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Staphylococcus Aureus

قسمتی از متن :

Staphylococcus Aureus As A Causative Agent Of Atopic Dermatitis/ Eczema Syndrome (ADES ) And Its Theraputic Implications

Abstract

From 286 studied ADES cases, (94.4, 86.36) % were from eczematous lesions and healthy areas and gave positive bacterial cultures (P<0.05). Staphylococcus aureus recorded the highest occurrence ratio (60.84, 17.48) % from same above areas respectively.

Antibiotic susceptibility of thirteen antibiotics against Staph. aureus were evaluated in this study. Some of these antibiotics were studied for the first time (Amoxicillin/ Clavulanic acid, Bacitracin, Doxycylin HCl, Rifamicin, and Vancomycin). Also, the results evidenced resistance of Staph. aureus to more of one antibiotic (three antibiotics or more) that indicated Staph. aureus developed a modern resistance against useful antibiotics.

Introduction

Atopic dermatitis/ eczema syndrome (ADES) is a chronic relapsing, pruritic inflammation of the skin, affecting 10-20% of children and 1-3% of adults worldwide with increasing prevalence in highly industrialized countries( 1 ). Staphylococcus aureus is the most important microorganism of the normal skin flora( 2 ). The bacterial skin flora of patients with atopic dermatitis is different from that in healthy people. In addition, such patients more often suffer from microbial infections such as impetigo, folliculitis, and furunculosis( 3 ). The microbial flora of AD patients shows striking differences in term of the presence of Staph. aureus. The relative rarity (2%-25%) of colonization by Staph. aureus on normal skin sites( 4 ) is in sharp contrast to the high carriage rate found in patients with ADES ranging from 76% on unaffected areas and up to 100% on acute, weeping lesions( 5 ). As the colonization correlates significantly with the severity of ADES, anti-staphylococcal treatment measurements are widely used( 6 ).

The aims of the present study are to determine presence / or occurrence ratio of Staphylococcus aureus in eczematous lesion and healthy area of patients with ADES, and testing the antibiotic susceptibility on these bacteria.

Material & Methods

Patients

A total of 286 patients (males & females) in various age groups were included in this study. The patients suffered from atopic dermatitis / eczema syndrome (ADES) attending the outpatients department of dermatology of the main hospitals in the Basrah providence (outpatients-ased study). ADES was diagnosed under supervision of dermatologists based on criteria of Hanifin & Rajka, 1980( 7 ), Spergel & Schneider, 1999( 8 ), and Stanway, 2005( 9 ). The study was carried out during a period from November 2003 to July 2005

Primary isolation

Skin swabs were collected from eczematous lesions and nearly healthy areas of ADES patients saturated by Brain Heart Infusion Broth (Oxoid), and transported immediately to the laboratory( 10 ). Then, they were cultured on primary isolation media: Blood Agar Base (Oxoid), MacConkey Agar, and Nutrient Agar (Himedia) and incubated at 37°c for 24-48 hrs aerobically. Samples that cultured on Chocolate Agar in addition to Nutrient Agar were incubated and CO2 in candle jar at the same temperature and period mentioned above( 10 ).

Identification technique

API technique (bioMerieux, France) as a rapid identification system was used for identification of various bacterial isolates based on enclosed instruction of supplied company. Some specialized biochemical tests and grew on Mannitol Salt Agar and Staph 110 Agar (Himedia)-that used as a selective media-were done for confirmation the diagnosis of Staph. aureus( 10 , 11 , 12 ).

Antibiotics susceptibility

Thirteen antibiotics (Himedia, India) common used with treatment of atopic dermatitis( 6 , 13 ) were used to testing the antibiotic susceptibility of Staph. aureus :

Amoxycillin / Clavulanic acid (20/10mg) (AC), Bacitracin (10U)(B), Cephalothin (30mg)(Ch), Chloramphenicol (30mg)(C), Clindamcin (2mg)(cd), Co-trimoxazole (trimethoprim/sulphametaxazole) (1.25/23.75mg) (Co), Doxycyclin hydrochloride 30mg) (Do), Erythromycin (15mg)(E), Gentamicin (10mg)(G), Methicillin (5mg)(M), Rifampicin (5mg) (R) Tetracyclin (30mg)(T), and Vancomycin (30mg) (Va).

