mupirocin and Epidermolysis-Bullosa

Dialkylcarbamoylchloride (DACC)-coated cotton acetate dressing works directly through hydrophobic interaction to reduce the number of bacteria without the risk of resistance. It is easy to use and therefore expected to improve patient's compliance. This study aimed to assess the clinical efficacy of DACC-coated cotton acetate dressing compared to a combination of normal saline dressing and 2% mupirocin ointment. A single-blind controlled trial was conducted and included 14 infected epidermolysis bullosa (EB) wounds which were divided into two groups. Group I received DACC-coated cotton acetate dressing, and Group II received the combination of normal saline dressing and 2% mupirocin ointment. Study results showed that the average time required for complete wound closure was 8.6 and 11.1 days in Groups I and II, respectively (p = .014), which was statistically significant. Both groups showed complete bacterial elimination on Day 3 based on negative Gram stain results and on Day 6 based on clearance of clinical manifestations (p = 1.000). This is a novel study in EB-infected wounds, which shows that DACC-coated cotton acetate dressing promotes faster wound closure and is as effective as the combination of normal saline dressing and 2% mupirocin ointment in eliminating bacterial infection.

Topics: Acetates; Administration, Topical; Adolescent; Adult; Anti-Infective Agents, Local; Child; Drug Therapy, Combination; Epidermolysis Bullosa; Female; Humans; Male; Mupirocin; Occlusive Dressings; Ointments; Risk Assessment; Saline Solution; Single-Blind Method; Wound Healing; Wound Infection; Young Adult

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.. A retrospective analysis of 739 wound cultures from 158 patients from 13 centers between 2001 and 2018.. 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.. 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.

Topics: Anti-Bacterial Agents; Canada; Epidermolysis Bullosa; Humans; Mupirocin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Cutaneous; Anti-Infective Agents; Child; Dermatitis, Atopic; Dermatologic Surgical Procedures; Diabetic Foot; Drug Resistance, Bacterial; Epidermolysis Bullosa; Humans; Impetigo; Mupirocin; Patient Compliance; Skin; Skin Diseases, Infectious

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Epidermolysis Bullosa; Female; Genital Diseases, Female; Humans; Middle Aged; Mupirocin; Skin; Tibia; Vulva

In a long-term, open study, 47 patients with epidermolysis bullosa were treated with topical 2% mupirocin (Bactroban) ointment to decrease bacterial infection and promote wound healing. This antibiotic is effective against gram-positive but not gram-negative organisms. No significant adverse effects were noted, although some patients have been treated for more than 4 years. We sought evidence in this patient population for the appearance of bacterial strains with decreased sensitivity to mupirocin. In five patients cultures from nonhealing wounds revealed Staphylococcus aureus resistance to mupirocin. Four of these patients were given oral antibiotics to which S. aureus was sensitive; they improved clinically, and cultures of their wounds became negative for pathogens.

Topics: Adult; Anti-Bacterial Agents; Child; Drug Resistance, Microbial; Epidermolysis Bullosa; Fatty Acids; Humans; Mupirocin; Ointments; Penicillin Resistance; Staphylococcal Skin Infections; Staphylococcus aureus; Time Factors; Wound Healing

Wound healing is reviewed in the context of the unique problems of the chronic ulcerating skin lesions associated with epidermolysis bullosa. Management approaches, including treatment of erosions with epidermal autografts, are considered.

Topics: Adolescent; Adult; Anemia; Anti-Bacterial Agents; Child; Child, Preschool; Epidermolysis Bullosa; Fatty Acids; Humans; Infant; Infant, Newborn; Middle Aged; Mupirocin; Nutritional Status; Skin Transplantation; Wound Healing

Cutaneous infections with Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa are major complications of epidermolysis bullosa. Application of impermeable occlusive dressings over denuded skin colonized with these bacteria results in rapid multiplication and the hazard of severe pyoderma. Approaches to the prophylactic treatment of these infections during the long-term management of epidermolysis bullosa are considered.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Epidermolysis Bullosa; Fatty Acids; Humans; Mupirocin; Occlusive Dressings; Pyoderma; Staphylococcal Skin Infections; Streptococcal Infections; Streptococcus pyogenes

A 36-year-old female patient with severe autosomal recessive dystrophic epidermolysis bullosa, who had spent her entire life from age 2 as an inpatient in the dermatology unit, recently died of metastatic squamous cell carcinoma of the skin. The development of malignancy was not prevented by continuous medical and nursing supervision and, despite early detection, rapidly led to her death. Oral phenytoin and topical mupirocin ointment had not reduced blistering.

Topics: Adult; Anti-Bacterial Agents; Carcinoma, Squamous Cell; Epidermolysis Bullosa; Fatty Acids; Female; Hand; Humans; Inpatients; Lung Neoplasms; Lymphatic Metastasis; Mupirocin; Phenytoin; Pleural Neoplasms; Skin Neoplasms

We have successfully treated chronic facial erosions in three boys with junctional epidermolysis bullosa. In each patient, keratinocytes were harvested from the roof of suction blisters created on clinically uninvolved skin. They were grown in tissue culture on collagen sponges and grafted onto facial erosions that were previously treated with 2% mupirocin ointment. This experimental antibiotic ointment has proved efficacy in eradicating cutaneous pathogens such as Staphylococcus aureus from chronic wounds. In two patients, complete reepithelialization was achieved over 7 and 10 months, respectively, and partial reepithelialization occurred in another patient in whom treatment is ongoing. Epidermal autografts are a promising means for improving function and appearance in eroded skin caused by junctional epidermolysis bullosa.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Culture Techniques; Epidermolysis Bullosa; Fatty Acids; Graft Survival; Humans; Male; Mupirocin; Skin; Skin Transplantation; Transplantation, Autologous