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Fusidic Acid-resistant Staphylococcus aureus in Impetigo Contagiosa and Secondarily Infected Atopic Dermatitis
Fusidic acid-resistant Staphylococcus aureus (FRSA) has been identified as a causative agent in outbreaks of impetigo and its emergence has been associated with increased use of topical fusidic acid. The frequency of FRSA in atopic dermatitis (AD) has been less extensively investigated. The aim of this study was to investigate the bacterial spectrum and frequency of FRSA in patients with impetigo or secondarily infected AD. A prospective study in our clinic in 2004 to 2008 included 38 patients with impetigo and 37 with secondarily infected AD. S. aureus was the predominant finding in all groups (bullous impetigo 92% (12/13), impetigo 76% (19/25) and secondarily infected AD 89% (33/37)). Seventy-five percent of S. aureus were fusidic acid resistant in bullous impetigo, 32% in impetigo and 6.1% in secondarily infected AD (bullous impetigo vs. AD p < 0.0001, impetigo vs. AD p < 0.05). We then performed a retrospective patient record review including all patients with impetigo or secondarily infected AD seen at the clinic during the first and last year of the prospective study. In the first year 33% (19/58) of the S. aureus isolates were fusidic acid-resistant in impetigo and 12% (5/43) in secondarily infected AD (p < 0.05). In the last year corresponding values were 24% (6/25) for impetigo and 2.2% (1/45) for AD (p < 0.01). In summary, the prospective study and the patient record review both showed higher FRSA levels in impetigo than in AD. FRSA levels were persistently low in AD. Continued restrictive use of topical fusidic acid is advised to limit an increase in FRSA levels in dermatology patients.
Mikael Alsterholm, Ingela Flytström, Ing-Marie Bergbrant, Jan Faergemann
Howden BP, Grayson ML. Dumb and dumber – the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus. Clin Infect Dis 2006; 42: 394–400.
Shanson DC. Clinical relevance of resistance to fusidic acid in Staphylococcus aureus. J Antimicrob Chemother 1990; 25 Suppl B: 15–21.
Osterlund A, Eden T, Olsson-Liljequist B, Haeggman S, Kahlmeter G. Clonal spread among Swedish children of a Staphylococcus aureus strain resistant to fusidic acid. Scand J Infect Dis 2002; 34: 729–734.
Tveten Y, Jenkins A, Kristiansen BE. A fusidic acid-resistant clone of Staphylococcus aureus associated with impetigo bullosa is spreading in Norway. J Antimicrob Chemother 2002; 50: 873–876.
Brown EM, Thomas P. Fusidic acid resistance in Staphylococcus aureus isolates. Lancet 2002; 359: 803.
Brown EM, Wise R. Fusidic acid cream for impetigo. Fusidic acid should be used with restraint. Br Med J 2002; 324: 1394.
Treatment of impetigo. Swedish Medical Products Agency. 2003. Available from: http: //www.lakemedelsverket.se/Tpl/RecommendationsPage____2979.aspx
Larsen AR, Skov RL, Jarlier V, Henriksen AS. Epidemiological differences between the UK and Ireland versus France in Staphylococcus aureus isolates resistant to fusidic acid from community-acquired skin and soft tissue infections. J Antimicrob Chemother 2008; 61: 589–594.
Denton M, O’Connell B, Bernard P, Jarlier V, Williams Z, Henriksen AS. The EPISA study: antimicrobial susceptibility of Staphylococcus aureus causing primary or secondary skin and soft tissue infections in the community in France, the UK and Ireland. J Antimicrob Chemother 2008; 61: 586–588.
Laurent F, Tristan A, Croze M, Bes M, Meugnier H, Lina G, et al. Presence of the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus in France. J Antimicrob Chemother 2009; 63: 420–421.
O’Neill AJ, Larsen AR, Skov R, Henriksen AS, Chopra I. Characterization of the epidemic European fusidic acid-resistant impetigo clone of Staphylococcus aureus. J Clin Microbiol 2007; 45: 1505–1510.
O’Neill AJ, Larsen AR, Henriksen AS, Chopra I. A fusidic acid-resistant epidemic strain of Staphylococcus aureus carries the fusB determinant, whereas fusA mutations are prevalent in other resistant isolates. Antimicrob Agents Chemother 2004; 48: 3594–3597.
O’Neill AJ, McLaws F, Kahlmeter G, Henriksen AS, Chopra I. Genetic basis of resistance to fusidic acid in staphylococci. Antimicrob Agents Chemother 2007; 51: 1737–1740.
O’Neill AJ, Chopra I. Molecular basis of fusB-mediated resistance to fusidic acid in Staphylococcus aureus. Mol Microbiol 2006; 59: 664–676.
Abeck D, Mempel M. Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications. Br J Dermatol 1998; 139 Suppl 53: 13–16.
Sule O, Brown NM, Willocks LJ, Day J, Shankar S, Palmer CR, et al. Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use. Int J Antimicrob Agents 2007; 30: 78–82.
Peeters KA. Resistance of Staphylococcus aureus to fusidic acid. Int J Dermatol 2004; 43: 235.
Hoeger PH. Antimicrobial susceptibility of skin-colonizing S. aureus strains in children with atopic dermatitis. Pediatr Allergy Immunol 2004; 15: 474.
Niebuhr M, Mai U, Kapp A, Werfel T. Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp Dermatol 2008; 17: 953–957.
Antimicrobial resistance surveillance in Sweden: ResNet. 2009. Available from: http: //www.srga.org/ResNet_sok.htm
Osterlund A, Kahlmeter G, Haeggman S, Olsson-Liljequist B. Staphylococcus aureus resistant to fusidic acid among Swedish children: a follow-up study. Scand J Infect Dis 2006; 38: 334.
Mitra A, Mohanraj M, Shah M. High levels of fusidic acid-resistant Staphylococcus aureus despite restrictions on antibiotic use. Clin Exp Dermatol 2009; 34: 136–139.
Ravenscroft JC. Observations on high levels of fusidic acid resistant Staphylococcus. Clin Exp Dermatol 2000; 25: 327.
Ravenscroft JC, Layton AM, Eady EA, Murtagh MS, Coates P, Walker M, et al. Short-term effects of topical fusidic acid or mupirocin on the prevalence of fusidic acid resistant (FusR) Staphylococcus aureus in atopic eczema. Br J Dermatol 2003; 148: 1010–1017.
Mason BW, Howard AJ. Fusidic acid resistance in community isolates of methicillin susceptible Staphylococcus aureus and the use of topical fusidic acid: a retrospective case-control study. Int J Antimicrob Agents 2004; 23: 300–303.
Whitman TJ. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Dis Mon 2008; 54: 780–786.
Jappe U, Heuck D, Strommenger B, Wendt C, Werner G, Altmann D, et al. Staphylococcus aureus in dermatology outpatients with special emphasis on community-associated methicillin-resistant strains. J Invest Dermatol 2008; 128: 2655–2664.
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Volume 90, Issue 1
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