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Jayawardena NS, Wargon O, Tatian AH. Review: the spectrum of antimicrobial resistance in bacteria isolated from wounds of patients with epidermolysis bullosa. J DERMATOL TREAT 2024; 35:2370424. [PMID: 38936964 DOI: 10.1080/09546634.2024.2370424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
Purpose: Cutaneous infection in epidermolysis bullosa (EB) can cause significant morbidity, mortality, and dangerous sequelae. This review article aims to delve into the known epidemiology of EB, highlight the disease's primary causative agents and their antimicrobial resistance spectrum.Materials and methods: A thorough literature search was conducted using Medline, EMBASE, JBI and PubMed to gather data on the microbial landscape of EB wounds. The focus was on identifying the most common bacteria associated with EB infections and assessing their antimicrobial resistance profiles.Results: The analysis revealed that Staphylococcus aureus is the most frequently identified bacterium in EB wounds, with a notable prevalence of methicillin-resistant strains (MRSA). Specific studies on mupirocin resistance further indicated rising rates of mupirocin-resistant Staphylococcus aureus, with one study reporting rates as high as 16.07%. Additionally, high resistance to other antibiotics, such as levofloxacin and trimethoprim/sulfamethoxazole, was observed in MRSA isolates.Conclusions: The findings highlight the critical need for regular resistance surveillance and the prudent use of mupirocin to manage infections effectively in EB. The multi-drug resistant nature of pathogens in EB presents a significant challenge in treatment, highlighting the importance of antimicrobial stewardship. Ultimately, given the sparse literature and the rarity of large-scale studies, further longitudinal research on the antimicrobial resistance profile of bacteria isolated from EB wounds is essential.
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Affiliation(s)
- Nikhila S Jayawardena
- Department of Dermatology, Sydney Children's Hospital, Randwick, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Orli Wargon
- Department of Dermatology, Sydney Children's Hospital, Randwick, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
| | - Artiene H Tatian
- Department of Dermatology, Sydney Children's Hospital, Randwick, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, Australia
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Abreu Molnar B, Levin L, Yun D, Morel K, Wiss K, Wieser J, Ward C, Trice H, Garcia-Romero MT, Stephenson A, Provost A, Price HN, Perman MJ, Moxon M, Moeves B, McCuaig CC, McCarthy C, Lucky AW, Levy ML, Lee M, Lara-Corrales I, Henner N, Halliburton N, Griffith E, Gorell E, Glick S, Eichenfield L, Collins C, Bruckner AL, Boulrice B, Bayliss S, Badger K, Paller AS. Inpatient management of epidermolysis bullosa: Consensus-based hands-on instructions for neonates and postneonates. J Am Acad Dermatol 2024; 91:290-299. [PMID: 38604489 DOI: 10.1016/j.jaad.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Epidermolysis bullosa (EB), characterized by skin fragility and blistering, often requires hospitalization. Training for inpatient management of EB is limited, with no unified recommendations available in North America. OBJECTIVE To develop consensus-derived best practices for hands-on inpatient management of EB in both the neonatal and postneonatal period. METHODS A modified Delphi method (expert-based input via 2 surveys and a final review) was implemented. Available guidelines from EB Clinical Research Consortium centers were analyzed to determine areas of focus and formulate statements to be voted on by EB Clinical Research Consortium members, experienced EB nurses, and select family members. Study participants evaluated statements using a Likert scale: statements with at least 70% agreement were accepted; statements with 30% or more disagreement were rejected. RESULTS Ten areas of focus were identified. Delphi participants included 15 dermatologists, 8 nurses, and 6 nonhealth care caregivers. Consensus was established on 103/119 neonatal statements and 105/122 postneonatal statements; no statements were rejected. Most recommendations applied to both age groups. LIMITATIONS Recommendations may require adjustment based on individual patient's clinical context. CONCLUSION Using the Delphi method, a consensus-derived resource for hospital-based health care professionals who manage patients with EB has been developed to improve the quality of inpatient care.
