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[Carriage of Staphylococcus aureus. A severity factor of erysipelas?]
Introduction:
Occasional superinfection or co-infection with Staphylococcus aureus led us to search for S. aureus carriage prospectively in patients with non-necrotizing bacterial dermophypodermitis, in particular erysipelas.
Patients And Methods:
This prospective study included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included: 1) direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies taken on day 0, 2) samples from the nasal orifices, the intergluteal fold, and potential skin portals for bacteriology culture, and 3) assay of antistreptolysine O and antistreptodornase B on day 0 and 15.
Results:
The study group included 42 patients (23 females, 19 males, mean age 64 +/- 3.5 yr). In 39 cases (93%) bacterial dermohypodermitis was located on the lower limb with a potential skin portal in 36 cases (86%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). Nasal, intergluteal or potential portal were identified in 19 patients (45%) including 16 with demonstrated presence of streptococci. The rate of cure after oral pristinamycin did not vary significantly between carriers (79%) an non-carriers (91%) of Staphylococcus aureus. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment; 4 of them were carriers of S. aureus.
Conclusion:
This prospective study demonstrated that cutaneous-mucosal carriage of Staphylococcus aureus is frequent in patients with non-necrotizing dermohypodermitis. This carriage is not a factor of over-morbidity as shown in this group of infections largely dominated by erysipelas.
Insights
Staphylococcus aureus carriage is common in patients with non-necrotizing bacterial skin infections like erysipelas. This carriage does not appear to increase the risk of complications in these patients.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Context:
- Non-necrotizing bacterial dermohypodermitis, particularly erysipelas, can be complicated by Staphylococcus aureus superinfection.
- Investigating S. aureus carriage is crucial for understanding disease progression and management.
Purpose:
- To prospectively evaluate the prevalence of Staphylococcus aureus carriage in patients with non-necrotizing bacterial dermohypodermitis.
- To determine if S. aureus carriage influences patient morbidity or treatment outcomes.
Summary:
- A prospective study of 42 immunocompetent patients with bacterial dermohypodermitis found S. aureus carriage in 45% of cases.
- Streptococci were identified in 79% of patients, with nasal or skin carriage identified in 19 patients.
- S. aureus carriage did not significantly affect cure rates with pristinamycin or influence outcomes after abscess drainage.
Impact:
- Cutaneous-mucosal carriage of Staphylococcus aureus is frequent in patients with non-necrotizing dermohypodermitis.
- This carriage is not associated with increased morbidity in this patient group, largely affected by erysipelas.