rifampin and Staphylococcal-Skin-Infections

Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS).

Topics: Anti-Bacterial Agents; Biofilms; Clindamycin; Corynebacterium Infections; Hidradenitis Suppurativa; Humans; Rifampin; Skin; Staphylococcal Skin Infections; Staphylococcus aureus; Staphylococcus epidermidis; Tetracycline

Eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonisation may prevent transmission of strains between patients and reduces the risk of clinical infection. Colonisation of the throat is associated with prolonged carriage and is more difficult to eradicate. An open randomised study was conducted to evaluate two eradication protocols. Patients with pharyngeal carriage of MRSA were enrolled at six Swedish centres during 4 years. One treatment group received oral rifampicin and either clindamycin or trimethoprim/sulfamethoxazole (SXT) for 7 days in combination with nasal mupirocin. Patients in the other group were treated with nasal mupirocin only. Patients in the same household were randomised together. Both groups followed a hygiene protocol including chlorhexidine washing. Cultures from the nares, perineum and throat were taken at baseline and then at 2 weeks, 2 months and 6 months after the end of treatment. A total of 28 patients received rifampicin-based systemic antibiotics and 24 subjects received mupirocin only. At follow-up 6 months after the end of treatment, 61% of patients and 50% of households in the systemic antibiotics group had culture results negative for MRSA. Significantly less patients (12%) and households (10%) became decolonised in the group receiving topical treatment only. A combination of rifampicin and either clindamycin or SXT was more effective in eliminating pharyngeal MRSA carriage compared with topical treatment with mupirocin only.

Topics: Administration, Oral; Administration, Topical; Chlorhexidine; Clindamycin; Drug Combinations; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Rifampin; Staphylococcal Skin Infections; Sulfamethizole; Trimethoprim

