como la pediculosis e infecciones micóticas.
Trichomycosis is a superficial infection caused by Corynebacterium flavescens, which regularly affects axillary, and to a a lesser extent, pubic, scrotal and intergluteal, and exceptionally, head hairs or trichomycosis capitis (TC). This condition is characterised by the formation of bacterial nodules. Clinically, it can be confused with white piedra or pediculosis. The diagnosis is made by microscopic and dermoscopic observation and confirmed by culture. OBJECTIVE: To present a case of TC in an infant and illustrate the microscopic, dermoscopic, and ultrastructural characteristics. CLINICAL CASE: A 6 month-old boy, otherwise healthy, with multiple yellowish concretions on the hairs of the head. TC was confirmed by yellow fluorescence with Woods light; white-yellowish beads, like "rosaries of crystalline stones" were observed on dermoscopy, direct examination showed bacterial masses, and Corynebacterium flavescens was identified by culture. A superficial infection, without perforation of the hairs, was confirmed by electron microscopy. Treatment with fusidic acid for 3 weeks achieved a clinical and microbiological cure. CONCLUSION: TC is a rare condition that affects children, and tends to be mistaken for other diseases of the hair, such as pediculosis and mycotic infections.
Subject(s)
Humans , Male , Infant , Corynebacterium Infections/diagnosis , Dermoscopy/methods , Fusidic Acid/therapeutic use , Lice Infestations/diagnosis , Treatment Outcome , Corynebacterium/isolation & purification , Corynebacterium Infections/microbiology , Corynebacterium Infections/drug therapy , Hair/microbiology , Hair Diseases/diagnosis , Hair Diseases/microbiology , Hair Diseases/drug therapy , Microscopy , Anti-Bacterial Agents/therapeutic useABSTRACT
Background: Drug utilization studies conducted in Libya during the period 1991-2013, have pointed out that there is an irrational use of antibiotics as a common practice that costs the health system more than 7.7 million Libyan Dinars / year. The aim of this study is to assess the trend of antimicrobial consumption in the Eastern region of Libya during 2012 2013.Methods: Antimicrobial consumption data from the years 2012 and 2013 were obtained mainly from Benghazi office, Medical Supply Organization (MSO; the only official drug-importing body in Libya). This study is concerned with antibiotics imported only to the Eastern region of Libya, population of which representing approximately 35% of total Libyan population. The WHO, Anatomical-Therapeutic-Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology were used to calculate antibiotic consumption. The total antimicrobial consumption data were calculated as DDD/1000 inhabitants/day.Results: Total utilization of antibiotics decreased dramatically from 15.47 DDD/1000 inhabitants/day in 2012 to 4.30 DDD/1000 inhabitants/day in 2013 which in turn shows a significant decline compared to 41.72 DDD/1000 inhabitants/day during the period 1991-1993. Consumption of penicillins decreased from 19.902 DDD/1000 inhabitants/day during 1991-1993 to 1.896 DDD/1000 inhabitants/day during 2012-2013 with pattern of amoxicillin/clavulanic acid consumption which equals 3 times ampicillin consumption and is the highest compared to all penicillins. This was accompanied by a prominent increase in consumption of amphenicols and fusidic acid during 2012-2013, noting that fusidic acid consumption was the highest among all antibiotics. Conclusion: MSO since 2011 (post 17th February, 2011 revolution) lost its control over importing medicine due to receiving many drugs, as donations from different international sources without acceptable levels of coordination. This has been reflected on drug purchasing policy of MSO during 2013, which failed to regain the previously accepted level of DDD/1000 inhabitants/day for antibiotics consumption. The decreased consumption of penicillins together with increased consumption of amphenicols and fusidic acid complies with the pattern of antibiotic resistance reported previously in Libya. Similar studies should be conducted to evaluate national drug consumption under normal conditions, to be compared with regional and international data
Subject(s)
Anti-Infective Agents , Antibiotic Prophylaxis , Delivery of Health Care , Drug Utilization , Fusidic Acid , LibyaABSTRACT
BACKGROUND: Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. METHODS: A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. RESULTS: Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). CONCLUSIONS: Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.
