High Usage of Topical Fusidic Acid and Rapid Clonal Expansion of Fusidic Acid–Resistant Staphylococcus aureus: A Cautionary Tale

Williamson, Deborah A.; Monecke, Stefan; Heffernan, Helen; Ritchie, Stephen; Roberts, Sally; Upton, Arlo; Thomas, Mark G.; Fraser, John D.

doi:10.1093/cid/ciu658

Cited by 63 publications

(69 citation statements)

References 10 publications

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“…The size of the nodes represents the number of isolates included in that type Patients with hand eczema in Östergötland County are rarely treated with antibiotics, systemically or locally, which is reflected in the low prevalence of resistance and resistance genes in S. aureus isolated from patients. The fusidic acid resistant t127/CC1 clone colonizing three patients in our study has previously been frequently isolated around the globe [33][34][35].…”

Section: Discussionmentioning

confidence: 69%

Staphylococcus aureus colonization related to severity of hand eczema

Mernelius

Carlsson

Henricson

et al. 2016

Eur J Clin Microbiol Infect Dis

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Knowledge on Staphylococcus aureus colonization rates and epidemiology in hand eczema is limited. The aim of this study was to clarify some of these issues. Samples were collected by the "glove juice" method from the hands of 59 patients with chronic hand eczema and 24 healthy individuals. Swab samples were taken from anterior nares and throat from 43 of the 59 patients and all healthy individuals. S. aureus were spa typed and analysed by DNA-microarray-based genotyping. The extent of the eczema was evaluated by the hand eczema extent score (HEES). The colonization rate was higher on the hands of hand eczema patients (69 %) compared to healthy individuals (21 %, p < 0.001). This was also seen for bacterial density (p = 0.002). Patients with severe hand eczema (HEES ≥ 13) had a significantly higher S. aureus density on their hands compared to those with milder eczema (HEES = 1 to 12, p = 0.004). There was no difference between patients and healthy individuals regarding colonization rates in anterior nares or throat. spa typing and DNA-microarray-based genotyping indicated certain types more prone to colonize eczematous skin. Simultaneous colonization, in one individual, with S. aureus of different types, was identified in 60-85 % of the study subjects. The colonization rate and density indicate a need for effective treatment of eczema and may have an impact on infection control in healthcare.

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Section: Discussionmentioning

confidence: 69%

Staphylococcus aureus colonization related to severity of hand eczema

Mernelius

Carlsson

Henricson

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…This was also a clonal dissemination, although with a different clone than in Europe. In parallel to this clonal dissemination, a significant increase in dispensing rates for topical fusidic acid was seen in New Zealand (Williamson et al 2014). The correlation between previous topical use of fusidic acid and resistance in S. aureus has previously been shown in dermatology patients (Heng et al 2013).…”

Section: Fusidic Acid Resistancementioning

confidence: 80%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

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Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

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“…Previous study has demonstrated that these spa types correspond to multilocus sequence type 5 (ST5) and ST1, respectively, and that both of these clones in NZ (ie, t002 ST5 MRSA and t127 ST1 MSSA) are generally resistant to fusidic acid. 16 Interestingly, of the 142 children who had concurrent nasal and oropharyngeal colonization in 2013, 57 children (40.1%) had discordant isolates on the basis of spa typing. …”

Section: Molecular Typing and Discordance Between Nasal And Oropharynmentioning

confidence: 99%

Persistence, Discordance and Diversity of Staphylococcus aureus Nasal and Oropharyngeal Colonization in School-aged Children

Williamson

Ritchie

Keren

et al. 2016

Pediatric Infectious Disease Journal

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High Usage of Topical Fusidic Acid and Rapid Clonal Expansion of Fusidic Acid–Resistant Staphylococcus aureus: A Cautionary Tale

Cited by 63 publications

References 10 publications

Staphylococcus aureus colonization related to severity of hand eczema

Staphylococcus aureus colonization related to severity of hand eczema

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Persistence, Discordance and Diversity of Staphylococcus aureus Nasal and Oropharyngeal Colonization in School-aged Children

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