Rifampicin (RFP) is a potential treatment for canine multidrug-resistant (MDR) meticillin-resistant staphylococci (MRS), yet the use of lower doses based on recent MIC data has not been evaluated in vivo.. To provide information on the efficacy and safety of low-dose range RFP (≤6 mg/kg/day) for the treatment of canine MDR MRS pyoderma.. Fifty-one client-owned dogs.. Retrospective review of dogs medical records. Dogs were from 11 US dermatology referral practices and had oral RFP at ≤6 mg/kg/day. Data evaluated included response to treatment, adverse events, and serum changes in alanine aminotransferase (ALT) and alkaline phosphatase (ALP).. Complete resolution of pyoderma occurred in 39 of 51 dogs (76.5%). Topical antimicrobials were used concurrently in most cases (47 of 51; 92.2%). ALP elevation >1.5-fold of baseline or the high end of the reference range occurred in nine of 37 (24.3%) dogs, while ALT elevation above baseline and the high end of the reference range occurred in two of 36 (5.6%). Only six of 51 (11.8%) had clinical adverse events during treatment; five of six (83.3%) were mild reactions consisting of lethargy and gastrointestinal signs, while one dog had a possible cutaneous adverse drug reaction. Of those that experienced clinical adverse events, four of six (66.7%) did not have concurrent increased liver enzyme activity, while two of six (33.3%) had elevations in ALP alone.. Low-dose RFP (≤6 mg/kg/day) appears to be a relatively safe and effective single-agent systemic antibiotic in combination with topical antimicrobials for canine MDR MRS pyoderma.. La rifampicine (RFP) est un traitement potentiel des staphylocoques canins multirésistants (MDR) résistants à la méticilline (MRS), mais l'utilisation de doses plus faibles sur la base de données récentes sur la CMI n'a pas été évaluée in vivo. Hypothèse/Objectifs : Fournir des informations sur l'efficacité et l'innocuité des RFP à faible dose (≤ 6 mg/kg/jour) pour le traitement de la pyodermite MDR-MR canine. Animaux : Cinquante et un chiens de propriétaires. Matériels et méthodes : Revue rétrospective de chiens ayant reçu RFP par voie orale à des doses ≤ 6 mg/kg/jour provenant des dossiers médicaux de 11 centres de référés en dermatologie aux États-Unis. Les données évaluées comprenaient la réponse au traitement, les événements indésirables et les modifications sériques de l'alanine aminotransférase (ALT) et de la phosphatase alcaline (ALP). Résultats : Une résolution complète de la pyodermite s'est produite chez 39 des 51 chiens (76,5 %). Des antimicrobiens topiques ont été utilisés simultanément dans la plupart des cas (47 sur 51 ; 92,2 %). Une élévation de l'ALP> 1,5 fois la ligne de base ou l'extrémité supérieure de la plage de référence s'est produite chez neuf des 37 (24,3%) chiens, tandis qu'une élévation de l'ALT au-dessus de la ligne de base et de l'extrémité supérieure de la plage de référence s'est produite chez deux des 36 (5,6%). Seuls six sur 51 (11,8 %) ont eu des événements indésirables cliniques pendant le traitement ; cinq des six (83,3 %) étaient des réactions bénignes consistant en une léthargie et des signes gastro-intestinaux, tandis qu'un chien a eu un possible effet indésirable cutané au médicament. Parmi ceux qui ont subi des événements indésirables cliniques, quatre sur six (66,7 %) n'ont pas eu d'augmentation simultanée de l'activité des enzymes hépatiques, tandis que deux sur six (33,3 %) ont présenté des élévations de l'ALP seule. Conclusions et pertinence clinique : La RFP à faible dose (≤ 6 mg/kg/jour) semble être un antibiotique systémique à agent unique relativement sûr et efficace en association avec des antimicrobiens topiques pour la pyodermite MDR MRS canine.. Introducción- la rifampicina (RFP) es un tratamiento potencial para los estafilococos resistentes a múltiples fármacos (MDR) y meticilina (MRS), sin embargo, el uso de dosis más bajas basado en datos recientes de MIC no se ha evaluado in vivo. Hipótesis/Objetivos- Proporcionar información sobre la eficacia y seguridad de RFP en el rango de dosis bajas (≤6 mg/kg/día) para el tratamiento de la pioderma canina MDR MRS. Animales- Cincuenta y un perros propietarios particulares. Materiales y métodos- revisión retrospectiva de perros que recibieron RFP oral a dosis ≤6 mg/kg/día obtenida de historiales clínicos de 11 prácticas de referencia de dermatología de los Estados Unidos. Los datos evaluados incluyeron la respuesta al tratamiento, los eventos adversos y los cambios séricos en la alanina aminotransferasa (ALT) y la fosfatasa alcalina (ALP). Resultados- una resolución completa de la pioderma ocurrió en 39 de 51 perros (76,5 %). Antimicrobianos tópicos se usaron al mismo tiempo en la mayoría de los casos (47 de 51; 92,2%). En nueve de 37 (24,3 %) perros se produjo una elevación de ALP >1,5 veces respecto al valor inicial o el extremo superior del rango de referencia, mientras que en dos de 36 (5,6 %) se produjo una elevación de ALT por encima del valor inicial y en el límite superior del rango de referencia. Solo seis de 51 (11,8%) tuvieron eventos adversos clínicos durante el tratamiento; cinco de seis (83,3 %) fueron reacciones leves que consistieron en letargo y signos gastrointestinales, mientras que un perro tuvo una posible reacción cutánea adversa al medicamento. De los que experimentaron eventos adversos clínicos, cuatro de seis (66,7 %) no tuvieron un aumento simultáneo de la actividad de las enzimas hepáticas, mientras que dos de seis (33,3 %) tuvieron elevaciones en la ALP por sí sola. Conclusiones y relevancia clínica- la dosis baja de RFP (≤6 mg/kg/día) parece ser un antibiótico sistémico de uso único relativamente seguro y efectivo en combinación con antimicrobianos tópicos para la pioderma canina MDR MRS.. Hintergrund: Rifampicin (RFP) ist eine mögliche Behandlung für multi-resistente (MDR) Methicillin-resistente Staphylokokken (MRS) des Hundes, wobei allerdings der Einsatz niedrigerer Dosen basierend auf jüngsten MIC Daten bis jetzt noch nicht in vivo evaluiert wurden. Hypothese/Ziele: Informationen zu liefern in Bezug auf die Wirksamkeit und die Sicherheit von niedrig-dosiertem RFP (≤6 mg/kg/Tag) zur Behandlung der MDR MRS Pyodermie des Hundes. Tiere: Einundfünfzig Hunde in Privatbesitz Material und Methoden: Es handelt sich hierbei um eine retrospektive Review von Hunden, die RFP bei einer Dosierung von ≤6 mg/kg/Tag per os erhielten; diese wurden aus den Patientenkarteien von 11 dermatologischen Überweisungspraxen in den Vereinigten Staaten herausgesucht. Die Daten, die evaluiert wurden, betrafen Antwort auf die Behandlung, Nebenwirkungen, Serumveränderungen der Alanin Aminotransferase (ALT) und der alkalischen Phosphatase (ALP). Ergebnisse: Eine komplette Abheilung der Pyodermie erfolgte in 39 von 51 Hunden (76,5%). Topische antimikrobielle Substanzen wurden in den meisten Fällen (47 von 51; 92,2%) gleichzeitig angewendet. Eine ALP Erhöhung auf das 1,5-fache der Ausgangsbasis oder dem oberen Rand der Referenzwerte erfolgte in neun von 37 (24,3%) der Hunde während ALT Erhöhungen über den Ausgangswert und das obere Limit des Referenzwertes nur bei zwei von 36 (5,6%) Hunden auftrat. Nur sechs von 51 (11,8%) zeigten klinische Nebenwirkungen während der Behandlung; fünf von sechs (83,3%) zeigten milde Reaktionen, die aus Lethargie und gastrointestinalen Beschwerden bestanden, während ein Hund eine mögliche kutane Nebenwirkungsreaktion zeigte. Von jenen Hunden, die klinische Nebenwirkungen zeigten, hatten vier von sechs (66,7%) keine bleibenden erhöhten Leberwerte, während zwei von sechs (33,3%) nur eine erhöhte ALP zeigten. Schlussfolgerungen und klinische Bedeutung: RFP niedrig dosiert (≤6 mg/kg/Tag) in Kombination mit topischen antimikrobiellen Substanzen scheint eine relativ sichere und wirksame Methode zu sein, um mit einem einzigen Antibiotikum die MDR MRS Pyodermie des Hundes systemisch zu behandeln.. 背景- リファンピシン(RFP)は犬の多剤耐性(MDR)メチシリン耐性ブドウ球菌(MRS)に対する治療薬として期待されているが，最近のMICデータに基づく低用量の使用はin vivoでは評価されていない。 仮説/目的- 本研究の目的は、犬のMDR MRS膿皮症に対する低用量域RFP(≦6 mg/kg/day)の有効性および安全性に関する情報を提供することであった。 供試動物- オーナー所有犬 51 頭。 材料と方法- 米国11カ所の皮膚科紹介施設の診療記録から入手した、6mg/kg/day以下の用量のRFPを経口投与された犬の回顧的レビュー。評価したデータは、治療に対する反応、有害事象、アラニンアミノトランスフェラーゼ(ALT)およびアルカリホスファターゼ(ALP)の血清変化などである。 結果 51頭中39頭(76.5%)で膿皮症は完治した。ほとんどの症例で外用抗菌薬が併用された(51頭中47頭，92.2%)。ALPが基準値の1.5倍以上または基準値の上限を超えたのは37頭中9頭(24.3%)、ALTが基準値の上限を超えたのは36頭中2頭(5.6%)であった。臨床的有害事象は51頭中6頭(11.8%)に発現し，6頭中5頭(83.3%)が嗜眠や消化器症状からなる軽度の反応であり，1頭が皮膚の副作用の可能性があった。また，臨床的有害事象のうち，6頭中4頭(66.7%)は肝酵素活性の上昇を同時に認めず，6頭中2頭(33.3%)はALPのみの上昇を認めた。 結論と臨床的関連性 犬のMDR型MRS膿皮症に対する低用量RFP(≦6 mg/kg/day)は，外用抗菌薬との併用で比較的安全かつ有効な単剤全身用抗菌薬と思われた。.. 背景:利福平 (RFP) 是治疗犬多重耐药 (MDR) 耐甲氧西林葡萄球菌 (MRS) 的潜在药物，但基于最近的 MIC 数据，尚未评价在体内较低剂量的使用。 假设/目的:提供低剂量范围RFP(≤6 mg/kg/天)治疗犬 MDR MRS 脓皮病的疗效和安全性信息。 动物:51只私家犬。 材料和方法:回顾性审查接受剂量≤6 mg/kg/天 RFP 经口给药的犬，来自11家美国皮肤科转诊诊所的病历。评价的数据包括治疗效果、不良反应和血清丙氨酸氨基转移酶 (ALT) 和碱性磷酸酶 (ALP) 变化。 结果:51只犬中有39只 (76.5%) 的脓皮病完全消退。大多数病例同时使用外部抗菌剂 (47/51；92.2%)。37只犬中有9只 (24.3%) 发生 ALP 升高 > 1.5倍基线值或参考范围上限，而36只犬中有2只 (5.6%) 发生 ALT 升高高于基线值和参考范围上限。治疗期间，51只犬中仅6只 (11.8%) 发生临床不良反应；6只犬中的5只 (83.3%) 为轻度反应，包括嗜睡和胃肠道症状，而1只犬可能发生皮肤药物不良反应。在发生临床不良反应的犬中，6例中的4例 (66.7%) 未同时发生肝酶活性升高，而6例中的2例 (33.3%) 仅发生 ALP 升高。.. Contexto - A rifampicina (RFP) é um tratamento potencial para estafilococos resistentes à meticilina (MRS) multirresistentes (MDR) e a utilização de doses mais baixas baseado em dados recentes de MIC não foi avaliada in vivo. Hipótese/Objetivos: Fornecer informações sobre a eficácia e segurança de RFP em menor dosagem (≤6 mg/kg/dia) para o tratamento de piodermite canina por MRS MDR. Animais: Cinquenta e um cães de clientes. Materiais e métodos: Uma revisão retrospectiva dos prontuários de cães que receberam RFP oral na dose de ≤6 mg/kg/dia em 11 clínicas dermatológicas nos Estados Unidos. Os dados avaliados incluíram resposta ao tratamento, eventos adversos, alterações séricas de alanina aminotransferase (ALT) e fosfatase alcalina (FA). Resultados: Resolução completa da piodermite ocorreu em 39 de 51 dos cães (76,5%). Antimicrobianos tópicos foram utilizados concomitantemente na maioria dos casos (47 de 51; 92,2%). Elevação de mais de 1,5 vezes na FA ou para o limite superior do intervalo de referência ocorreu em nove de 37 cães (24,3%), enquanto a elevação de ALT acima do valor inicial e o limite superior do valor de referência ocorreu em dois de 36 (5,6%). Apenas cinco de 51 (11,8%) apresentaram efeitos adversos durante o tratamento; cinco de seis (83,3%) tiveram reações leves caracterizadas por letargia e sinais gastrointestinais, enquanto um cão apresentou uma possível farmacodermia. Dos que apresentaram eventos adversos, quatro de seis (66,7%) não apresentaram aumento concomitante de enzimas hepáticas, enquanto dois de seis (33,3%) tiveram aumento de FA isoladamente. Conclusões e relevância clínica - RFP em baixa dosagem (≤6 mg/kg/dia) aparenta ser relativamente segura e eficaz em monoterapia no tratamento da piodermite canina por MRS MDR por via sistêmica, associada a antimicrobianos tópicos.