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Affiliation(s)
- Brenda Abreu Molnar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Dermatology, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura Levin
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Duri Yun
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kimberly Morel
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Julie Wieser
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Ward
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haley Trice
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Allison Stephenson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adrienne Provost
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Harper N Price
- Division of Dermatology, Children's Hospital, Phoenix, Arizona
| | - Marissa J Perman
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morgan Moxon
- Dell Medical School, University of Texas at Austin Dell Children's Medical Center, Austin, Texas
| | - Beth Moeves
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Christine McCarthy
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne W Lucky
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Moise L Levy
- Dell Medical School, University of Texas at Austin Dell Children's Medical Center, Austin, Texas
| | - Michelle Lee
- Division of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Henner
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nichole Halliburton
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily Griffith
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Gorell
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sharon Glick
- State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Lawrence Eichenfield
- University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Clara Collins
- Department of Dermatology, Columbia College of Physicians and Sumccrgeons, New York, New York
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Brenda Boulrice
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susan Bayliss
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Kellie Badger
- Division of Dermatology, Children's Hospital, Phoenix, Arizona
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Tabor A, LeQuang JAK, Pergolizzi J. Practical Tips on Epidermolysis Bullosa for Caregivers: Part 2. Cureus 2024; 16:e55499. [PMID: 38571870 PMCID: PMC10988563 DOI: 10.7759/cureus.55499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
The heritable condition epidermolysis bullosa (EB) is a rare but potentially devastating and life-threatening condition that is characterized primarily by cutaneous fragility, manifested when the dermis and epidermis fail to adhere properly. EB has no cure, and because of its rarity, few healthcare professionals have experience in treating it. Most families with an EB child are forced to rely on family caregiving which can be disruptive to family routines but, more importantly, place enormous time and emotional and financial burdens on the family. EB can be extremely painful, and families are often caught in the bind of trying to manage overwhelming financial burdens in an effort to help their children cope with excruciating pain. For many years, the nonprofit organization NoBabyBlisters.org has worked on five continents with families caring for EB children. Many of these families reside in under-developed nations with hot climates and limited healthcare resources. Over time, the healthcare professionals with NoBabyBlisters.org have worked with EB families both internationally and in the United States to develop a series of simple tips or "hacks" that may provide relief or great benefit to these children. The objective of this article is to share these field-tested tips with a wider audience. This is not a scientific study or a systematic review and is offered as a companion article to an earlier article on the same subject.
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Affiliation(s)
- Aaron Tabor
- Research, No Baby Blisters, Colorado Springs, USA
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Feinstein JA, Bruckner AL, Chastek B, Anderson A, Roman J. Clinical characteristics, healthcare use, and annual costs among patients with dystrophic epidermolysis bullosa. Orphanet J Rare Dis 2022; 17:367. [PMID: 36175960 PMCID: PMC9524120 DOI: 10.1186/s13023-022-02509-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dystrophic epidermolysis bullosa (DEB) is a serious, ultra-rare, genetic blistering disease that requires a multidisciplinary care team and lifelong, proactive disease management. To organize and optimize care, we comprehensively examined diagnoses, healthcare use, and annual costs in patients with DEB across all healthcare settings. Methods A retrospective study was performed using electronic health record (EHR) data from Optum Clinical Database (January 1, 2016, through June 30, 2020). Patients with an epidermolysis bullosa (EB) diagnosis between July 1, 2016, and December 31, 2019, with ≥ 6 months of baseline and 12 months of follow-up activity were included. Patients were stratified by EB type: recessive DEB (RDEB), dominant DEB (DDEB), DEB (type unknown), and EB unspecified. Demographics, comorbid conditions, and healthcare resource utilization were identified from EHR data. Cost of bandages and total medical costs (US$) were identified from linked claims data. Results A total of 412 patients were included, classified as having DDEB (n = 17), RDEB (n = 85), DEB (type unknown; n = 45), and EB unspecified (n = 265). Mean age was 38.4 years, and 41.7% had commercial insurance coverage. The most common comorbidities were mental health disorders, malnutrition, and constipation. Rates of cutaneous squamous cell carcinoma ranged from 0% (DDEB) to 4.4% (RDEB). Prescriptions included antibiotics (56.6%), pain medications (48.3%), and itch medications (50.7%). On average, patients had 19.7 ambulatory visits during the 12-month follow-up, 22.8% had an emergency department visit, and 23.8% had an inpatient stay. Direct medical costs among patients with claims data (n = 92) ranged from $22,179 for EB unspecified to $48,419 for DEB (type unknown). Conclusions This study demonstrated the range of comorbidities, multiple healthcare visits and prescription medications, and treatment costs during 1 year of follow-up for patients with DEB. The results underscore that the clinical and economic burden of DEB is substantial and primarily driven by supportive and palliative strategies to manage sequelae of this disease, highlighting the unmet need for treatments that instead directly address the underlying pathology of this disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02509-0.
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Affiliation(s)
- James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, 13123 E 16th Ave, B570, Aurora, CO, 80045, USA
| | | | - Amy Anderson
- Optum, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Juan Roman
- Krystal Biotech, 2100 Wharton Street, Suite 701, Pittsburgh, PA, 15203, USA.
