Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2010:76:5;572-574
doi: 10.4103/0378-6323.69064
PMID: 20827007

Bacteriological profile of community-acquired pyodermas with special reference to methicillin resistant Staphylococcus aureus

Parveen Thind1 , S Krishna Prakash1 , Anupriya Wadhwa1 , VK Garg2 , Binod Pati1
1 Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India
2 Department of Dermatology, Maulana Azad Medical College, New Delhi - 110 002, India

Correspondence Address:
S Krishna Prakash
Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002
India
How to cite this article:
Thind P, Prakash S K, Wadhwa A, Garg V K, Pati B. Bacteriological profile of community-acquired pyodermas with special reference to methicillin resistant Staphylococcus aureus. Indian J Dermatol Venereol Leprol 2010;76:572-574
Copyright: (C)2010 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

In recent years, there has been a paucity of data from northern India on the bacteriological profile and antimicrobial susceptibility patterns of isolates from cases of pyoderma and the incidence of community-acquired MRSA from pyodermas. We tried to correlate the clinical and bacteriological profile of community-acquired pyodermas, and establish the isolation rate of methicillin resistant Staphylococcus aureus (MRSA).

One hundred patients of all ages and both sexes attending the outpatient Department of Dermatology at Lok Nayak Hospital (LNH) presenting with infection of the skin and soft tissue (both primary and secondary) with no history of hospitalization in the preceding one year and no history of intake of any antimicrobial therapy during the previous month were enrolled in this case series. Clinical and bacteriological profiles were studied using standard techniques. The minimum inhibitory concentration (MICs) of oxacillin, vancomycin, fusidic acid(range; 0.016-256 ug/ml) and mupirocin(Range; 0.064-1024 ug/ml) were determined by the E test (AB - Biodisk Solna, Sweden). Staphylococcus aureus ATCC 25923 reference strain was included as control.

The age of the patients varied from 6 months to 60 years. The peak incidence of pyoderma was observed in the first decade with no significant predominance of either sex. There were 88 cases of primary pyoderma and 12 cases of secondary pyoderma, maximum incidence being of impetigo contagiosa(42) similar to other Indian reports. [1] In all, 96 cases yielded growth and from these, a total of one hundred bacterial isolates were obtained.[Table - 1]. Similar to various other studies, [1],[2],[3] in this study also Staphylococcus aureus was a predominant pathogen, isolated as the sole pathogen in 79% of the cases while beta-hemolytic streptococci were isolated as the sole pathogen in 9% of the cases similar to the findings of other workers. [1],[2],[3] A total of 13 isolates of beta- hemolytic streptococci were isolated among which 12 were group A streptococci while one isolate was group B streptococci, confirmed by serogrouping using a commercially available latex test kit for serogrouping (Plasmatec Laboratory Products Ltd.)

Table 1 : Clinicobacteriological profile of cases of pyoderma

A total of 83 strains of Staphylococcus aureus were tested for sixteen antimicrobial agents by disc diffusion method employing the Stokes technique. All the strains (100%) were resistant to penicillin. The resistance seen to most other antimicrobials was fairly low. All the strains appeared to be sensitive to amikacin, fusidic acid, vancomycin, teicoplanin, linezolid, quinpristin - dalfopristin [Table - 2].

Table 2 : Antimicrobial resistance of Staphylococcus aureus to various antibiotics

Seventy five of the total of 83 strains(90.4%) of Staphylococcus aureus were sensitive to methicillin (MSSA) and eight strains appeared to be resistant to methicillin (MRSA). MRSA identification was done by three methods namely oxacillin agar screening technique, MIC of oxacillin by the E test and cefoxitin disc diffusion technique.

Although MRSA infections are acquired primarily in hospital setting, of late it is felt that probably MRSA is circulating in the community as well. In 2004, Nagaraju et al,[3] reported an isolation rate of MRSA as 10.9% from community acquired infections in India, similar to our study(9.6%) indicating that the prevalence of MRSA in the community has remained constant. The susceptibility of the eight strains of MRSA was determined against 16 antimicrobials. In 1991, Gosbell et al[4] coined the term NORSA to denote non-multi resistant oxacillin resistant Staphylococcus aureus which tested resistant to methicillin or oxacillin and were either sensitive to erythromycin or resistant to erythromycin and sensitive to ciprofloxacin or tetracycline. All eight strains fulfilled the definition of non-multiresistant MRSA (NORSA).

The MIC of the Community MRSA isolates was done by the E test. It was interesting to note that all the eight strains showed MIC values of >256 μg/ml for oxacillin. All eight strains were confirmed as MRSA by both the agar screening test and the cefoxitin disc diffusion method. In the latter, none of the strains showed any zone of inhibition, further strengthening the confirmation that all these strains had MICs of >256 μg/ml for oxacillin.

The results of disc diffusion that were performed for vancomycin were in total agreement with the MIC results, i.e., all the strains appeared sensitive to vancomycin by both the disc diffusion method and the MIC determination by the E test (an MIC 90 value of 2.0 μg/ml) as it is well known that the widely used disc diffusion technique does not differentiate strains with reduced susceptibility to vancomycin from susceptible strains. [5] All the MRSA strains also appeared sensitive to both fusidic acid and mupirocin by the E test. To the best of our knowledge, there are no published reports about the MIC values of community MRSA to these agents used commonly in dermatological practice. We observed 100% sensitivity to fusidic acid among all the strains of Staphylococcus aureus including MRSA by the disc diffusion method and the E test, done for the eight strains of MRSA showed an MIC range of 0.016-0.047 μg/ml for fusidic acid [Table - 2] and [Table - 3]. None of our strains of MRSA appeared resistance to mupirocin. While the MIC range for mupirocin ranged between <0.064 and 0.125 μg/ml, the MIC 90 value itself was quite low at 0.125 μg/ml [Table - 3].

Table 3 : MICs of MRSA strains to various antimicrobials by the E test

To conclude, MRSA as a cause of pyodermas is a reality albeit with very low incidence rate (9.6%). It was heartening to note that, all the MRSA from the community appeared to be NORSA leaving the therapeutic options to the treating clinician wide open. All the strains were uniformly sensitive to two important antimicrobials used in dermatological practice, viz, fusidic acid and mupirocin and the MICs to both these agents was very low.

References
1.
Ramani TV, Jayakar PA. Bacteriological Study of 100 Cases of Pyodermas with Special Reference To Staphylococci, Their Antibiotic Sensitivity and Phage Pattern. Indian J Dermatol Venereol Leprol 1980;46:282-6.
[Google Scholar]
2.
Patil R, Baveja S, Nataraj G, Khopkar U. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol Leprol 2006;72:126-8.
[Google Scholar]
3.
Nagaraju U, Bhat G, Kuruvila M, Pai GS, Jayalakshmi, Babu RP. Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma. Int J Dermatol 2004;43:412-4.
[Google Scholar]
4.
Gosbell IB, Mercer JL, Neville SA, Crone SA, Chant KG, Jalaludin BB, et al. Non-multiresistant and multiresistant methicillin-resistant Staphylococcus aureus in community-acquired infections. Med J Aust 2001;174:627-30.
[Google Scholar]
5.
Tenover FC, Lancaster MV, Hill BC, Steward CD, Stocker SA, Hancock GA, et al. Characterization of staphylococci with reduced susceptibilities to vancomycin and other glycopeptides. J Clin Microbiol 1998;36:1020-7.
[Google Scholar]

Fulltext Views
243

PDF downloads
121
Show Sections