Subject(s)
Female , Humans , Breast , Dizziness , Fusidic Acid , Headache , Hypotension , Incidence , Mammaplasty , Mastectomy , Necrosis , Nitroglycerin , Ointments , Retrospective Studies , SkinABSTRACT
Abstract: Background: Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective: To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods: We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results: A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions: Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Staphylococcus aureus/drug effects , Drug Resistance, Bacterial , Dermatitis, Atopic/microbiology , Anti-Bacterial Agents/pharmacology , Bacitracin/pharmacology , Gentamicins/pharmacology , Neomycin/pharmacology , Cross-Sectional Studies , Mupirocin/pharmacology , Disk Diffusion Antimicrobial Tests/methods , Fusidic Acid/pharmacologyABSTRACT
ABSTRACT Fusidic acid is an antibiotic steroid indicated for the treatment of infections caused by the genus Staphylococcus, including methicillin resistant Staphylococcus aureus strains, and other Gram-positive bacteria. In the present study, a stability-indicating reversed-phase liquid chromatography (RP-LC) method was developed and validated for the determination of fusidic acid in dermatological cream as an alternative to existing methods. Analyses were performed using a C18 column and guard column at room temperature, eluting with an isocratic mobile phase of acetonitrile and water (72:28, v/v), adjusted to pH 3.5 with acetic acid, pumped at a flow rate of 1.0 mL min-1, detection at 210 nm and 20 µL of injection volume. The forced degradation study was conducted under acidic, alkaline, neutral, photolytic, and oxidative stress conditions. The method was validated according to ICH and FDA guidelines; it was linear, precise, accurate, selective, and robust over concentrations of 5-95 µg mL-1, with detection and quantification limits of 0.43 and 1.31 μg mL-1, respectively. Therefore, we conclude that this method is suitable for quantifying fusidic acid in pharmaceutical dermatological creams and determining its stability, representing a more economical and practical alternative for routine analysis in quality control.
Subject(s)
Chromatography, High Pressure Liquid/methods , Fusidic Acid/pharmacokinetics , Dermatology/methods , Cosmetic Stability , Chromatography, Reverse-PhaseABSTRACT
Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) has become widespread in the community and healthcare settings, and a number of clonal lineages emerged on every country. Sequence type (ST) 80 clone of CA-MRSA was dominant in Europe and has increasingly been isolated from the Middle East but so far never found in Korea. In this study, 48 MRSA isolates recovered from ear infections were characterized by multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec) typing, staphylocoagulase (SC) genotyping, staphylococcal protein A gene (spa) typing, accessory gene regulator (agr) typing, and virulence gene profiling. Most MRSA strains belonged to three major clones: ST5-SCCmec II-SC type II (n=19, 39.6%), ST239-SCCmec III-SC type IV (n=15, 31.2%), and ST72-SCCmec IV-SC type Vb (n=11, 22.9%). Among the isolates, one strain was Panton- Valentine leukocidin (PVL)-positive ST80-SCCmec IV-SC type XIa - spa type t044-agr group III, and exfoliative toxin D-positive. This strain was susceptible to most antibiotics, but resistant to tetracycline and fusidic acid. This is the first report on the emergence of European ST80 CA-MRSA clone in Korea.
Subject(s)
Anti-Bacterial Agents , Clone Cells , Coagulase , Delivery of Health Care , Ear , Europe , Fusidic Acid , Korea , Leukocidins , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Middle East , Multilocus Sequence Typing , Staphylococcal Protein A , Staphylococcus aureus , Tetracycline , VirulenceABSTRACT
BACKGROUND: A small subset of adolescents atopic dermatitis (AD) tends to persist. This also leads to get more antibiotics exposure with advancing years. Antibiotic resistance has been regarded as a serious problem during Staphylococcus aureus treatment, especially methicillin-resistant S. aureus (MRSA). OBJECTIVE: It was investigated the S. aureus colonization frequency in the skin lesions and anterior nares of adolescent AD patients and evaluated the changes in S. aureus antimicrobial susceptibility for years. METHODS: Patients who visited our clinic from September 2003 to August 2005 were classified into group A, and patients who visited from August 2010 to March 2012 were classified into group B. To investigate the differences with regard to patients' age and disease duration, the patients were subdivided into groups according to age. Lesional and nasal specimens were examined. RESULTS: Among the 295 AD patients, the total S. aureus colonization rate in skin lesions was 66.9% (95/142) for group A and 78.4% (120/153) for group B. No significant changes in the systemic antimicrobial susceptibilities of S. aureus strains isolated from adolescent AD patients were observed during about 10-year period. The increased trend of MRSA isolation in recent adolescent AD outpatients suggest that the community including school could be the source of S. aureus antibiotic resistance and higher fusidic acid resistance rates provides evidence of imprudent topical use. CONCLUSION: Relatively high MRSA isolation and fusidic acid resistance rates in recent AD patients suggest that the community harbors antibiotic-resistant S. aureus.