Statistical analysis

Chi-square test and ANOVA test were carried by using computer program SPSS ver. 11, and statistical similarities were carried by using Minitab program ver. 10.

Results

Table (1) illustrates all bacterial types isolated from eczematous lesions and nearly healthy areas. The total number of positive cultures were (270, 247) cases from 286 studied ADES cases in percentages (94.4, 86.36) % from eczematous and healthy areas respectively (P<0.05). In general, twenty bacterial types were isolated from both area separately and (959, 744) isolates with isolation ratio (3.35:1, 2.6:1) isolates: case were identified in each above area respectively. Staph. aureus recorded the highest occurrence ratio (60.48%, 17.48%) from above area compared to those of all of isolated bacterial agents that recorded the following percentage in eczematous lesions and healthy areas: (P<0.05).

Staph. epidermidis (17.13, 57.34)%, Staph. xylosus (2.79)% in each, Staph. saprophyticus (5.24, 10.48)%, Staph. capitis (2.79)% in each, Staph. hominis (22.37, 9.44)%, Strept. pyogenes (17.13, 9.79)%, Strept. Faecalis (23.07, 17.83)%, Strept. Mutans (14.68, 9.44)%, E. coli (25.52, 33.21)%, Enterobacter sp. (5.59, 17.83)%, Klebsiella sp. (3.14, 1.39)%, Acinetobacter sp. (5.59, 3.49)%, Proteus sp. (5.94)% in each, Pseudomonas aeruginosa (17.48, 5.59)%, Probionibacterium acnes (19.58,3.49)%, Pr.granulosum (20.27, 18.53)%, Haemophilus influenzae (21.32, 11.53)%, Bacteroid sp. (18.18, 3.84)% and Corynebacterium sp. (26.92, 17.83)%.

Table (2) illustrates antibiotic, susceptibility pattern of Staph. aureus isolated from eczematous lesions and healthy areas against various antibiotics. The percentages of sensitivity modes against antibiotics in each of above areas respectively same as follows: Ac (87.28, 66.0)%, B (86.7, 72.0)%, Cd (53.75, 70.0)%, Ch (70.52, 62.0)%, Co(24.85, 46.0)%, Do (31.21, 50.0)%, C (48.55, 64.0)%, E (17.91, 10.0)%, G (73.41, 100)%, M (46.82, 72.0)%, R (74.56, 78.0)%, T (49.13, 80.0)% and Va (89.59, 100)%.

Highly significant differences were found (P<0.01) between three modes of antibiotic susceptibility within the same antibiotics and between these modes of various antibiotics.

Table (3) determines the percentages of antibiotics resistance modes of Staph. aureus according the biggest percentages as follows: (P<0.05) (36.41, 24.27, 16.76, 13.87 and 8.67)% of resistance to three, double, single, four and five or over of antibiotics respectively for eczematous lesions. (36.0, 22.0, 20.0, 14.0, and 8.0)% of resistance to double, single, three, four, and five or over of antibiotics respectively for healthy areas of ADE patients.

The statistical similarities between antibiotics affecting modes on Staph. aureus are shown in figure (1). It has been found that the antibiotic affecting on Staph. aureus isolated from eczematous lesions are tightly correlated with each other in similarity ranged from 8.75-99.13)% and splitted from the same antibiotics affecting on Staph. aureus isolated from healthy area that also closed related with each others and have a similarity ranged from (97.0-100)%. (P<0.001).

Discussion

تصاویری از چند صفحه نخست فایل :

توجه فرمایید بدلیل تهیه ی تصویر با نرم افزار های خارجی متن نمایش داده شده در تصاویر ممکن است دارای اشکالاتی در نمایش برخی حروف باشد که در فایل اصلی بدون مشکل است