Clinico-microbiological profile of Staphylococcus aureus pyodermas in Dermatology outpatients

Tanumay, Raychaudhury (2011) Clinico-microbiological profile of Staphylococcus aureus pyodermas in Dermatology outpatients. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA), a known nosocomial pathogen, has been increasingly reported globally in patients from the community, without hospital-related risk factors. Pyodermas represent majority of the disease burden caused by MRSA. Community associated-MRSA (CA-MRSA) and methicillinsusceptible S.aureus (MSSA) may harbour Panton-Valentine leucocidin (PVL) which is associated with necrotic and severe infections. There is no published data on demographic and clinical features of MRSA and PVL associated pyodermas from India. OBJECTIVES: The study sought to evaluate the clinical and microbiological features of Staphylococcus aureus, isolated from outpatients presenting with pyodermas to the Dermatology outpatient department between July 2009 and July 2010. METHODS: An open, prospective, cross-sectional study was carried out in the Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore from July 2009 to July 2010 for patients presenting with pyodermas. Pus cultures were obtained by standard methods and S.aureus isolates were further characterized for methicillin-susceptible (MSSA) and methicillin-resistant S.aureus (MRSA) phenotypically and genotypic characterization for presence of PVL was done by PCR. MRSA were further subclassified to community associated-MRSA (CAMRSA) and hospital associated-MRSA, as per CDC criteria for clinicians. RESULTS: 298 patients (184 males, 114 females) were enrolled into the study. S.aureus was the most commonly isolated organism 66.4% (198/298). Among all S.aureus, 27.3% (54/198) were MRSA. CA-MRSA accounted for 92.6% (50/54) of MRSA. Furuncles (49.1%) and non-bullous impetigo (14.1%) were the most common presentations among primary pyodermas. Overcrowding, low socioeconomic status, exposure to two or more systemic antibiotics, prior exposure to β-lactam antibiotics or macrolides in the past 1 year and history of recurrent pyodermas or household clusters of infection was significantly associated with MRSA pyodermas. Clinical signs like surrounding erythema (p=0.015), induration (p=0.009), lymphangitis (p=0.001) and fever (p=<0.0001) were significantly associated with MRSA. There was no significant association between MRSA and presence of PVL (p=0.174). None of the HA-MRSA isolates were found to be positive for PVL carriage. Necrotic changes in primary pyodermas were found to be significantly associated with PVL (p=0.001). CONCLUSION: The prevalence of MRSA in this study was higher compared to other studies from India. PVL positive S.aureus are prevalent in India and were isolated in both MSSA and MRSA. Further studies are required on larger populations from India to study association of PVL with antimicrobial susceptibility and outcome of disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: methicillin-resistant Staphylococcus aureus (MRSA), Panton-Valentine leucocidin (PVL), Staphylococcus aureus pyodermas, Dermatology outpatients, Clinico-microbiological profile.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 11 Jan 2020 04:15
Last Modified: 15 Jan 2020 15:11

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