Subject(s)
Adolescent , Humans , Anti-Bacterial Agents , Colon , Dermatitis, Atopic , Drug Resistance, Microbial , Fusidic Acid , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Outpatients , Skin , Staphylococcus aureus , StaphylococcusABSTRACT
This study evaluated retrospectively the effect of fusidic acid on the management of desquamative gingivitis (DG). The study population consisted of 15 patients with DG. Patients were requested to make topical application of 2% fusidic acid ointment 4 times a day for 6 weeks. Clinical assessments were recorded at baseline, at 6 weeks and 12 months after beginning the therapy. Patients' examination involved lesion size area, pain score and impact on daily activities. All patients presented lesions in maxilla; in 9 patients (60.0%) lesions were predominately at the anterior region and 6 (40.0%) at the posterior region of maxilla. Treatment significantly (p<0.05) reduced the pain intensity (from 5.4±1.12 to 1.16±0.97) and its periodicity (from 53.33% with pain>3 x/week to 13.33%), and the lesion size in 72.47% (±4.12) immediately after 6 weeks of treatment. Improvements were sustained for 12 months compared to baseline (p<0.001). It also reduced the impact of disease in daily activities (eating and oral hygiene performance), and improved the emotional condition of patients, who reported better social relationships and habits. Topical application of fusidic acid may be a possible alternative local palliative therapy for desquamative gingivitis treatment.
.Este estudo avaliou retrospectivamente o efeito do ácido fusídico sobre o manejo da gengivite descamativa (DG). A população do estudo consistiu de 15 pacientes com DG. Os pacientes foram solicitados a fazer aplicação tópica de pomada de ácido fusídico 2% 4 vezes ao dia, durante 6 semanas. As avaliações clínicas foram registradas no início do estudo, em 6 semanas e 12 meses após o início da terapia. O exame dos pacientes envolveu tamanho da área da lesão, intensidade da dor e impacto nas atividades diárias. Todos os pacientes apresentaram lesões na maxila; em 9 pacientes (60,0%) as lesões foram predominantemente na região anterior e em 6 (40,0%) na região posterior da maxila. O tratamento significantemente (p<0,05) reduziu a intensidade da dor (de 5,4±1,12 para 1,16±0,97) e a sua periodicidade (de 53,33% com dor>3x/semana para 13,33%), e o tamanho da lesão em 72,47% (±4,12) imediatamente após 6 semanas de tratamento. As melhorias foram sustentadas por 12 meses, quando comparado aos valores iniciais (p<0,001). Também reduziu o impacto da doença nas atividades diárias (alimentação e desempenho de higiene oral), e melhorou a condição emocional dos pacientes, que relataram melhores relações e hábitos sociais. A aplicação tópica de ácido fusídico pode ser uma alternativa para terapia local paliativa no tratamento de gengivite descamativa.
.Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Fusidic Acid/therapeutic use , Gingivitis/drug therapy , Follow-Up StudiesABSTRACT
BACKGROUND: Staphylococcus aureus is a well-known microbe that colonizes or infects the skin in atopic dermatitis (AD). The prevalence of methicillin-resistant S. aureus (MRSA) in AD has recently been increasing. OBJECTIVE: This study aimed to determine the antimicrobial susceptibility patterns in AD skin lesions and evaluate the prevalence of MRSA in Korea. We also recommend proper first-line topical antibiotics for Korean patients with AD. METHODS: We studied S. aureus-positive skin swabs (n=583) from the lesional skin of infants, children, and adults who presented to our outpatient clinic with AD from July 2009 to April 2012. RESULTS: S. aureus exhibited high susceptibility against most antimicrobial agents. However, it exhibited less susceptibility to benzylpenicillin, erythromycin, clindamycin, and fusidic acid. The prevalence of MRSA was 12.9% among 583 S. aureus isolates, and the susceptibility to oxacillin was significantly lower in infants in both acute and chronic AD lesions. CONCLUSION: S. aureus from AD has a high prevalence of MRSA and multidrug resistance, especially in infants. In addition, the rate of fusidic acid resistance is high among all age groups, and mupirocin resistance increases with age group regardless of lesional status. This is the first study comparing the antimicrobial susceptibility rates of S. aureus isolates from AD cases with respect to age and lesion status in Korea.