Topics: Animals; Anti-Bacterial Agents; Dog Diseases; Dogs; Methicillin; Methicillin Resistance; Pyoderma; Retrospective Studies; Rifampin; Staphylococcal Skin Infections; Staphylococcus

To determine the frequency and antibiotic susceptibility pattern of CA-MRSA in patients with uncomplicated skin and soft tissue infections reporting to the dermatology outpatient of a tertiary health care hospital.. A descriptive study.. Dermatology outpatient of a tertiary care hospital in Punjab province of Pakistan, from September 2020 to August 2021.. Patients of all age groups and both genders reporting during the study period with community-associated uncomplicated bacterial skin and soft tissue infections were enrolled in the study. Samples were collected from skin lesions and cultured on blood agar and MacConkey agar plates. Antimicrobial susceptibility testing using the modified Kirby Baur disc diffusion technique was performed.. A total of 157 patients were included in the study. Impetigo was most common infection (n=80, 51%), followed by Furunculosis (n=47, 29.9%). The frequency of MRSA isolates was 54.1% (n=85). MRSA was significantly more frequently isolated from patients with furunculous, carbuncle and cutaneous abscesses as compared to impetigo. All MRSA isolates were sensitive to linezolid, teicoplanin, and vancomycin. 97.6%, 84.7%, and 72.9% of MRSA isolates were sensitive to rifampicin, minocycline, and fusidic acid respectively. 89.4% of MRSA were sensitive to amikacin and clindamycin. 63.5% were sensitive to doxycycline and 58.8% were sensitive to co-trimoxazole. Only 20% of MRSA were sensitive to ciprofloxacin.. The antibiotics active against CA-MRSA including rifampicin, minocycline, amikacin, and clindamycin may be used empirically in patients with furunculosis, cutaneous abscess, and carbuncles. Linezolid, teicoplanin, and vancomycin should be reserved for severe infections.. Uncomplicated skin and soft tissue infections, Community-associated Methicillin-resistant staphylococcus aureus (CA-MRSA), Antibiotic susceptibility pattern.