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Asimakopoulou E, Andreou A, Patelarou A, Patelarou E, Sopjani I, Argyriadis A. Epidermolysis Bullosa: A case study in Cyprus and the nursing care plan. Int J Nurs Knowl 2022; 33:312-320. [PMID: 35302717 DOI: 10.1111/2047-3095.12364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To present a case study with Epidermolysis bullosa (EB) in Cyprus and to determine the nursing care plan, explaining the nursing interventions and showing the importance of nursing care of patients with EB. METHODS Literature review on EB and semi-structured interviews commenced through a direct discussion with open-ended questions to the research subject as well as to a close relative describing his feelings, experiences, and concerns about the disease. FINDINGS Thematic analysis approach was used to identify and analyze patterns in the data. Then, data were synthesized using the standardized nursing terminology of NANDA-I and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient. CONCLUSIONS Nurses should apply evidence-based practice interventions for EB wound care, pain management, nutrition, psychological and social support to these patients. IMPLICATIONS FOR NURSING PRACTICE Although EB is classified in the category of rare diseases, the presentation of a case study in Cyprus and the nursing care plan contribute further bibliographically to the holistic and at the same time individualized nursing practice.
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Affiliation(s)
| | - Aspasia Andreou
- Nursing Department, School of Health Sciences, Frederick University, Nicosia, Cyprus
| | - Athina Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Evridiki Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Crete, Greece
| | | | - Alexandros Argyriadis
- Nursing Department, School of Health Sciences, Frederick University, Nicosia, Cyprus
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Predominance of Staphylococcus correlates with wound burden and disease activity in dystrophic epidermolysis bullosa: a prospective case-control study. J Invest Dermatol 2022; 142:2117-2127.e8. [PMID: 35149000 DOI: 10.1016/j.jid.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 01/04/2023]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is characterized by skin blistering and wounds. To uncover changes in skin and mucosal microbiome related to age and disease progression, and microbiome impact on clinical and inflammatory laboratory parameters, swabs from wounded and unwounded skin, oral mucosa and stool samples of 28 children with RDEB and 28 healthy controls were subjected to 16S-rRNA gene sequencing. Skin microbiome of RDEB patients showed significantly reduced alpha diversity compared to healthy controls and early, age-dependent predominance of Staphylococcus aureus first in wounds, then in unwounded skin. These findings were more pronounced in severe disease with higher abundances of Staphylococcus aureus compared to intermediate disease. Staphylococcus aureus abundance correlated significantly with both acute and chronic wound burden. Changes in oral mucosal and gut microbiome were discrete with no significant differences in alpha diversity. Our findings show that children with RDEB experience skin microbiome changes early in life. Longitudinal studies should confirm that dysbiosis starts in wounds and later extends to unwounded skin. The predominance of Staphylococcus aureus significantly correlates with wound burden and disease activity, and to some extent with systemic inflammation.
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Alheggi A, Alzakry L, Khunayn R, Alshareef R, Al-Khalid Y. Skin cleansing and wound care practice in patients with epidermolysis bullosa: A cross-sectional study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elhage KG, St Claire K, Daveluy S. Acetic acid and the skin: a review of vinegar in dermatology. Int J Dermatol 2021; 61:804-811. [PMID: 34350993 DOI: 10.1111/ijd.15804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
Vinegar is commonly used as a home remedy for many skin problems. It is important for dermatologists to understand the evidence supporting its use in skin disease, as well as potential adverse effects, so they can properly counsel patients on the safe use of this widely available treatment. Vinegar possesses antimicrobial and antioxidant properties that provide utility in wound care as well as bacterial and fungal infections. There is also evidence to support its use in pruritus, head lice removal, and treatment of striae gravidarum. While generally safe, inappropriate use can result in damage to the skin. In this review, we discuss the evidence supporting vinegar as a treatment for skin disease, as well as adverse events reported from misuse, to provide dermatologists the knowledge to counsel patients on the safe and appropriate use of vinegar.
