High levels of fusidic acid-resistant Staphylococcus aureus despite restrictions on antibiotic use
ABSTRACT High rates of fusidic acid (FA)-resistant Staphylococcus aureus (FRSA) in patients with skin disease have been previously attributed to high usage of topical FA.
To assess whether local community guidelines to restrict topical FA has affected its prescription and use and the level of FRSA in patients with skin disease.
Stapylococcus aureus isolates from microbiology samples received over a 4-month period in 2004 were tested for antibiotic sensitivities. Comparison was then made with the results of a previous study carried out in 2001.
A significant fall was seen in the use of topical FA in dermatology patients. In 2001, 62% of patients had used FA-containing preparations within the previous 6 months, compared with just 15% of patients in 2004 (P < 0.001). The number of topical FA prescriptions in primary and secondary care dropped between 2001 and 2004. The proportion of S. aureus isolates resistant to FA in dermatology patients had not significantly fallen between 2001 (50%) and 2004 (41%) (P = 0.4). However, there was a significant increase in FA resistance within hospital inpatients, nondermatology outpatients and primary-care patients (P < 0.05). The FRSA level had doubled in hospital inpatients (20%) and almost tripled in nondermatology outpatients (28%) and primary care patients (25%).
Persistent high levels of FA resistance may represent the development of an FRSA reservoir in the community. Continued restriction of FA is still recommended.
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ABSTRACT: Background: Staphylococcus aureus (S aureus) is the major cause of skin and soft tissue infections (SSTIs). Increased methicillin-resistant strains have attracted a global concern. The aim of this study is to evaluate the prevalence of methicillin-resistant S aureus (MRSA) SSTIs in dermatologic settings and evaluate their susceptibility results. Methods: A retrospective chart analysis of patients diagnosed with SSTIs in the Department of Dermatology, Buddhist Tzu Chi General Hospital in Hualien, Taiwan from November 2003 to July 2007 was conducted. Wound or pus bacterial culture results from a wound site were collected. The epidemiology, microbiology,and antibiotic susceptibility were assessed. Minocycline treatment experience in 15 MRSA SSTIs inpatients was presented. Results: Of the 443 SSTI episodes included, 59.6% were males and 40.4% were females. S aureus was the leading cause (53.3%), and among them 53.0% were MRSA. Minocycline (94.4%), trimethoprim/sulfamethoxazole (95.2%), levofloxacin (95.7%), and fusidic acid (98.9%) were the major susceptible antimicrobial agents to MRSA. Only 14.4% was susceptible to clindamycin. In the MASA infected inpatients, 75.6% were community-associated. In our clinical experience, 15 inpatients with poor clinical response to beta-lactam empirical antimicrobial therapy received minocycline as combination therapy based on the susceptibility results, all of which obtained satisfied clinical remission. Conclusions: S aureus is still the leading causative bacterial organism for SSTIs in the dermatologic settings in eastern Taiwan. Methicillin-resistant strains are increasing and among which most are community-associated in eastern Taiwan. MRSA strains are still susceptible to other non-beta lactam antibiotics, such as minocycline, trimethoprim/sulfamethoxazole, levofloxacin, and fusidic acid in dermatological settings, of which minocycline is an alternative choice in our clinical experience. CopyrightDermatologica Sinica 09/2011; 29(3):86-90. DOI:10.1016/j.dsi.2011.07.002 · 0.57 Impact Factor
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ABSTRACT: BACKGROUND: Fusidic acid (FA) resistance in Staphylococcus aureus poses a problem for treating systemic methicillin-resistant S. aureus infection, in which FA may otherwise remain a viable option. It can also result in treatment failure of common dermatological conditions such as impetigo and infected atopic eczema. Several studies have linked trends in prescribing medication and topical use of FA to development of resistance. However, few case-control studies have evaluated risk factors for developing FA resistance in S. aureus. METHODS: A clinical audit for antimicrobial resistance was performed in dermatology patients from the National Skin Centre who were admitted for inpatient care from 2006 to 2008 and had positive bacterial cultures for S. aureus. Each FA-resistant S. aureus (FRSA) case was compared with four randomly selected FA-susceptible (FSSA) cases. Medical records were reviewed retrospectively, and potential risk factors for development of resistance were analyzed. RESULTS: Thirteen of 37 patients with FRSA (35.1%) had used FA topically compared with 11 of 148 patients with FSSA (7.4%). Findings from multivariate analysis indicate that previous use of topical FA was the only independent risk factor of FA resistance (adjusted OR 7.46, 95% CI [2.60-21.41], P < 0.001). Patients' coexisting illnesses, recent hospitalization, or systemic antibiotic use were not significant risks. CONCLUSIONS: Previous recent topical FA use correlated positively with FA resistance in S. aureus. Prescribing physicians must be vigilant of the rise of FA resistance and its resultant problems and prescribe topical FA discerningly.International journal of dermatology 02/2013; 52(7). DOI:10.1111/j.1365-4632.2012.05747.x · 1.23 Impact Factor
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ABSTRACT: Superficial bacterial skin infection and superinfection of skin diseases are usually treated by general practitioners using antiseptics or antibiotics. However, acquired resistance to biocidal agents, both systemic and topical, is growing. Our aim was to assess the skill of GPs in clinical situations involving common skin infections. On 16 June 2010, we sent a questionnaire to all GPs in a rural region of France (the Cher department) together with a stamped addressed envelope for the reply. The questionnaire contained seven pages of multiple-choice questions and five clinical cases, each one illustrated with a photograph (sty, furuncle, whitlow, colonized chronic wounds and impetigo). Anonymity of responses was guaranteed. Data was analysed using the Clinsight(®) software package. The response rate was 51% (102 responses). GPs reported little difficulty in treating these patients (median 3, range 1 to 8 on a scale of increasing difficulty from 0 to 10). The main results of the study are firstly the frequency of combination of at least one antiseptic with one antibiotic (46%); secondly, the frequency of combination of two antibiotics (20% of cases); thirdly, the frequent prescription of systemic antibiotics for chronic wounds colonized by Pseudomonas aeruginosa (61%). Our study shows the high frequency of prescriptions for combined therapy to treat superficial skin infections despite the fact that monotherapy with either an antiseptic or an antibiotic would probably suffice. It also shows the unnecessary prescription of antibiotics for colonization of a chronic wound. The study was limited in terms of size and design: it was a questionnaire rather than an analysis of prescriptions actually made in "real life", and the response rate was 51%. In addition, aside from impetigo, for which randomised studies and recommendations were given, the other surface infections (sty, folliculitis, whitlow) tend to be treated more empirically. Dissemination of recommendations regarding the respective role of antiseptics and antibiotics (and their route of administration, topical or systemic) in superficial skin infections would doubtless be useful for prescribers, and more rational use of these agents would help limit bacterial resistance.Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):755-62. DOI:10.1016/j.annder.2013.07.001 · 0.67 Impact Factor