Topics: Agar; Amikacin; Animals; Anti-Bacterial Agents; Clindamycin; Community-Acquired Infections; Female; Furunculosis; Humans; Impetigo; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Minocycline; Rifampin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Teicoplanin; Vancomycin

Topics: Administration, Cutaneous; Animals; Anti-Bacterial Agents; Bacteriocins; Drug Resistance, Multiple, Bacterial; Drug Synergism; Drug Therapy, Combination; Female; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Recurrence; Rifampin; Staphylococcal Skin Infections; Staphylococcus; Treatment Outcome

Staphylococcus aureus can cause persistent infections and is known to develop persister cells in vitro. However, the in vivo significance of in vitro persisters in general is largely unclear. Here, we evaluated S. aureus stationary phase cultures and biofilm bacteria enriched in persister bacteria in comparison with actively growing log phase bacteria in terms of their ability to cause disease in a mouse skin infection model. We found that mice infected with the stationary phase and biofilm bacteria, which were enriched with persisters, produced more pronounced skin lesions that took longer to heal, and had more severe skin pathology and higher bacterial load than mice infected with log phase bacteria. Using our persistent infection mouse model, we showed that the clinically recommended treatment for recurrent S. aureus skin infection, doxycycline + rifampin, was not effective in eradicating the bacteria in mice. Analogous findings were observed in a Caenorhabditis elegans model, where stationary phase S. aureus caused greater virulence or mortality than log phase bacteria as early as two days post-infection. Our findings associate in vitro persisters and biofilm bacteria with more persistent and more severe infections and emphasize the importance of quality or metabolic status of the inoculum bacteria (persister bacteria versus growing bacteria) not just the number of bacteria in causing disease. The persistent infection mouse model we developed with persister inocula should have implications for understanding the process of disease establishment and pathogenesis, for developing persistent infection animal models, and for developing more effective treatments for chronic persistent infections in general.

Topics: Animals; Biofilms; Caenorhabditis elegans; Disease Models, Animal; Doxycycline; Female; Mice; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus

The aim of this study was to investigate the antibacterial activity of a synthetic aryl isonitrile compound (35) that was developed as part of a compound library to identify new antibacterial agents effective against methicillin-resistant Staphylococcus aureus (MRSA).. Compound 35 was evaluated against MRSA isolates by the broth microdilution assay and for toxicity to mammalian keratinocytes using the MTS assay. A multistep resistance selection assay was conducted to investigate MRSA resistance development to 35. A Caco-2 bidirectional permeability assay was employed to evaluate the ability of 35 to permeate across the gastrointestinal tract, and compound 35 was incubated with human liver microsomes to determine susceptibility to hepatic metabolism. Finally, compound 35 was evaluated in an uncomplicated MRSA skin infection mouse model and an MRSA neutropenic thigh infection mouse model.. Compound 35 inhibited the growth of MRSA clinical isolates at 2-4μM and was non-toxic to human keratinocytes. No resistance formation was observed with MRSA against compound 35 after 10 serial passages. In a murine skin wound model, compound 35 significantly reduced the burden of MRSA, similar to the antibiotic fusidic acid. Compound 35 exhibited a marked improvement both in permeability and stability to hepatic metabolism (half-life >11h) relative to the first-generation lead compound. In a neutropenic thigh infection mouse model, compound 35 successfully reduced the burden of MRSA in immunocompromised mice.. In summary, compound 35 was identified as a new lead aryl isonitrile compound that warrants further investigation as a novel antibacterial agent.

Topics: Animals; Anti-Bacterial Agents; Caco-2 Cells; Disease Models, Animal; Female; Fusidic Acid; Humans; Keratinocytes; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Microsomes, Liver; Nitriles; Rifampin; Skin; Staphylococcal Infections; Staphylococcal Skin Infections

Topics: Adolescent; Anti-Bacterial Agents; Carbuncle; Community-Acquired Infections; Humans; Intracranial Embolism; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pulmonary Embolism; Rifampin; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Periodic investigations into patterns of antimicrobial resistance can help to optimize the efficacy of treatment and limit the development of resistance.. The aim of this study was to update information on patterns of antimicrobial resistance in Staphylococcus aureus isolated from skin infections in South Korea.. We retrospectively analyzed clinical information and in vitro antimicrobial resistance data for 965 clinical S. aureus isolates obtained from skin infections during 2010-2013 in a university hospital in South Korea.. The rate of resistance to oxacillin (methicillin-resistant S. aureus [MRSA]) was 47.4%. Similar rates of resistance to erythromycin (45.6%), fusidic acid (44.0%), and clindamycin (42.3%) were noted. The rate of resistance to mupirocin was 8.4%. Overall, 4.9% of isolates were resistant to both fusidic acid and mupirocin. None of the isolates showed resistance to habekacin, synercid, teicoplanin, or vancomycin. Generally, antimicrobial resistance rates did not increase from 2010 to 2013 except with reference to a few agents such as mupirocin and rifampin. Isolates from surgical patients, inpatients, non-dermatology outpatients, and adult patients showed relatively high rates of resistance to multiple antimicrobials. Resistance to mupirocin was not only lower than that to fusidic acid but was consistent across clinical contexts.. The prevalence of MRSA in skin infections in South Korea did not increase during 2010-2013. Isolates from dermatology outpatients showed relatively lower rates of resistance to multiple antimicrobials than isolates from non-dermatology outpatients. Among topical antimicrobials, resistance to mupirocin was relatively low regardless of clinical condition.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Ciprofloxacin; Clindamycin; Dibekacin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Fusidic Acid; Gentamicins; Humans; Infant; Infant, Newborn; Ketolides; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Oxacillin; Republic of Korea; Retrospective Studies; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Teicoplanin; Tetracycline; Vancomycin; Virginiamycin; Young Adult