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Affiliation(s)
| | - Kayla St Claire
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven Daveluy
- Wayne State University School of Medicine, Detroit, MI, USA.,Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
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Tang JY, Marinkovich MP, Lucas E, Gorell E, Chiou A, Lu Y, Gillon J, Patel D, Rudin D. A systematic literature review of the disease burden in patients with recessive dystrophic epidermolysis bullosa. Orphanet J Rare Dis 2021; 16:175. [PMID: 33849616 PMCID: PMC8045359 DOI: 10.1186/s13023-021-01811-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVE Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic collagen disorder characterized by skin fragility leading to blistering, wounds, and scarring. There are currently no approved curative therapies. The objective of this manuscript is to provide a comprehensive literature review of the disease burden caused by RDEB. METHODS A systematic literature review was conducted in MEDLINE and Embase in accordance with PRISMA guidelines. Observational and interventional studies on the economic, clinical, or humanistic burden of RDEB were included. RESULTS Sixty-five studies were included in the review. Patients had considerable wound burden, with 60% reporting wounds covering more than 30% of their body. Increases in pain and itch were seen with larger wound size. Chronic wounds were larger and more painful than recurrent wounds. Commonly reported symptoms and complications included lesions and blistering, anemia, nail dystrophy and loss, milia, infections, musculoskeletal contractures, strictures or stenoses, constipation, malnutrition/nutritional problems, pseudosyndactyly, ocular manifestations, and dental caries. Many patients underwent esophageal dilation (29-74%; median dilations, 2-6) and gastrostomy tube placement (8-58%). In the severely affected population, risk of squamous cell carcinoma (SCC) was 76% and mortality from SCC reached 84% by age 40. Patients with RDEB experienced worsened quality of life (QOL), decreased functioning and social activities, and increased pain and itch when compared to other EB subtypes, other skin diseases, and the general population. Families of patients reported experiencing high rates of burden including financial burden (50-54%) and negative impact on private life (79%). Direct medical costs were high, though reported in few studies; annual payer-borne total medical costs in Ireland were $84,534 and annual patient-borne medical costs in Korea were $7392. Estimated annual US costs for wound dressings ranged from $4000 to $245,000. Patients spent considerable time changing dressings: often daily (13-54% of patients) with up to three hours per change (15-40%). CONCLUSION Patients with RDEB and their families/caregivers experience significant economic, humanistic, and clinical burden. Further research is needed to better understand the costs of disease, how the burden of disease changes over the patient lifetime and to better characterize QOL impact, and how RDEB compares with other chronic, debilitating disorders.
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Affiliation(s)
- Jean Yuh Tang
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - M Peter Marinkovich
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Eleanor Lucas
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Emily Gorell
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Albert Chiou
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Ying Lu
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Jodie Gillon
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA
| | - Dipen Patel
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Dan Rudin
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA.
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Levin LE, Shayegan LH, Lucky AW, Hook KP, Bruckner AL, Feinstein JA, Whittier S, Lauren CT, Pope E, Lara-Corrales I, Wiss K, McCuaig CC, Powell J, Eichenfield LF, Levy ML, Diaz L, Glick SA, Paller AS, Price HN, Browning JC, Morel KD. Characterization of wound microbes in epidermolysis bullosa: Results from the epidermolysis bullosa clinical characterization and outcomes database. Pediatr Dermatol 2021; 38:119-124. [PMID: 33247481 PMCID: PMC7906915 DOI: 10.1111/pde.14444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Patients with epidermolysis bullosa (EB) require care of wounds that are colonized or infected with bacteria. A subset of EB patients are at risk for squamous cell carcinoma, and bacterial-host interactions have been considered in this risk. The EB Clinical Characterization and Outcomes Database serves as a repository of information from EB patients at multiple centers in the United States and Canada. Access to this resource enabled broad-scale analysis of wound cultures. METHODS A retrospective analysis of 739 wound cultures from 158 patients from 13 centers between 2001 and 2018. RESULTS Of 152 patients with a positive culture, Staphylococcus aureus (SA) was recovered from 131 patients (86%), Pseudomonas aeruginosa (PA) from 56 (37%), and Streptococcus pyogenes (GAS) from 34 (22%). Sixty-eight percent of patients had cultures positive for methicillin-sensitive SA, and 47%, methicillin-resistant SA (18 patients had cultures that grew both methicillin-susceptible and methicillin-resistant SA at different points in time). Of 15 patients with SA-positive cultures with recorded mupirocin susceptibility testing, 11 had mupirocin-susceptible SA and 6 patients mupirocin-resistant SA (2 patients grew both mupirocin-susceptible and mupirocin-resistant SA). SCC was reported in 23 patients in the entire database, of whom 10 had documented wound cultures positive for SA, PA, and Proteus species in 90%, 50%, and 20% of cases, respectively. CONCLUSIONS SA and PA were the most commonly isolated bacteria from wounds. Methicillin resistance and mupirocin resistance were reported in 47% and 40% of patients tested, respectively, highlighting the importance of ongoing antimicrobial strategies to limit antibiotic resistance.
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Affiliation(s)
- Laura E Levin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leila H Shayegan
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Anne W Lucky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristen P Hook
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - James A Feinstein
- Departments of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan Whittier
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christine T Lauren
- Departments of Pediatrics and Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catherine C McCuaig
- Departments of Pediatrics and Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Julie Powell
- Department of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, University of California San Diego, San Diego, CA, USA
| | - Moise L Levy
- Departments of Pediatrics and Dermatology, Dell Children's Medical Center, Austin, TX, USA
| | - Lucia Diaz
- Department of Dermatology, Dell Children's Medical Center, Austin, TX, USA
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Amy S Paller
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, IL, USA
| | - Harper N Price
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - John C Browning
- Department of Dermatology, The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Kimberly D Morel
- Departments of Pediatrics and Dermatology, Columbia University Irving Medical Center, New York, NY, USA
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