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Abrha S, Tesfaye W, Thomas J. Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments. Antibiotics (Basel) 2020; 9:E909. [PMID: 33333955 PMCID: PMC7765423 DOI: 10.3390/antibiotics9120909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023] Open
Abstract
Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.
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Affiliation(s)
- Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
- Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle 7000, Ethiopia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
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Coombs GW, Mowlaboccus S, Daley D, Lee T, Pearson J, Pang S, Robinson JO. Sulfamethoxazole/trimethoprim resistance overcall by VITEK® 2 and BD Phoenix™ in community-associated MRSA and MSSA. J Antimicrob Chemother 2019; 74:3639-3641. [DOI: 10.1093/jac/dkz361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Denise Daley
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Terence Lee
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Julie Pearson
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James O Robinson
- Antimicrobial Resistance and Infectious Diseases Laboratory, School of Veterinary Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
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Davey RX, Tong SYC. The epidemiology of Staphylococcus aureus skin and soft tissue infection in the southern Barkly region of Australia's Northern Territory in 2017. Pathology 2019; 51:308-312. [PMID: 30819539 DOI: 10.1016/j.pathol.2018.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
The aim of this study was to describe the burden and organism antibiotic resistance patterns of skin and soft tissue infections (SSTI) due to Staphylococcus aureus presenting in a remote Australian Northern Territory community in the Barkly region. We collated reported antibiograms of all skin and superficial soft tissue swab specimens obtained from the town's Indigenous medical clinic from 12 of the 13 months between November 2016 and December 2017. Clinician's notes for the consultation associated with each test request were examined to determine the nature of the clinical problem and to access other relevant data. Amongst 309 tissue swab specimens, S. aureus was cultured in 215 (70%), of which 202 isolations were from Indigenous Australians. Of the 215 S. aureus, 98 [46%, 95% confidence interval (CI) 31-52] were methicillin resistant S. aureus (MRSA) and 117 (54%, 95% CI 48-61) sensitive (MSSA). Significant numbers were also resistant to other frequently used oral antibiotics, with resistance to erythromycin in 52 (24%), clindamycin in 51 (24%), trimethoprim in 22 (10%) and fusidic acid in eight (4%). In the Barkly region of Australia's NT in 2017, community-acquired staphylococcal SSTI needing professional care is equally likely to be caused by MRSA as by MSSA.
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Affiliation(s)
| | - Steven Y C Tong
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia; Menzies School of Health Research, Darwin, NT, Australia
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Cuningham W, McVernon J, Lydeamore MJ, Andrews RM, Carapetis J, Kearns T, Clucas D, Dhurrkay RG, Tong SYC, Campbell PT. High burden of infectious disease and antibiotic use in early life in Australian Aboriginal communities. Aust N Z J Public Health 2019; 43:149-155. [PMID: 30727032 DOI: 10.1111/1753-6405.12876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/01/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To quantify the childhood infectious disease burden and antibiotic use in the Northern Territory's East Arnhem region through synthesis and analysis of historical data resources. METHODS We combined primary health clinic data originally reported in three separate publications stemming from the East Arnhem Healthy Skin Project (Jan-01 to Sep-07). Common statistical techniques were used to explore the prevalence of infectious conditions and the seasonality of infections, and to measure rates of antibiotic use. RESULTS There was a high monthly prevalence of respiratory (mean: 32% [95% confidence interval (CI): 20%, 34%]) and skin (mean: 20% [95%CI: 19%, 22%]) infectious syndromes, with upper respiratory tract infections (mean: 29% [95%CI: 27%, 31%]) and skin sores (mean: 15% [95%CI: 14%, 17%]) the most common conditions. Antibiotics were frequently prescribed with 95% (95%CI: 91%, 97%) of children having received at least one antibiotic prescription by their first birthday, and 47% having received six antibiotic prescriptions; skin sores being a key driver. CONCLUSIONS Early life infections drive high antibiotic prescribing rates in remote Aboriginal communities. Implications for public health: Eliminating skin disease could reduce antibiotic use by almost 20% in children under five years of age in this population.
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Affiliation(s)
- Will Cuningham
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Jodie McVernon
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Michael J Lydeamore
- School of Mathematics and Statistics, The University of Melbourne, Victoria.,Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Australian Capital Territory
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia and Princess Margaret Hospital for Children, Western Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Danielle Clucas
- Clinical Haematology, The Alfred Hospital and Monash Medical Centre, Victoria
| | | | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria
| | - Patricia T Campbell
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Victoria.,Murdoch Children's Research Institute, The Royal Children's Hospital, Victoria
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Harris TM, Bowen AC, Holt DC, Sarovich DS, Stevens K, Currie BJ, Howden BP, Carapetis JR, Giffard PM, Tong SYC. Investigation of trimethoprim/sulfamethoxazole resistance in an emerging sequence type 5 methicillin-resistant Staphylococcus aureus clone reveals discrepant resistance reporting. Clin Microbiol Infect 2018; 24:1027-1029. [PMID: 29723570 DOI: 10.1016/j.cmi.2018.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/12/2018] [Accepted: 04/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- T M Harris
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - A C Bowen
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - D C Holt
- Menzies School of Health Research, Darwin, Northern Territory, Australia; School of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - D S Sarovich
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - K Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - B J Currie
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - B P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - J R Carapetis
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - P M Giffard
- Menzies School of Health Research, Darwin, Northern Territory, Australia; School of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - S Y C Tong
- Menzies School of Health Research, Darwin, Northern Territory, Australia; Victorian Infectious Disease Service, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection & Immunity, University of Melbourne, Melbourne, Victoria, Australia.
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D'Cunha NM, Peterson GM, Baby KE, Thomas J. Impetigo: A need for new therapies in a world of increasing antimicrobial resistance. J Clin Pharm Ther 2017; 43:150-153. [PMID: 29063621 DOI: 10.1111/jcpt.12639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Impetigo is a highly contagious bacterial skin infection and is one of the most common skin infections in children. Antibiotics are the first-line treatment when multiple lesions exist, but with an increasing prevalence of antibiotic-resistant bacteria the successful management of impetigo in the future is an area of concern. COMMENT Current treatment options that favour the use of oral antibiotic therapy are increasingly problematic. Widespread use of these agents contributes to antimicrobial resistance and has adverse consequences for individuals and communities. There is a need for new topical antimicrobials and antiseptics as an alternative treatment strategy. WHAT IS NEW AND CONCLUSION To successfully treat impetigo into the future and ensure that therapy does not contribute to bacterial resistance, additional research is required to ascertain the usefulness of alternative agents, including new topical antimicrobials and antiseptics.
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Affiliation(s)
- N M D'Cunha
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - G M Peterson
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
| | - K E Baby
- The Canberra Hospital, Yamba Drive, Garran, ACT, Australia
| | - J Thomas
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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