Skin and chronic wound infections caused by highly antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) are an increasing and urgent health problem worldwide, particularly with sharp increases in obesity and diabetes. New Zealand manuka honey has potent broad-spectrum antimicrobial activity, has been shown to inhibit the growth of MRSA strains, and bacteria resistant to this honey have not been obtainable in the laboratory. Combinational treatment of chronic wounds with manuka honey and common antibiotics may offer a wide range of advantages including synergistic enhancement of the antibacterial activity, reduction of the effective dose of the antibiotic, and reduction of the risk of antibiotic resistance. The aim of this study was to investigate the effect of Medihoney in combination with the widely used antibiotic rifampicin on S. aureus. Using checkerboard microdilution assays, time-kill curve experiments and agar diffusion assays, we show a synergism between Medihoney and rifampicin against MRSA and clinical isolates of S. aureus. Furthermore, the Medihoney/rifampicin combination stopped the appearance of rifampicin-resistant S. aureus in vitro. Methylglyoxal (MGO), believed to be the major antibacterial compound in manuka honey, did not act synergistically with rifampicin and is therefore not the sole factor responsible for the synergistic effect of manuka honey with rifampicin. Our findings support the idea that a combination of honey and antibiotics may be an effective new antimicrobial therapy for chronic wound infections.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Drug Synergism; Leptospermum; Methicillin-Resistant Staphylococcus aureus; Plant Extracts; Rifampin; Risk; Staphylococcal Skin Infections

Methicillin-resistant Staphylococcus aureus (MRSA) has a high prevalence in Emergency Departments (EDs). The objective of this study was to determine the ability of emergency physicians to predict MRSA infection in purulent wounds. A prospective observational study was conducted in an urban, tertiary academic center in ED patients presenting with purulent wounds and abscesses that received wound culture. Physicians completed a questionnaire with patient demographic data and their own suspicion for MRSA infection in eligible patients. For emergency physician ability to predict positive culture for MRSA, sensitivities, specificities, and positive and negative likelihood ratios (LRs) were calculated. Risk factors were assessed for statistical significance using a chi-squared test with p < 0.05. There were 176 patients enrolled, and 19 were eliminated for incomplete data. Physician suspicion of MRSA had a sensitivity of 80% (95% confidence interval [CI] 71%-87%) and a specificity of 23.6% (95% CI 14%-37%) for the presence of MRSA on wound culture with a positive LR of 1.0 (95% CI 0.9-1.3) and a negative LR of 0.8 (95% CI 0.5-1.3). Prevalence was 64%. Only intravenous drug use was significantly associated with MRSA. Emergency physician's suspicion of MRSA infection is a poor predictor of MRSA infection.

Topics: Anti-Infective Agents; Emergency Service, Hospital; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Prospective Studies; Rifampin; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

This study addressed the efficacy of daptomycin, vancomycin, rifampicin, daptomycin/rifampicin and vancomycin/rifampicin against a polysaccharide intercellular adhesin (PIA)-dependent and -independent Staphylococcus epidermidis biofilm using flow cell and guinea pig tissue cage models.. The flow cell model of both PIA-dependent and -independent biofilms demonstrated that the viable cell count after treatment with daptomycin/rifampicin was significantly lower (P<0.05) than after treatment with vancomycin, vancomycin/rifampicin, daptomycin or rifampicin alone. To validate these observations, a guinea pig tissue cage model was used. The results demonstrated that the addition of rifampicin to daptomycin or vancomycin sterilized 5/6 tissues cages colonized with S. epidermidis 1457 (PIA producing). Similar results were noted with S. epidermidis 1457 icaADBC::dhfr (non-PIA producing), where daptomycin/rifampicin and vancomycin/rifampicin sterilized 5/6 and 6/6 tissue cages, respectively. There was no statistical difference in comparison with the no-treatment control when both 1457 and 1457 icaADBC::dhfr were treated with vancomycin and daptomycin alone. Furthermore, treatment with rifampicin alone sterilized 5/6 and 3/6 1457 and 1457 icaADBC::dhfr tissue cages, respectively.. Interpretation of these data suggests that rifampicin is highly active against S. epidermidis biofilms and both vancomycin and daptomycin are effective at reducing the subpopulation of bacteria that develop rifampicin resistance.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Daptomycin; Disease Models, Animal; Drug Synergism; Guinea Pigs; Microbial Sensitivity Tests; Polysaccharides, Bacterial; Rifampin; Staphylococcal Skin Infections; Staphylococcus epidermidis; Vancomycin; Virulence Factors

