Impetigo in a population over 8.5 years: incidence, fusidic acid resistance and molecular characteristics

Rørtveit, Sverre; Skutlaberg, Dag Harald; Langeland, Nina; Rørtveit, Guri

doi:10.1093/jac/dkr102

Cited by 15 publications

(21 citation statements)

References 10 publications

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“…Beginning around 2000, impetigo caused by fusidic acid-resistant MSSA was observed in countries of northern Europe. The bacteria were found to represent a clone, namely, EEFIC (ST123, CC121), which has been observed in the United Kingdom, Ireland, France, and Scandinavian countries (8,9). This clonal S. aureus strain is characterized as spa type 171 or single-locus variants t408, t659, t874, and t875.…”

Section: Discussionmentioning

confidence: 96%

“…This clonal S. aureus strain is characterized as spa type 171 or single-locus variants t408, t659, t874, and t875. The presence of the agrIV allele, eta (and in a large proportion etb), and fusB is highly indicative of the aforementioned clone (8,9,14). The last report of the aforementioned clone was from Norway in 2014, showing evidence of extinction from 2012 (15).…”

Section: Discussionmentioning

confidence: 99%

“…This clone is characterized by concurrent resistance to kanamycin, fusidic acid, and tetracycline. Secondarily, resistance to FA and a predilection for impetigo among S. aureus strains are linked to the so-called epidemic European fusidic acid-resistant impetigo clone (EEFIC) in numerous northern European countries (8,9). Molecular typing of this clone showed that it belonged to ST123 (clonal complex 121 [CC121]) (9).…”

mentioning

confidence: 99%

“…Secondarily, resistance to FA and a predilection for impetigo among S. aureus strains are linked to the so-called epidemic European fusidic acid-resistant impetigo clone (EEFIC) in numerous northern European countries (8,9). Molecular typing of this clone showed that it belonged to ST123 (clonal complex 121 [CC121]) (9). Occasional resistance of methicillin-sensitive S. aureus (MSSA) strains to FA was observed in our settings in past years but never at an alarming level (Ͻ5%) (A. Doudoulakakis, unpublished data).…”

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confidence: 99%

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Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections

et al. 2017

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Skin and soft tissue infections (SSTIs) caused by mupirocin-resistant Staphylococcus aureus strains have recently increased in number in our settings. We sought to evaluate the characteristics of these cases over a 43-month period. Data for all community-acquired staphylococcal infections caused by mupirocin-resistant strains were retrospectively reviewed. Genes encoding products producing high-level resistance (HLR) to mupirocin (mupA), fusidic acid resistance (fusB), resistance to macrolides and lincosamides (ermC and ermA), Panton-Valentine leukocidin (PVL) (lukS/lukF-PV), exfoliative toxins (eta and etb), and fibronectin binding protein A (fnbA) were investigated by PCRs in 102 selected preserved strains. Genotyping was performed by SCCmec and agr typing, whereas clonality was determined by pulsedfield gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 437 cases among 2,137 staphylococcal infections were recorded in 2013 to 2016; they were all SSTIs with the exception of 1 case of primary bacteremia. Impetigo was the predominant clinical entity (371 cases [84.9%]), followed by staphylococcal scalded skin syndrome (21 cases [4.8%]), and there were no abscesses. The number of infections detected annually increased during the study years. All except 3 isolates were methicillin susceptible. The rates of HLR to mupirocin and constitutive resistance to clindamycin were 99% and 20.1%, respectively. Among the 102 tested strains, 100 (98%) were mupA positive and 97 (95%) were fusB positive, 26/27 clindamycin-resistant strains (96.3%) were ermA positive, 83 strains (81.4%) were lukS/lukF positive, 95 (93%) carried both eta and etb genes, and 99 (97%) were fnbA positive. Genotyping of methicillin-sensitive S. aureus (MSSA) strains revealed that 96/99 (96.7%) belonged to one main pulsotype, pulsotype 1, classified as sequence type 121 (ST121). The emergence of a single MSSA clone (ST121) causing impetigo was documented. Resistance to topical antimicrobials and a rich toxinogenic profile confer to this clone adaptability for spread in the community.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections

et al. 2017

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“…Over the past decade, several European countries have reported a rise in general practice consultations for impetigo ( 12 , 13 ). Many European countries have established primary care databases, such as the Information System for the Development of Research in Primary Care in Catalonia ( 14 ) or the Health Search Database in Italy ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Use of Primary Care Data for Detecting Impetigo Trends, United Kingdom, 1995–2010

Shallcross¹,

Petersen²,

Rosenthal³

et al. 2013

Emerg. Infect. Dis.

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Cellulitis, Necrotizing Fasciitis, and Subcutaneous Tissue Infections

Pasternack¹,

Swartz²

2015

Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

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Impetigo in a population over 8.5 years: incidence, fusidic acid resistance and molecular characteristics

Abstract: S. aureus resistance to fusidic acid in relation to impetigo is now less frequent in this population than at the start of the century. At present, most S. aureus bacteria resistant to fusidic acid in impetigo belong to the EEFIC.

Cited by 15 publications

References 10 publications

Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections

Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections

Use of Primary Care Data for Detecting Impetigo Trends, United Kingdom, 1995–2010

Cellulitis, Necrotizing Fasciitis, and Subcutaneous Tissue Infections

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