Wound cultures from patients with the rare disease of epidermal epidermal infections (EB) are most often positive for Staphylococcus aureus (SA), Pseudomonas aeruginosa (PA) and Streptococcus pyogenes (GAS) – and resistance birth was common – in a retrospective analysis of 700 wound cultures from 158 patients across the US and Canada.

According to Laura E. Levin, MD, and Kimberly D. Morel, MD, of the department of dermatology and pediatrics, Columbia University Irving Medical Center, New York, respectively, are the lead author and author of the paper, respectively. The paper was recently published in the journal Pediatric Dermatology.

Almost all 158 patients with at least one wound culture recorded in the database from 2001-2018 had one or more positive cultures. Of the 152 patients who were cultured positive, 131 (86%) were positive for SA and 56 (37%) and 34 (22%) were positive for PA and GAS, respectively. Other bacteria isolated include Corynebacterium spp and Proteus spp. Nearly half (47%) of patients with culture-positive SA had methicillin-resistant SA and 68% had methicillin-sensitive SA. (Some patients develop both MSSA and MRSA at different times.)

Mupirocin susceptibility testing was performed only at some of the 13 participating centers. Of the 15 patients whose cultures had a mupirocin-sensitive SA test, 11 had a positive culture for mupirocin-sensitive SA and 6 (40%) had mupirocin-resistant SA isolates (2 patients had increased chief of both). Of these six patients, half had isolates that were also resistant to methicillin.

Mupirocin, a topical antibiotic, is the cornerstone of decontamination regimens for MSSA and MRSA, but resistance has also been demonstrated in other studies and is not specific for EB, Levin, Morel.

“Pediatric dermatologists often rely on topical antibiotics in the treatment of their patients’ open wounds to prevent and treat infection, depending on the clinical situation,” and surveillance cultures with Routine testing for mupirocin resistance can help guide antibiotic selection and management strategies, Levin said in an interview.

She adds, “it would be helpful to know which bacteria frequently enter the wound, not causing infection, compared with those that are more likely to be associated with infection, chronic wound or risk of injury. skin cancer development… [để biết ] Which wound needs more aggressive treatment? “A small number of patients with EB are at increased risk for squamous cell carcinoma,” Morel said in an interview, and the study suggested that certain bacteria “contribute to wound inflammation.”

SCC was reported in 23 of the 717 patients in the database – but less than half of the patients with SCC reported wound culture. The small numbers prevented the identification of bacteria that could pose a significant risk.

Correlation of specific bacteria with clinical features will also require more research. Approximately half (57%) of the patients with wound culture reported a purulent wound or other features of clinical infection. However, the presence or absence of clinical signs of infection was not temporally correlated with culture results in the database. The 158 patients with wound transplantation had a mean age of 12.8 years and represented a wide range of EB subtypes.

The authors noted that PA was present in the wound of a 1-month-old young patient. Investigators are “looking to further investigate PA and characterize clinical … to understand more about this bacterium and its impact on EB patients,” Morel said.

Meanwhile, the analysis reaffirms the importance of antibiotic management. Mupirocin is labeled for use three times a day for a short time, says Morel, but “tends to be prescribed and used with less caution than intended.” “The most important is [không lạm dụng nó]. We have found that the culture results of patients becoming re-sensitized to mupirocin in the future when they avoid it for a period of time.”

The work was supported by the EB Research Partnership and the EB Medical Research Foundation, as well as an NIH/NCATS grant. No investigator disclosures are listed.

Source: Dermatol Pediatrics. November 28, 2020


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