The widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from patients with atopic dermatitis
The widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from patients with atopic dermatitis
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DOI：
10.1111/bjd.16722
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发表时间：
2018-10-01
影响因子：
10.3
通讯作者：
Holden, M. T. G.
中科院分区：
文献类型：
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作者：
Harkins, C. P.;McAleer, M. A.;Holden, M. T. G.
背景特应性皮炎（AD）患者皮损金黄色葡萄球菌的携带率约为70%.疾病发作期间疾病严重程度和总体疾病严重程度的增加与S.金黄色。因此，AD的治疗通常针对S。目的：探讨金黄色葡萄球菌对局部和全身抗菌药物的敏感性和耐药的遗传决定因素。金黄色葡萄球菌分离自AD儿童和健康儿童鼻携带者皮肤。金黄色葡萄球菌分离株从患有AD的儿童（n = 50）参加医院皮肤科对鼻携带分离株从没有皮肤病的儿童（n = 49）参加医院急诊科的非感染性条件。使用全基因组测序，我们产生了一个系统发育框架的基础上，在核心基因组的变化的菌株，然后比较抗菌药物耐药表型和基因型疾病groups. ResultsConclusions金黄色葡萄球菌的病例和对照组之间的平均相似的表型耐药每隔离。病例分离株的耐药模式不同，夫西地酸耐药（Fus（R））在AD中更常见（P = 0.009）。Fus（R）的遗传基础也区分了人群，其中fusA中的染色体突变在AD中占主导地位（P = 0.049）。分析表明，Fus（R）在种群中经历了多次进化，并通过多种机制进化。携带的质粒衍生的qac基因，这已与减少敏感性的防腐剂，是8倍，更频繁的AD（P = 0.016）。结果表明，强大的选择压力驱动的出现和维持特定的电阻在AD。
BackgroundCarriage rates of Staphylococcus aureus on affected skin in atopic dermatitis (AD) are approximately 70%. Increasing disease severity during flares and overall disease severity correlate with increased burden of S. aureus. Treatment in AD therefore often targets S. aureus with topical and systemic antimicrobials.ObjectivesMethodsTo determine whether antimicrobial sensitivities and genetic determinants of resistance differed in S. aureus isolates from the skin of children with AD and healthy child nasal carriers.In this case-control study, we compared S. aureus isolates from children with AD (n = 50) attending a hospital dermatology department against nasal carriage isolates from children without skin disease (n = 49) attending a hospital emergency department for noninfective conditions. Using whole genome sequencing we generated a phylogenetic framework for the isolates based on variation in the core genome, then compared antimicrobial resistance phenotypes and genotypes between disease groups.ResultsConclusionsStaphylococcus aureus from cases and controls had on average similar numbers of phenotypic resistances per isolate. Case isolates differed in their resistance patterns, with fusidic acid resistance (Fus(R)) being significantly more frequent in AD (P = 0009). The genetic basis of Fus(R) also differentiated the populations, with chromosomal mutations in fusA predominating in AD (P = 0049). Analysis revealed that Fus(R) evolved multiple times and via multiple mechanism in the population. Carriage of plasmid-derived qac genes, which have been associated with reduced susceptibility to antiseptics, was eight times more frequent in AD (P = 0016).The results suggest that strong selective pressure drives the emergence and maintenance of specific resistances in AD.