The Incidence of Isolation of Methicillin-resistant Staphylococcus aureus (MRSA) Strains from Skin Infections during the Past Three Years (1989–1991)

We did a statistical study of 294 strains of Staphylococcus aureus (S. aureus) isolated from skin infections during the period from January of 1989 to December of 1991 in the Department of Dermatology, Kansai Medical University Hospital. We especially examined methicillin-resistant S. aureus (MRSA) from the point of view of incidence, variety of skin infections with MRSA, coagulase type, phase type, and resistance against antimicrobial agents. The frequency of isolation of MRSA has been increasing. In 1991, the proportion of MRSA isolates among all S. aureus strains isolated from skin infections was 41.5%. MRSA was isolated most often from infectious decubitus. Coagulase type II and phage group NT (not typable) MRSA were most frequently isolated. The resistance of MRSA to OFLX and IMP/CS had remarkably increased. Notably, the resistance to MINO was low before 1991.     

MRSA eradication in dermatologic outpatients - theory and practice

Background: The dissemination of methicillin resistant staphylococcus aureus (MRSA) is an increasing challenge in medical care. Apart from hospital acquired MRSA, there has also been an increase in community acquired and livestock associated MRSA. While the risks of MRSA (e. g. wound infections) and consequences (e. g. rejection of patients) are well known, there are little data on the effectiveness of eradication procedures. Patients and methods: 32 patients with proven MRSA colonization were monitored during eradication for the following aspects: (1) localization of MRSA (swabs from hairline, anterior nares, throat, axillae, groins, perineum, and wounds, if present), (2) presence of eradication‐impairing factors, (3) length of time needed for eradication, (4) cost of eradication, (5) molecular fingerprint and risk assessment (spa‐types). Results: We describe the successful eradication of MRSA in all 32 patients. Most positive nasal swabs were obtained from the anterior nares and the throat and only rarely from the hairline or axillae. The greater the number of positive swabs, the more time was needed for eradication. In most patients (37.5%), eradication with topical antiseptics was successful. The average time for eradication was 12.97 (± 7.6) days. Twelve patients required systemic antibiotic therapy. Treatment costs associated with the use of systemic antibiotics were significantly higher. The most frequent spa types were t032 and t003. Conclusions: We report successful MRSA eradication in outpatients. Systemic antibiotics are unnecessary in the majority of patients. A combined anti‐MRSA strategy for inpatients and outpatients is recommended.     

Methicillin-resistant Staphylococcus aureus colonization in inflammatory versus non-inflammatory skin diseases: who should be screened?

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was prospectively investigated in a dermatology outpatient setting. Swabs were taken from anterior nares, perineum and lesional skin in 229 patients with erosive inflammatory skin diseases (n=88), venous leg ulcers (n=58) or basal cell carcinoma (n=83) and processed by standard methods. The isolated MRSA strains were characterized by pulsed-field gel electrophoresis after digestion with the restriction enzyme SmaI. MRSA carriage was detected in 10/88 patients with inflammatory skin diseases, 5/58 with venous leg ulcers and 0/83 with basal cell carcinoma. Most of the MRSA isolates could be identified as either the Rhine-Hessen epidemic strain or local epidemic strains. None of the isolated strains was resistant to vancomycin, gentamicin or mupirocin. MRSA is uncommon in outpatients in our dermatology clinic; however, the presence of chronic ulcers and erosions was significantly associated with MRSA positivity. Therefore, patients with chronic ulcers and erosions should be screened for MRSA colonization to implement infection control measures.     

2018-2020年皮肤科住院患者金黄色葡萄球菌感染状况及MRSA与MSSA耐药性分析

目的:研究我院住院患者中皮肤软组织感染者(SSTIs)金黄色葡萄球(SA)感染情况及MR-SA与MSSA耐药特点.方法:选取我院2018年1月1日至2020年12月31日入院时存在SSTIs且进行细菌培养及药敏试验的患者,分析SA及MRSA检出率、病种分布,以及MRSA与MSSA耐药性的差异.结果:共分析1455例患者...     

Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. It can also cause community-acquired infections. Indian reports about MRSA in community-acquired infections are rare. AIM: To evaluate the rate of MRSA in community-acquired pyoderma and the nasal colonisation with S. aureus in such patients. METHODS: Two hundred and fifty patients with community-acquired pyoderma, who attended outreach camps around Mangalore, south India between January 2000 and July 2001, were studied. Swabs collected from the skin lesions and anterior nares were inoculated onto blood agar and MacConkey's agar. Antimicrobial sensitivity testing was performed using Kirby-Bauer disk diffusion, agar dilution, and agar screen. RESULTS: Of 250 pyoderma cases, S. aureus was isolated from 202 (80.8%) patients. Twenty-two (10.9%) S. aureus isolates were methicillin resistant, 179 (88.6%) were resistant to penicillin, and 114 (56.4%) were resistant to erythromycin. S. aureus colonization in the anterior nares was observed in 136 (54.4%) cases, 11.8% of which were MRSA. Antibiograms of clinical isolates of S. aureus matched with nasal isolates in 99 (49%) cases. CONCLUSION: The emergence of MRSA in the community is a warning. A high nasal carriage rate may contribute to recurrent pyoderma. A correct antimicrobial policy and the avoidance of inappropriate antimicrobial usage are mandatory to reduce the spread of MRSA in the community.     

Comparative molecular analysis of meticillin‐resistant Staphylococcus aureus isolates from children with atopic dermatitis and healthy subjects in Taiwan

Background Children with atopic dermatitis (AD) are more frequently colonized by Staphylococcus aureus than healthy children. Objectives To assess whether any relationship exists between nasal meticillin‐resistant S. aureus (MRSA) colonization and subsequent skin and soft‐tissue infections (SSTI). Patients and methods From 2005 through 2006, comparative molecular analyses of 23 MRSA‐colonizing isolates from 133 children with AD, 44 MRSA‐colonizing isolates from 490 healthy controls, and 12 MRSA‐infecting isolates from 20 children with AD and concurrent SSTI were conducted. Results Nasal MRSA colonization in children with AD was significantly higher compared with normal individuals (17·3% vs. 9·0%; P = 0·01). The molecular characteristics differed significantly between the MRSA isolates from children with AD and the MRSA‐colonizing isolates from healthy controls. The clone characterized as sequence type (ST)59 (338)/pulsotype B/staphylococcal cassette chromosome mec (SCCmec) V_T/Panton–Valentine leucocidin (PVL)‐positive/staphylococcal enterotoxin B (SEB)‐positive accounted for half of the MRSA isolates from children with AD, and another clone, characterized as ST59/pulsotype A/SCCmec IV/PVL‐negative/SEB‐positive accounted for 61% of the MRSA‐colonizing isolates from healthy controls. Conclusions We found MRSA colonizing the anterior nares of a large number of Taiwanese children, especially among those with AD. Analysis of our data provides evidence that links MRSA‐colonizing isolates to MRSA‐infecting isolates from concurrent SSTI in children with AD.     

Adherence characteristics and susceptibility to antimicrobial agents of Staphylococcus aureus strains isolated from skin infections and atopic dermatitis

We examined the adherence characteristics and susceptibility to various antimicrobial agents of 130 strains of Staphylococcus aureus isolated from infective skin lesions and 135 strains of S. aureus isolated from non-infective eczematous lesions of atopic dermatitis (AD) patients. The isolation rate of methicillin-resistant S. aureus (MRSA) was 27.7% in strains from clinical sources excluding AD and 31.1% in those from AD. Coagulase type II strains were most frequently observed in MRSA strains isolated from all sources excluding AD, and coagulase type III strains were most frequently observed in those isolated from AD. We proposed that antimicrobial treatment for AD patients should be carefully designed to prevent MRSA infection. Plasma coagulation ability was lowest in S. aureus strains isolated from abscesses, suggesting that the lower production of fibrin observed in abscesses may assist the infiltration of neutrophils into skin tissues and that a decrease in plasma coagulation ability may enable abscess formation. Adherence to polypropylene tubes with slime production was most evident in S. aureus strains isolated from felon and least evident in those isolated from cellulitis and lymphangitis. Tube adherence was characteristic of the S. aureus strains attached to superficial skin tissues, but not necessarily for strains that had infiltrated the deep skin tissues. Fusidic acid demonstrated significant antimicrobial activity against the MRSA strains, but rifampicin was the strongest antimicrobial agent.     

Phage typing in dermatitis cruris pustulosa et atrophicans: does staphylococcal carrier status have a role?