Subject(s)
Adult , Child , Humans , Infant , Ambulatory Care Facilities , Anti-Bacterial Agents , Anti-Infective Agents , Clindamycin , Colon , Dermatitis, Atopic , Drug Resistance, Multiple , Erythromycin , Fusidic Acid , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Mupirocin , Oxacillin , Penicillin G , Prevalence , Skin , Staphylococcus aureus , StaphylococcusABSTRACT
BACKGROUND: The in vitro activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) from Korea are not well understood. OBJECTIVE: This study aimed to determine the activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant MRSA. METHODS: Clinical isolates of mupirocin-resistant MRSA were collected from two tertiary hospitals. The minimal inhibitory concentrations of mupirocin, fusidic acid, and retapamulin were determined using agar dilution method. Polymerase chain reaction was used to confirm the identity of the species and the presence of resistance genes. Pulsed-field gel electrophoresis (PFGE) patterns of chromosomal DNA were used to determine the genetic similarity of high-level mupirocin-resistant isolates. RESULTS: Of the 497 MRSA isolates tested, 22 (4.4%) were mupirocin-resistant. Of these, 9 (1.8%) and 13 (2.6%) had high-level and low-level mupirocin resistance, respectively. Analysis of the PFGE patterns of the high-level mupirocin-resistant MRSA isolates identified five clusters. All 13 of the low-level mupirocin-resistant isolates were resistant to fusidic acid but susceptible to retapamulin. However, among the 9 high-level mupirocin-resistant isolates, 56% were resistant to fusidic acid, and all were susceptible to retapamulin. CONCLUSION: Retapamulin is highly active in vitro against Korean clinical isolates of high-level mupirocinand methicillin-resistant Staphylococcus aureus with different genetic backgrounds. Fusidic acid is more active against high-level mupirocin-resistant MRSA than low-level mupirocin-resistant MRSA.
Subject(s)
Agar , DNA , Electrophoresis, Gel, Pulsed-Field , Furosemide , Fusidic Acid , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Mupirocin , Polymerase Chain Reaction , Tertiary Care CentersABSTRACT
BACKGROUND: The in vitro activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) from Korea are not well understood. OBJECTIVE: This study aimed to determine the activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant MRSA. METHODS: Clinical isolates of mupirocin-resistant MRSA were collected from two tertiary hospitals. The minimal inhibitory concentrations of mupirocin, fusidic acid, and retapamulin were determined using agar dilution method. Polymerase chain reaction was used to confirm the identity of the species and the presence of resistance genes. Pulsed-field gel electrophoresis (PFGE) patterns of chromosomal DNA were used to determine the genetic similarity of high-level mupirocin-resistant isolates. RESULTS: Of the 497 MRSA isolates tested, 22 (4.4%) were mupirocin-resistant. Of these, 9 (1.8%) and 13 (2.6%) had high-level and low-level mupirocin resistance, respectively. Analysis of the PFGE patterns of the high-level mupirocin-resistant MRSA isolates identified five clusters. All 13 of the low-level mupirocin-resistant isolates were resistant to fusidic acid but susceptible to retapamulin. However, among the 9 high-level mupirocin-resistant isolates, 56% were resistant to fusidic acid, and all were susceptible to retapamulin. CONCLUSION: Retapamulin is highly active in vitro against Korean clinical isolates of high-level mupirocinand methicillin-resistant Staphylococcus aureus with different genetic backgrounds. Fusidic acid is more active against high-level mupirocin-resistant MRSA than low-level mupirocin-resistant MRSA.
