Prevalence and antimicrobial resistance profile of Staphylococcus aureus in inherited epidermolysis bullosa: a cross‐sectional multicenter study in Brazil

Abstract

Background Infection is an important complication of epidermolysis bullosa (EB), and Staphylococcus aureus has been pointed out as the most common pathogen among this population. The objective of this study was to investigate the prevalence and antimicrobial resistance profile of S. aureus colonizing EB patients in Brazil. Methods This cross‐sectional multicenter study was conducted between December 2015 and December 2017. We included a total of 89 individuals with EB from medical centers across Brazil. Data were obtained through clinical and bacteriological investigation. S. aureus were identified by biochemical tests. The nuc and mecA genes were confirmed by PCR assay. Antimicrobial susceptibility was investigated by disk diffusion method. Results The overall prevalence of S. aureus was 51.7% (46/89). Methicillin‐resistant S. aureus (MRSA) was detected in 24.7% (19/77) of all S. aureus isolates, colonizing 15.7% (14/89) of all patients. Community‐associated (CA)‐MRSA strains were resistant against sulfamethoxazole/trimethoprim and levofloxacin (P < 0.05%). S. aureus colonization of the nares and belly button represented a 3.4 times higher risk of simultaneous skin lesion colonization (P < 0.05%). Conclusions The high frequency of MRSA colonizing patients with EB is alarming considering its association with life‐threatening complications and poorer outcomes. EB patients are at increased risk of colonization and infection by Staphylococcus aureus and CA‐MRSA. Getting to know S. aureus carriage sites and its antimicrobial susceptibility profile is key when planning new individualized and more effective prophylactic and therapeutic measures.

Longitudinal study of wound healing status and bacterial colonisation of Staphylococcus aureus and Corynebacterium diphtheriae in epidermolysis bullosa patients

“…Interestingly, from all SA‐positive cultures 31% were resistant to Ciprofloxacin and only 7% were MRSA. These results are in contrast with a recent Brazilian study, where they show a lower SA prevalence (51.7%) and higher MRSA frequency (24.7%) 18 . These prevalence and antibiotic resistance differences could be due to clinical management, country‐specific population, environment and other factors.…”

“…The most common isolated microorganisms were SA, CD, PA and Streptococcus spp. which is consistent with previous studies performed in different settings 6,10,18,19 . Interestingly, from all SA‐positive cultures 31% were resistant to Ciprofloxacin and only 7% were MRSA.…”

“…which is consistent with previous studies performed in different settings. 6 , 10 , 18 , 19 Interestingly, from all SA‐positive cultures 31% were resistant to Ciprofloxacin and only 7% were MRSA. These results are in contrast with a recent Brazilian study, where they show a lower SA prevalence (51.7%) and higher MRSA frequency (24.7%).…”

“…Reimer‐Taschenbrecker et al 15 also give evidence for the need to develop longitudinal studies, in order to understand healing outcomes with different types of bacterial colonisation. Only a few studies to date have reported antibiotic susceptibility for EB culture isolates 10,16‐19 . For example, for methicillin‐resistant SA (MRSA), reports from different countries have shown prevalence ranging from 6.7% to 57%.…”

“…Only a few studies to date have reported antibiotic susceptibility for EB culture isolates. 10 , 16 , 17 , 18 , 19 For example, for methicillin‐resistant SA (MRSA), reports from different countries have shown prevalence ranging from 6.7% to 57%. This considerable MRSA prevalence variation within a rare patient population may be related to a small sample size, but it also highlights possible country‐specific intrinsic clinical differences, showing a need for more studies in this field.…”