The potential for reutericyclin derivatives to be used as topical antibiotics to treat staphylococcal skin infections was investigated. All reutericyclins inhibited the growth of clinical isolates of drug-resistant Staphylococcus aureus. Unlike the standard topical agent mupirocin, most reutericyclin derivatives eradicated staphylococcal biofilms. Moreover, two compounds formulated in hydrophilic petrolatum (10%, wt/wt) were efficacious in treating S. aureus superficial skin infections in mice. These data exemplify the prospect of developing reutericyclins as new topical antibiotics.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Cell Line; Fibroblasts; Humans; Male; Mice; Pyrrolidinones; Staphylococcal Skin Infections; Tenuazonic Acid

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTI) have become increasingly common. This study's objectives were to describe the clinical spectrum of MRSA in a community health center and to determine whether the use of specific antimicrobials correlated with increased probability of clinical resolution of SSTI. A retrospective chart review of 399 sequential cases of culture-confirmed S. aureus SSTI, including 227 cases of MRSA SSTI, among outpatients at Fenway Community Health (Boston, MA) from 1998 to 2005 was done. The proportion of S. aureus SSTI due to MRSA increased significantly from 1998 to 2005 (P<0.0001). Resistance to clindamycin was common (48.2% of isolates). At the beginning of the study period, most patients with MRSA SSTI empirically treated with antibiotics received a beta-lactam, whereas by 2005, 76% received trimethoprim-sulfamethoxazole (TMP-SMX) (P<0.0001). Initially, few MRSA isolates were sensitive to the empirical antibiotic, but 77% were susceptible by 2005 (P<0.0001). A significantly higher percentage of patients with MRSA isolates had clinical resolution on the empirical antibiotic by 2005 (P=0.037). Use of an empirical antibiotic to which the clinical isolate was sensitive was associated with increased odds of clinical resolution on empirical therapy (odds ratio=5.91), controlling for incision and drainage and HIV status. MRSA now accounts for the majority of SSTI due to S. aureus at Fenway, and improved rates of clinical resolution on empirical antibiotic therapy have paralleled increasing use of empirical TMP-SMX for these infections. TMP-SMX appears to be an appropriate empirical antibiotic for suspected MRSA SSTI, especially where clindamycin resistance is common.

Topics: Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Boston; Female; HIV Infections; Humans; Male; Methicillin Resistance; Middle Aged; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome

There are increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in horses and evidence that MRSA can be transmitted between horses and humans. The objective of this study was to investigate reports of skin infection in personnel working with a foal with community-associated MRSA colonization and subsequent infection. Clinical diagnostic specimens were collected from individuals reporting skin lesions following contact with the affected foal. Nasal and groin screening swabs were collected from other veterinary personnel that attended a voluntary screening clinic. MRSA skin infections were identified in three neonatal intensive care unit personnel. Nasal colonization was subsequently identified in 10/103 (9.7%) other veterinary hospital personnel. Isolates were indistinguishable by pulsed field gel electrophoresis, classified as Canadian epidemic MRSA-5, possessed SCCmecIV, were negative for the Panton-Valentine leukocidin and were multidrug resistant. Transmission to veterinary personnel despite short-term contact with standard protective barriers highlights the potential importance of MRSA as an emerging zoonotic pathogen, and indicates that further evaluation of interspecies transmission of MRSA and means to prevent zoonotic infection are required.

Topics: Adult; Animals; Animals, Newborn; Community-Acquired Infections; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Fusidic Acid; Horse Diseases; Horses; Hospitals, Animal; Humans; Methicillin Resistance; Mupirocin; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Zoonoses

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state.. Quasi-experimental study.. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005.. The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily (depending on the body weight) for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures.. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 (57.5%), while in group II the carrier state was found in 8 (20%) individuals (p<0.001). Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive (p<0.001). These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection.. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection.