Subject(s)
Agar , DNA , Electrophoresis, Gel, Pulsed-Field , Furosemide , Fusidic Acid , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Mupirocin , Polymerase Chain Reaction , Tertiary Care CentersABSTRACT
BACKGROUND: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. OBJECTIVE: This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. METHODS: Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. RESULTS: A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. CONCLUSION: Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.
Subject(s)
Humans , Anti-Bacterial Agents , Biopsy , Dermatologic Surgical Procedures , Drug Resistance, Microbial , Fusidic Acid , Gram-Positive Bacteria , Korea , Medical Records , Petrolatum , Postoperative Care , Retrospective Studies , Self-Assessment , Wound Healing , Wounds and InjuriesABSTRACT
Se presenta el caso de una paciente de 50 años de edad con cáncer de mama tratada con paclitaxel y BIBF 1120 semanal. La paciente desarrolló al final del duodécimo ciclo de quimioterapia una onicólisis distal, con exudado seroso intenso en el hiponiquio, dolor y mal olor en todas las uñas de las manos. Se trató con ácido fusídico tópico y aceponato de metilprednisolona al 1% dos veces al día, con una excelente respuesta desde los tres primeros días de tratamiento. A la semana de iniciar la terapia tópica, se observó una paroniquia bacteriana con la pérdida de la uña del quinto dedo de la mano izquierda, con cultivos positivos para Staphylococcus aureus sensible a meticilina. Hay pocos casos publicados de onicólisis exudativa asociada a quimioterapia. Sin embargo, están especialmente relacionados con paclitaxel. No se observaron recurrencias de las alteraciones ungueales semanas después de culminar la quimioterapia. Los corticoides tópicos y el ácido fusídico podrían ser considerados como una opción terapéutica cuando la onicólisis exudativa relacionada con paclitaxel esté establecida.
A case of a 50 years-old breast cancer patient treated with weekly paclitaxel and BIBF 1120 is reported herein. At the end of the twelfth cycle of chemotherapy, the patient developed distal onycholysis with intense hyponychium serous exudates, pain and malodor in all her fingernails. It was treated with topical fusidic acid and 1% methylprednisolone aceponate two times daily, with an excellent clinical response from the first three days of treatment. Bacterial paronychia with nail plate loss of the fifth left fingernail was observed a week after the topical therapy was started, with positive cultures for Methicillin susceptible Staphylococcus aureus. There are few reported cases of exudative onycholysis associated with chemotherapy. However, these are especially related to paclitaxel. No recurrences of nail disturbances were observed weeks after the end of chemotherapy. Topical corticosteroids and fusidic acid could be considered as a therapeutic option when exudative onycholysis related to paclitaxel is established.
Subject(s)
Female , Humans , Middle Aged , Angiogenesis Inhibitors/adverse effects , Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Breast Neoplasms/drug therapy , Indoles/adverse effects , Onycholysis/chemically induced , Paclitaxel/adverse effects , Paronychia/chemically induced , Staphylococcal Skin Infections/etiology , Angiogenesis Inhibitors/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/complications , Disease Susceptibility , Fusidic Acid/therapeutic use , Hand , Indoles/administration & dosage , Methylprednisolone/analogs & derivatives , Methylprednisolone/therapeutic use , Onycholysis/complications , Onycholysis/drug therapy , Onycholysis/microbiology , Paclitaxel/administration & dosage , Paronychia/drug therapy , Paronychia/microbiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/microbiologyABSTRACT
Fusidic acid is a bacteriostatic antibiotic that is effective primarily on gram-positive bacteria, such as Staphylococcus and Corynebacterium species. It is often topically applied to the skin, but is also given systemically as a tablet or injection. Allergic contact dermatitis, or urticaria, has been reported as a side effect of fusidic acid treatment, whereas anaphylaxis to topically administered fusidic acid has not been reported previously. A 16-year-old boy visited an outpatient clinic for further evaluation of anaphylaxis. He suffered abrasions on his arms during exercise, which were treated with a topical ointment containing sodium fusidate. Within 30 minutes, he developed urticaria and eyelid swelling, followed by a cough and respiratory difficulty. His symptoms were relieved by emergency treatment in a nearby hospital. To investigate the etiology, oral provocation with fusidate was performed. After 125 mg (1/2 tablet) of sodium fusidate was administered, he developed a cough and itching of the throat within 30 minutes, which was followed by chest discomfort and urticaria. Forced expiratory volume in 1 second (FEV1) dropped from 4.09 L at baseline to 3.50 L after challenge, although wheezing was not heard in his chest. After management with an inhaled bronchodilator using a nebulizer, chest discomfort was relieved and FEV1 rose to 3.86 L. The patient was directed not to use fusidate, especially on abrasions. Here we report the first case of anaphylaxis resulting from topical fusidic acid application to abrasions.