Background Dermatitis cruris pustulosa et atrophicans (DCPA) is a form of chronic folliculitis of the legs with a multifactorial etiopathogenesis, seen primarily in tropical countries. Staphylococcus aureus has been isolated from the pustules in earlier studies, although the organisms isolated have not been further characterized. Materials and methods Patients with DCPA, who attended the Dermatology outpatient clinic at JIPMER, Pondicherry, India, during the study period (December 2006–June 2008) were included. Pus from the lesions as well as swabs from carrier sites (nares, axillae, and gluteal fold) were cultured. Staphylococcus aureus isolates were subjected to phage typing at the National Staphylococcal Phage Typing Center, Department of Microbiology, Maulana Azad Medical College, New Delhi, India. Results Thirty‐seven patients were included in the study. Pus from the folliculitic lesions grew S. aureus in 32 (86.49%) patients. Based on the comparison of antibiotic sensitivity patterns, isolates from pus and carrier sites were found to be similar in 15 patients. Phage typing established the organism to be identical in five of these patients. Conclusions Characterization of S. aureus in DCPA shows that there is no specific phage type that is uniformly responsible for the lesions in most patients. However, in view of the unclear etiology of this condition, the pathogenicity of a staphylococcal carrier state in individual patients needs to be addressed.     

Methicillin-resistant Staphylococcus aureus (MRSA) sepsis following mesh graft transplantation to treat chronic leg ulcer

Infections with methicillin-resistant strains of Staphylococcus aureus (MRSA) from colonized leg ulcers are rare. We describe a case of MRSA sepsis following mesh graft transplantation to treat a chronic leg ulcer. MRSA were isolated from blood and midstream urine and typed by their antimicrobial sensitivity, phage and SmaI-macrorestriction patterns. A strain found during sepsis was identical to an epidemic MRSA related to epidemic MRSA 15 from Great Britain. Control swabs to detect MRSA should be implemented in epidemic areas of MRSA before grafting chronic ulcers.     

National hospital infection surveillance on methicillin-resistant Staphylococcus aureus

National hospital infection surveillances on methicillin-resistant Staphylococcus aureus (MRSA) had been carried out in 1995 and 1996. Recently, in the UK and the USA, the prevalence of MRSA has increased and strict precautions against MRSA are recommended. In Japan, hospital infection rates of MRSA have appeared to be stable in recent years, but a reevaluation is required to confirm this assumption. In a nationwide surveillance, the incidences of MRSA hospital infections per 100 admissions remained stable at between 0.7 and 0.8 from 1999 to 2003, with a tendency towards a slight decline being observed. This study shows that the precautions against MRSA infection in Japan may prove to be an effective preventive measure.     

Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance

BACKGROUND: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease. OBJECTIVE: To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas. METHODS: Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied. RESULTS: Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous beta-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-beta-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole. CONCLUSION: Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with beta-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that beta-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.     

湿疹与特应性皮炎皮损处细菌学研究

目的 探讨湿疹和特应性皮炎(AD)皮损处的细菌学特点及金黄色葡萄球菌(金葡菌)在湿疹及AD发病中的作用。方法 多中心随机双盲对207例湿疹患者和119例AD患者皮损及非皮损处取材做细菌培养,并对所分离到的金葡菌进行常规药敏试验和噬菌体分型。结果 207例湿疹患者皮损处的细菌检出阳性率、金葡菌的比例及定植均明显高于非皮损处,差异有显著性(P<0.01)。119例AD患者皮损处的细菌检出阳性率及金葡菌的定植明显高于非皮损处,差异有显著性。对分离到的141株金葡菌进行噬菌体分型。Ⅰ组占6.3%,Ⅱ组占7.0%,Ⅲ组占3.5%,Ⅴ组占0.7%,杂组占1.4%,不能分型占56%,MRSA分型噬菌体26株混合组占6.3%。药敏试验结果表明在常用的6种外用抗菌药物中莫匹罗星对金葡菌和表皮葡萄球菌的抗菌活性最强,其MIC范围、MIC₉₀和MIC₅₀是6种抗菌药物中最低的。且莫匹罗星对金葡菌及其中的各噬菌体分型和表皮葡萄球菌中的耐甲氧西林和耐甲氧西林凝固酶阴性菌株也有较好的抑菌能力。结论 湿疹和AD的发病与细菌感染密切相关,其中金葡菌是最重要的细菌,对湿疹和AD患者外用药治疗合并使用外用抗菌药物是必要的,根据对金葡菌抗菌活性的测定,莫匹罗星的效果较好。     

