<i>Staphylococcus aureus</i> and topical fusidic acid use: results of a clinical audit on antimicrobial resistance

Heng, Yee Kiat; Tan, Kian Teo; Sen, Priya; Chow, Angela; Leo, Yee Sin; Lye, David C.; Chan, Roy

doi:10.1111/j.1365-4632.2012.05747.x

Cited by 33 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In parallel to this clonal dissemination, a significant increase in dispensing rates for topical fusidic acid was seen in New Zealand (Williamson et al 2014). The correlation between previous topical use of fusidic acid and resistance in S. aureus has previously been shown in dermatology patients (Heng et al 2013). Although fusidic acid is not in clinical use in the USA, resistance has been reported (Jones et al 2011).…”

Section: Fusidic Acid Resistancementioning

confidence: 83%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

View full text Add to dashboard Cite

Staphylococcus aureus is a commensal of the human flora, primarily colonizing the anterior nares and throat, but it may also cause infections ranging from mild skin and soft tissue infections to severe diseases such as endocarditis and septicemia. S. aureus is also a major nosocomial problem increasing with the worldwide dissemination of methicillin-resistant S. aureus (MRSA).The main vector for bacterial cross-transmission in healthcare settings is the hands of healthcare workers (HCWs). No S. aureus was detected in the air in this thesis demonstrating that transmission through air is not important. Despite the fact that good compliance with hand hygiene is essential to prevent cross-transmission the compliance is generally less than 50 %.Gold standard to track bacterial transmission in healthcare settings has for long been pulsedfield gel electrophoresis (PFGE), a method that is labor-intensive, lacks consensus protocol and relies on semi-subjective analysis. Molecular typing by sequencing of the hypervariable part of the S. aureus protein A gene (spa typing) has overcome these problems and has shown promising results in epidemiological investigations.The aims of this thesis were to study bacterial transmission with S. aureus colonization of newborn infants as a model and to evaluate spa typing as a molecular tool. Additionally, the influence of compliance with hygiene guidelines on S. aureus transmission was assessed.Analysis of 280 MRSA isolates by spa typing revealed excellent typeability and epidemiological concordance and satisfactory discriminatory power. Additionally, spa typing was considered superior to PFGE thanks to its accessibility, ease of use and rapidity. Also, spa typing results are registered in a global database, facilitating inter-laboratory comparison.The prevalence of S. aureus ranged from 41 % to 66 % in the populations studied and males had the highest colonization rate. Throat was the premier colonization site for adults and transmission from individuals colonized in the throat only was documented, suggesting that throat cultures should be included in S. aureus screening programs. The umbilicus was the premier colonization site for newborn infants. Incubating the swabs in enrichment broth prior to plating increased the prevalence of S. aureus positive samples by 46 %, resulting in prevalence viii ranging from 51 % to 70 % in the populations studied. Thus enrichment prior to plating is necessary to determine more truthful S. aureus colonization rates. There were no indications of an institutional flora, as the colonization rates, spa type distribution and antibiotic resistance prevalence were similar among parents and HCWs.Direct observations and self-reporting by HCWs were both validated as tools for monitoring compliance with hygiene guidelines. The compliance with hygiene guidelines was significantly higher following a 10-point hygiene intervention as compared to baseline. The compliance was also higher three years after the intervention in three of four participating departm...

show abstract

Section: Fusidic Acid Resistancementioning

confidence: 83%

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Mernelius¹

2015

View full text Add to dashboard Cite

show abstract

“…However, the prevalence of resistant strains of skin bacteria is steadily increasing and cases of allergy or skin sensitisation are not uncommon. 30,31 Fusidic acid resistance has been shown to be related to high levels of use, for example. 32 Therefore, once a decision is made to prescribe antibiotic treatment, it is unclear whether topical or oral antibiotics are most effective and which cause the least 'collateral damage' to the microbiome in terms of driving resistance.…”

Section: Use Of Antimicrobial Treatments For Eczemamentioning

confidence: 99%

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Francis

Ridd

Thomas-Jones

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundSecondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice.ObjectiveTo determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema.DesignMulticentre randomised, double-blind, placebo-controlled trial.SettingGeneral practices and dermatology clinics in England, Wales and Scotland.ParticipantsChildren (aged 3 months to < 8 years) with a diagnosis of eczema (according to U.K. Working Party definition) and clinical suspicion of infection.Interventions(1) Oral flucloxacillin and topical placebo; (2) topical fusidic acid (Fucidin®, Leo Laboratories Limited) and oral placebo; and (3) oral and topical placebos, all for 1 week.Main outcome measuresPatient-Orientated Eczema Measure (POEM) at 2 weeks (assessing subjective severity in the week following treatment).ResultsWe randomised 113 children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children hadStaphylococcus aureuscultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) –1.35 to 4.40] and 1.49 (95% CI –1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI –0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings.ConclusionsOur data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection andS. aureuson their skin, participants primarily had mild–moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of ‘severe infection’. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2011-003591-37 and Current Controlled Trials ISRCTN96705420.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…Topical antibiotics are frequently used in ambulatory care, especially in combination products with topical corticosteroids, and their use can promote resistance and allergy or skin sensitization. [31][32][33] We found resistance to fusidic acid in more than a quarter of patients at baseline and nearly three-quarters of the group treated with fusidic acid at follow-up. Less than 1% of S. aureus from community samples is methicillin resistant, and the lack of benefit in the flucloxacillin group, despite low levels of resistance to flucloxacillin found in our baseline swabs, suggests that resistance is unlikely to account for the lack of effect observed in this study.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care

et al. 2017

View full text Add to dashboard Cite

show abstract

Staphylococcus aureus and topical fusidic acid use: results of a clinical audit on antimicrobial resistance

Abstract: 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.

Cited by 33 publications

References 33 publications

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care

Contact Info

Product

Resources

About