Subject(s)
Humans , Ambulatory Care Facilities , Anaphylaxis , Arm , Corynebacterium , Cough , Dermatitis, Allergic Contact , Emergency Treatment , Eyelids , Forced Expiratory Volume , Furosemide , Fusidic Acid , Gram-Positive Bacteria , Nebulizers and Vaporizers , Pharynx , Pruritus , Respiratory Sounds , Skin , Sodium , Staphylococcus , Thiram , Thorax , UrticariaABSTRACT
BACKGROUND: Mupirocin has been used for the treatment of skin infections and eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). The increased use of this antibiotic has been accompanied by outbreaks of MRSA that are resistant to mupirocin. OBJECTIVE: This study aims to determine the prevalence, genotype and antimicrobial susceptibility of mupirocin-resistant MRSA from 4 Korean hospitals. METHODS: A total 193 MRSA clinical isolates were collected from four university hospitals. Antimicrobial susceptibility tests, including mupirocin, and pulsed-field gel electrophoresis (PFGE) pattern analysis were performed. RESULTS: Overall, 27 of the 193 (14.1%) MRSA isolates were resistant to mupirocin. All of the (A) hospital isolates showed high-level (HL) mupirocin resistance and the low-level (LL) mupirocin resistant strains were from three other hospitals. The PFGE patterns of 16 mupirocin-resistant isolates were divided into 5 clusters (1-5), and the nine HL mupirocin-resistant isolates belonged to cluster 1. Both the HL and LL mupirocin-resistant MRSA isolates were susceptible to vancomycin and rifampin, but they were resistant to ciprofloxacin, clindamycin and tetracycline. The erythromycin and fusidic acid resistance rates were different between the HL and LL resistant isolates. CONCLUSION: HL mupirocin-resistant isolates that could transfer this resistance to other bacteria were detected and these isolates were clonally related. The emergence of mupirocin resistant isolates emphasizes the importance of using antibiotics judiciously and carefully monitoring the prevalence of mupirocin resistance.
Subject(s)
Anti-Bacterial Agents , Bacteria , Ciprofloxacin , Clindamycin , Disease Outbreaks , Electrophoresis, Gel, Pulsed-Field , Erythromycin , Fusidic Acid , Genotype , Hospitals, University , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Mupirocin , Prevalence , Rifampin , Skin , Tetracycline , VancomycinABSTRACT
Resistance to mupirocin in methicillin-resistant Staphylococcus aureus (MRSA) have increased with wide use of mupirocin in many countries, but the prevalence in Korea is not well-known. The aim of this study was to determine the prevalence, antimicrobial susceptibility, and clonality of mupirocin-resistant (MUP-R) isolates from three Korean hospitals. A total of 175 MRSA isolates were collected from three university hospitals in 2009-2010. Antimicrobial susceptibility was tested by the disk diffusion and the agar dilution methods. femA, mecA and mupA genes were detected by polymerase chain reactions. Pulsed-filed gel electrophoresis (PFGE) pattern of genomic DNA was determined after digestion with SmaI. Overall, 12 among the 175 MRSA isolates were resistant to mupirocin, with prevalence ranging from 0 to 10% depending on hospitals. Three high-level (HL) and nine low-level (LL) MUR-R isolates were obtained from two hospitals. All MUP-R isolates were susceptible to rifampin and vancomycin, but were resistant to ciprofloxacin, clindamycin, and erythromycin. Eight LL and one HL MUP-R isolates were also resistant to fusidic acid. PFGE analysis showed three HL MUP-R isolates belonged to arbitrary cluster 3, 5 and 6 with 60~90% similarity compared to LL MUP-R isolates. In conclusion, the HL resistance to mupirocin was detected in two hospitals, but HL MUP-R isolates were clonally not related.