S. Aureus Isolation from the Lesions,the Hands,and the Anterior Nares of Patients with Atopic Dermatitis

Abstract: Staphylococcus aureus colonization is common in atopic dermatitis (AD) and can exacerbate the disease. Additionally, some evidence shows that patients with AD may act as reservoirs for S. aureus transmission to others. This study compared S. aureus colonization in AD patients and their caregivers with control patients and their caregivers. Quantitative cultures were obtained from the lesions, clinically normal skin, hands, and anterior nares of 100 patients with AD, 100 controls with other cutaneous disorders, and 200 caregivers. AD patients had a significantly greater carriage of S. aureus from lesional and clinically normal skin as well as the hand. Significant increases in carriage of S. aureus were found in the anterior nares and hands of caregivers of AD patients compared with control caregivers. Topical corticosteroid use did not affect recovery of S. aureus. There was a significant correlation between recovery of S. aureus from lesional skin and recovery from the anterior nares (p = .002) and hands (p < .0001). These findings suggest that the anterior nares and the hands may be important reservoirs and vectors for transmission of S. aureus to lesional skin and to close contacts of these patients.     

Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis

BACKGROUND: The skin of up to 100% of patients with atopic dermatitis (AD) is colonized with Staphylococcus aureus. Of all S. aureus strains isolated from lesional skin, up to 65% have been shown to produce exotoxins with superantigenic properties. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. These studies did not consider the anterior nares as a reservoir of S. aureus, or the possibility of transmission between patients and their contacts. Moreover, adult patients have not so far been investigated. OBJECTIVES: To investigate the colonizing features of S. aureus in adults with AD and in their contacts, and the effect of an antimicrobial treatment of the patients and their partners. METHODS: Swabs were taken from the skin and anterior nares of 66 adults with AD. S. aureus strains were screened for the production of exotoxins in 32 patients. Ten patients (two with toxigenic strains, eight with non-toxigenic strains) were treated orally with cefalexin, chlorhexidine ointment was applied to the skin, and the anterior nares were treated with mupirocin ointment. A bath containing potassium permanganate was taken daily. In addition, their partners were treated topically. RESULTS: Sixty-two of 66 patients (94%) were carriers of S. aureus, and mostly harboured the bacteria on both skin and anterior nares. Ten of 32 (31%) patients were colonized with toxigenic strains. The Severity Scoring in AD (SCORAD) score decreased in nine of 10 patients who received antimicrobial treatment (P < 0.001), and this effect was more pronounced in patients with a baseline SCORAD > 50. CONCLUSIONS: S. aureus may play an important role as an aggravating factor in adults with AD, as antimicrobial treatment leads to a significant improvement of AD in patients who are colonized with the bacterium.     

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma

BACKGROUND: Although prevalence of MRSA strains is reported to be increasing, there are no studies of their prevalence in community-acquired primary pyodermas in western India. AIMS: This study aimed at determining the prevalence of MRSA infection in community-acquired primary pyodermas. METHODS: Open, prospective survey carried out in a tertiary care hospital in Mumbai. MATERIALS AND METHODS: Eighty-six patients with primary pyoderma, visiting the dermatology outpatient, were studied clinically and microbiologically. Sensitivity testing was done for vancomycin, sisomycin, gentamicin, framycetin, erythromycin, methicillin, cefazolin, cefuroxime, penicillin G and ciprofloxacin. Phage typing was done for MRSA positive strains. RESULTS: The culture positivity rate was 83.7%. Staphylococcus aureus was isolated in all cases except two. Barring one, all strains of Staphylococcus were sensitive to methicillin. CONCLUSIONS: Methicillin resistance is uncommon in community-acquired primary pyodermas in Mumbai. Treatment with antibacterials active against MRSA is probably unwarranted for community-acquired primary pyodermas.     

Propionibacteria in patients with acne vulgaris and in healthy persons

A total of 375 anaerobic and microaerophilic coryneform rods, isolated from the pilosebaceous ducts of 26 healthy persons (71 strains) and from comedones (93 strains), pustules (107 strains), and the unaffected skin (104 strains) of 36 acne patients were classified according to the species key in Bergey's manual, the biotyping scheme of Pulverer and ko, the serotyping schedule of H?ffer et al., and the phage typing schedule of Jong et al. The statistical evaluation demonstrated certain differences in the frequencies of the Propionibacterium species and types between the different groups tested. Thus, the species P. granulosum was isolated only from acne patients (50.0% of patients examined) and was found more frequently in comedones and pustules than in unaffected follicles in acne patients. The majority of P. granulosum strains belonged to serotype II (95). Biotype A propionibacteria were more frequently found in strains from healthy controls (52.1% of strains) than in strains from healthy controls (52.1% of strains) than in strains from comedones (17.2%), pustules (27.1%) and unaffected skin (38.5%) of the acne patients. The results of phage-typing showed that the P. acnes lysotype I was more frequent in acne patients (total: 73.2% of strains), especially in the inflamed pustules (88.5%), than in healthy controls (55.1%).     