Topics: Adolescent; Adult; Carrier State; Female; Furunculosis; Humans; Male; Middle Aged; Nose; Recurrence; Rifampin; Staphylococcal Skin Infections

A 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. Ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. A puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of Staphylococcus aureus. Antimicrobial susceptibility testing by disk diffusion showed resistant to cefalotin, erythromycin and clindamycin, and susceptibility to trimethoprim-sulfamethoxazole, ciprofloxacin and rifampicin. Methicilin-resistance was confirmed by Staphyslide agglutination testing (Biomérieux). The patient was treated with ciprofloxacin and rifampicin during four weeks, with a good clinical response. The frequency of CA-MRSA infections is increasing, and these are reported in patients without identified predisposing risks leading to failure on empiric therapy for community infections presumed to be due to staphylococcal agents.

Topics: Abscess; Adult; Anti-Infective Agents; Ciprofloxacin; Community-Acquired Infections; Humans; Male; Methicillin Resistance; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotics, Antitubercular; Community-Acquired Infections; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Triclosan; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Disinfection; Drug Resistance, Multiple; Family Health; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 47-year-old woman presented with erythematous lesions with papules and pustules on her parieto-occipital region that had been present for 8 months. Areas of sclero-atrophic alopecia were evident, whereas at different points tufted hair shafts were coming out from single dilatated follicular ostia. Before our observation, an antibiotic oral therapy with tetracyclines and local with erythromycin had been administered to the patient, with partial improvement and relapse on its suspension.. Bacterial culture from pustules showed the development of Staphylococcus aureus. A skin biopsy was done. According to clinical and histopathological findings a diagnosis of tufted hair folliculitis was made and a treatment with oral rifampicin was started at the dosage of 450 mg twice per day.. After 3 weeks of therapy, the pustular lesions regressed completely and after a follow-up of 1 year no relapse was observed.. Rifampicin is one of the best active antibiotics against S. aureus, which seems to play a role in the pathogenesis of tufted hair folliculitis. Our results, if further confirmed, may suggest a role for rifampicin either for the control of the pustular phase of this rare disorder or to prevent its relapses for a long time.

Topics: Anti-Bacterial Agents; Female; Folliculitis; Humans; Middle Aged; Rifampin; Scalp Dermatoses; Staphylococcal Skin Infections

Bacteria that adhere to implanted medical devices play an important role in industry and in modern medicine. Staphylococci are among the most common pathogens that cause biomaterial infections. Vascular prosthetic graft infection is one of the most feared complications that the vascular surgeon treats, frequently resulting in prolonged hospitalization, organ failure, amputation, and death. A rat model was used to investigate the topical efficacies of temporin A and the quorum-sensing inhibitor RNAIII-inhibiting protein (RIP) as prophylactic agents of vascular prosthetic graft infections caused by Staphylococcus aureus and Staphylococcus epidermidis with intermediate resistance to glycopeptides.. Graft infections were established in the back subcutaneous tissue of adult male Wistar rats by implantation of Dacron prostheses 1 cm2 followed by topical inoculation with 2x10(7) colony-forming units of bacterial strains. The study included, for each staphylococcal strain, a control group (no graft contamination), a contaminated group that did not receive antibiotic prophylaxis, and 6 contaminated groups that received grafts soaked with temporin A, RIP, rifampin, temporin A plus RIP, RIP plus rifampin, or temporin A plus RIP. The infection was evaluated by quantitative agar culture. When tested alone, temporin A and RIP showed comparable efficacies, and their efficacies were significantly higher than that of rifampin against both strains. All combinations showed efficacies significantly higher than that of each single compound. The combinations of temporin A and RIP exerted the strongest antistaphylococcal efficacies, eliminating infection by 100%.. The results of the present study make these molecules potentially useful for antimicrobial chemoprophylaxis in vascular surgery.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Drug Therapy, Combination; Glycopeptides; Implants, Experimental; Male; Microbial Sensitivity Tests; Oligopeptides; Polyethylene Terephthalates; Proteins; Rats; Rats, Wistar; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Staphylococcus epidermidis; Subcutaneous Tissue; Treatment Outcome; Vancomycin; Vancomycin Resistance

Fifty-six S. aureus episodes of catheter exit-site tunnel infections were diagnosed in 40 out of 163 patients treated by CAPD for 30 +/- 22 months, with standard double-cuff Tenckhoff catheters. The rate of infection was 1 episode every 29 patient/months. Local care and antibiotic therapy were effective in 52% of the cases. Whereas in 29 episodes in which the medical therapy failed to eradicate the infection the entire area of granulation tissue and cellulitis was excised then the outer dacron cuff was shaved from the silicone catheter. With this treatment 13 episodes (48%) were cured while, in the remaining 14 patients the catheters were removed because of peritonitis in 10; and for failure to eradicate the infection in 4.

Topics: Catheters, Indwelling; Debridement; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Rifampin; Staphylococcal Skin Infections; Vancomycin