The decline of the impetigo epidemic caused by the epidemic European fusidic acid-resistant impetigo clone: an 11.5-year population-based incidence study from a community in Western Norway

Abstract

BackgroundFrom around the year 2000, Northern Europe experienced a rise in impetigo caused by Staphylococcus aureus resistant to fusidic acid. A single clone of S. aureus was found to be the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK and Ireland, termed ‘the epidemic European fusidic acid-resistant impetigo clone’ (EEFIC). We have followed the incidence of impetigo during the years 2001–2012 based on all patients in general practice in the island community of Austevoll, Western Norway. We previously reported a marked decline of impetigo incidence in Austevoll, from 0.0260 cases per person-year in 2002 to 0.0038 in 2009. This article explores indications of an end to the impetigo epidemic caused by the EEFIC clone. Methods: All four general practitioners (GPs) in the community (mean population = 4400) were asked to diagnose impetigo in a uniform way and to take bacterial specimens from all impetigo cases. Phenotypic characteristics of specimen bacteria were determined for the whole period and molecular analyses were performed on isolates in the period 2008–2012. Results: We observed a further decline in incidence of impetigo in Austevoll in the study period. The proportion of fusidic acid-resistant S. aureus isolates decreased during the period 2002–2012, with a mean of 80% in the epidemic years of 2002–2004, 55% in 2005–2009, and 6% in 2010–2012. In total, 44 S. aureus isolates from impetigo were subject to molecular analyses in the period 2008–2012, and 11 were found to be related to the EEFIC. All EEFIC isolates were found in 2008–2009, with no new isolates in 2010–2012. Conclusion: There is an apparent end to the impetigo epidemic related to the EEFIC in this population in Western Norway.

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

“…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). In the present study, we have shown the dissemination in Greece of MSSA strains belonging to the same clonal complex (CC121), carrying common resistance and pathogenicity determinants.…”

Non-bullous Impetigo: Incidence, Prevalence, and Treatment in the Pediatric Primary Care Setting in Italy

“…The IRs estimated in our study are in line with studies in Northern Europe. In Norway, IR was estimated to be between 9 and 16 per 1,000 person-years from 2001 to 2004 ( 25 ), and 3 per 1,000 patient-years in 2012 ( 26 ), while a study in the UK estimated impetigo IR to have decreased from 20 to 14 per 1000 person-years from 2004 to 2010 ( 27 ). Interestingly, a study conducted in 29 general practices in Utrecht, the Netherlands, estimated the IR of NBI in children to be 64.4 per 1,000 person-years in 2015, with higher cases in summer (29.5%) ( 28 ).…”

“…The reduction in the IRs can be explained by the decline in the impetigo epidemic caused by the epidemic European fusidic acid-resistant impetigo clone. Indeed, in 2003, it was identified a single clone of S. aureus as being the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK, Ireland, France and the Netherland ( 26 ). However, findings from Norway from 2002 to 2012 reported a decline of this fusidic acid-resistant S.aureus that might be correlated to reduced impetigo IRs.…”

Emergence and spread of a mupirocin-resistant variant of the European epidemic fusidic acid-resistant impetigo clone of Staphylococcus aureus in Belgium, 2013 to 2023

“…The Staphylococcus aureus European epidemic fusidic acid-resistant impetigo clone (EEFIC) was rst described in 2007 after an increase in fusidic acid resistance among methicillin-susceptible S. aureus (MSSA) was observed in a number of northern European countries since circa 2000 [1]. A decade later, EEFIC was described as decreasing in these northern European countries [2,3] and remained rather unnoticed in Belgium at that time. However, a recent study showed not only the existence but also the persistence of EEFIC in Belgium [4].…”