Skin microflora of atopic eczema in first time hospital attenders

The bacterial flora of the skin was assessed quantitatively in 50 children with eczema, aged 6 months to 14 years, referred to the hospital for the first time. Twenty non-atopic controls with an unrelated non-infective disorder were also studied. Cotton-tipped swabs and contact agar discs were taken from the worst affected area of eczema and from an uninvolved site in patients and from the forearm in controls. Swabs were also taken from the nose, axilla and groin in all children. Bacterial colonization of the skin was consistently more common and greater in amount from patients compared with controls. Staphylococcus aureus was the most common pathogen isolated from patients only; from the worst affected area of eczema in 74% of patients and from an uninvolved skin site in 30% of patients. Quantitative assessment showed that the density of colonization was proportional to the severity of eczema. The most common S. aureus phage group was group II accounting for 32% of strains. Resistance to penicillin was present in 88% of strains and to two or more antibiotics in 38% of strains. No relationship was noted between the pattern of resistance and phage group.     

Infectious complications and managements for surgical site infections in genital Paget''s disease

BACKGROUND: Extramammary Paget's disease is an intra-epidermal carcinoma that occurs preferentially in genital areas. Patients with genital Paget's disease (GPD) sometimes develop severe post-surgical infections because of this anatomical disadvantage. OBJECTIVE: To study perioperative micro-organisms and surgical site infection (SSI) in GPD. METHODS: We examined micro-organisms isolated from preoperative lesions, necrotic sites and infected wounds in 60 adult patients with GPD who underwent surgery at our hospital between November 1990 and December 2005. Based on the obtained microbiological data, we assessed the incidence, risk factors and treatment of SSI. RESULTS: The colonized organisms found in preoperative GPD were Enterobacteriaceae (27.6%), methicillin-sensitive Staphylococcus aureus (MSSA) (22.4%) and coagulase-negative staphylococci (CNS) (15.5%), among others. In the postoperative necrotic sites, the frequency of MSSA isolation was reduced to 9.4%, while Pseudomonas aeruginosa and methicillin-resistant S. aureus (MRSA) both increased in frequency from 3.4% and 0% upon preoperative examination to 18.8% and 9.4%, respectively. The incidence of SSI was 15%. In 7 of 9 SSIs, MRSA and/or P. aeruginosa were isolated. CONCLUSION: We have successfully identified a number of perioperative micro-organisms in GPD. The present observations may be extremely useful in choosing appropriate antimicrobial agents for use in the surgical treatment of GPD.     

Staphylococcus aureus infection as a complication of isotretinoin therapy

Eighteen patients developed Staphylococcus aureus infection during or shortly after a five-month course of therapy with isotretinoin. Staphylococcus aureus was recovered both from lesions and from the anterior nares. In a prospective study, 4% of control patients treated with isotretinoin alone developed S aureus infection, while none who applied topical antibiotic to the anterior nares developed infection. Control patients had a 64% prevalence of anterior nares colonization with S aureus, compared with 18% in the topical antibiotic group.     

Staphylococcus aureus Isolated from Nostril Anteriors and Subungual Spaces of the Hand: Comparative Study of Medical Staff,Patients, and Normal Controls

An epidemiologic investigation of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus aureus (S. aureus) colonization was conducted at Kansai Medical University Hospital between 1990 and 1991. The incidence of nasal and subungual positivity for S. aureus was examined in a total of 156 subjects including inpatients, physicians, and nurses at a ward for dermatology, plastic surgery, and emergency patients, outpatients with atopic dermatitis and other skin diseases, and normal controls. Inpatients were most heavily colonized with MRSA (40.8%), but S. aureus colonization was most frequent in outpatients with atopic dermatitis (95.5%). Not only nostrils, which have been much discussed as a reservoir of S. aureus, but also subungual spaces seemed to be havens of S. aureus. Twelve out of 22 atopic dermatitis patients were positive for S. aureus on skin regions, and coagulase and phage testing showed a correlation between the nasal and skin-colonizing S. aureus. Coagulase type II and phase type NT (not typable) were the predominant types of S. aureus, including MRSA.