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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(04): 616-620
DOI: 10.1055/s-0043-1768635
Brief Report

Profile of Cutaneous Bacterial Flora in Pemphigus Patients

Srujana Mohanty 
1   Department of Microbiology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Swarnatrisha Saha
1   Department of Microbiology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Shehnaz Firdaus
1   Department of Microbiology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Chandra Sekhar Sirka
2   Department of Dermatology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
› Author Affiliations Funding None.
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Abstract

Objectives Pemphigus, a group of autoimmune bullous diseases, can be fatal, resulting from overwhelming opportunistic infection of lesions secondary to cutaneous bacterial infections. This study aimed to look into the cutaneous bacterial infection profile of pemphigus patients as timely identification and appropriate treatment can play a major role in reducing mortality.

Materials and Methods Pus samples/swabs received from patients with pemphigus over a 2-year period from July 2018 to June 2020 were subjected to standard microbiological culture techniques and susceptibility testing. The frequency of isolation and susceptibility profile of the different bacterial pathogens toward various antimicrobial agents were interpreted and analyzed as per the Clinical and Laboratory Standards Institute's guidelines.

Results Samples from 315 patients were received during the study period comprising of 203 (64.4%) males and 112 (35.5%) females. Of 211 samples which were culture-positive, a total of 245 bacterial isolates were obtained, comprising of 158 Gram-positive cocci and 87 Gram-negative bacilli. Staphylococcus aureus (138, 56.3%) was the most common isolate followed by Pseudomonas aeruginosa (41, 16.7%) and Escherichia coli (16, 6.5%). Methicillin resistance was observed in 24.6% Staphylococcus aureus isolates and carbapenem resistance in 9.5 to 14.6% Gram-negative bacilli.

Conclusions Study findings emphasize the need for continuous monitoring of cutaneous pemphigus lesions for appropriate choice of antimicrobial therapy.

Keywords

methicillin-resistant S. aureus - MRSA - pemphigus - Staphylococcus aureus - susceptibility

Ethics Approval

The study obtained review exemption by the Institutional Ethics Committee (IEC) of our Institute, i.e., the Institutional Ethics Committee of All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. Reference number - T/IM-NF/Micro/20/123 dated 24.09.2020.


Authors' Contributions

• S.M. - provided substantial contribution to the concept and design of the study, acquisition, analysis, and interpretation of data for the work, did the literature search, and revised the work for important intellectual content. She is the corresponding author who gave the final approval for the manuscript to be published.


• S.S. - provided substantial contribution to the acquisition, analysis, and interpretation of data for the work, did the literature search, and drafted the initial manuscript.


• S.F. - provided substantial contribution to the acquisition, analysis, and interpretation of data for the work, did the literature search, and revised the work for important intellectual content.


• C.S.S. – was the treating physician and contributed to the acquisition, analysis, and interpretation of data for the study as well as critically revised the work for important intellectual content.


Note

Department and institution to which work should be credited-Department of Microbiology and Dermatology, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India.




Publication History

Received: 01 February 2023

Accepted: 29 March 2023

Article published online:
05 May 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Korman N. Pemphigus. J Am Acad Dermatol 1988; 18: 1219-1238
    CrossrefPubMedGoogle Scholar
  • 2 Didona D, Maglie R, Eming R, Hertl M. Pemphigus: current and future therapeutic strategies. Front Immunol 2019; 10: 1418
    CrossrefPubMedGoogle Scholar
  • 3 Kanwar AJ, De D. Pemphigus in India. Indian J Dermatol Venereol Leprol 2011; 77 (04) 439-449
    CrossrefPubMedGoogle Scholar
  • 4 Li F, Wu Y, Bian W. et al. Features and associated factors of bacterial skin infections in hospitalized patients with pemphigus: a single-center retrospective study. Ann Clin Microbiol Antimicrob 2020; 19 (01) 46
    CrossrefPubMedGoogle Scholar
  • 5 Qadim HH, Hasani A, Zinus BM, Orang NJ, Hasani A. Etiology of pyrexia in pemphigus patients: a dermatologist's enigma. Indian J Dermatol Venereol Leprol 2012; 78 (06) 774
    CrossrefPubMedGoogle Scholar
  • 6 Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A. eds. Mackie and McCartney Practical Medical Microbiology. 14th ed.. London: Churchill Livingstone; 1996: 131-145
    Google Scholar
  • 7 CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed.. CLSI Supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020
    Google Scholar
  • 8 European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and Zone Diameters, 2020, Version 10.0. Accessed April 12, 2023, at: http://www.eucast.org
    Google Scholar
  • 9 Ren Z, Narla S, Hsu DY, Silverberg JI. Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample. J Eur Acad Dermatol Venereol 2018; 32 (10) 1768-1776
    CrossrefPubMedGoogle Scholar
  • 10 Belgnaoui FZ, Senouci K, Chraibi H. et al. Predisposition to infection in patients with pemphigus. Retrospective study of 141 cases [in French]. Presse Med 2007; 36 (11 Pt 1): 1563-1569
    PubMedGoogle Scholar
  • 11 Esmaili N, Mortazavi H, Noormohammadpour P. et al. Pemphigus vulgaris and infections: a retrospective study on 155 patients. Autoimmune Dis 2013; 2013: 834295
    PubMedGoogle Scholar
  • 12 Kiran KC, Madhukara J, Abraham A, Muralidharan S. Cutaneous bacteriological profile in patients with pemphigus. Indian J Dermatol 2018; 63 (04) 301-304
    CrossrefPubMedGoogle Scholar
  • 13 Solanki RB, Shah YB, Shah AN, Jain V. Bacterial culture and sensitivity in pemphigus. Indian J Dermatol Venereol Leprol 1997; 63 (02) 89-90
    PubMedGoogle Scholar
  • 14 Ahmed AR, Moy R. Death in pemphigus. J Am Acad Dermatol 1982; 7 (02) 221-228
    CrossrefPubMedGoogle Scholar
  • 15 Asati DP, Sharma VK, Khandpur S, Khilnani GC, Kapil A. Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi. Indian J Dermatol Venereol Leprol 2011; 77 (02) 141-147
    CrossrefPubMedGoogle Scholar
  • 16 Agrawal SK, Panigrahy A, Perumalla S, Kapil A, Dhawan B. Microbiological profile and antibiotic resistance pattern of skin and soft-tissue infections: A study from Northern India. J Lab Physicians 2018; 10 (04) 471-472
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Motallebi M, Alibolandi Z, Aghmiyuni ZF, van Leeuwen WB, Sharif MR, Moniri R. Molecular analysis and the toxin, MSCRAMM, and biofilm genes of methicillin-resistant Staphylococcus aureus strains isolated from pemphigus wounds: a study based on SCCmec and dru typing. Infect Genet Evol 2021; 87: 104644
    CrossrefPubMedGoogle Scholar
  • 18 Silva-Costa C, Friães A, Ramirez M, Melo-Cristino J. Macrolide-resistant Streptococcus pyogenes: prevalence and treatment strategies. Expert Rev Anti Infect Ther 2015; 13 (05) 615-628
    CrossrefPubMedGoogle Scholar
  • 19 Tsai WC, Shen CF, Lin YL. et al. Emergence of macrolide-resistant Streptococcus pyogenes emm12 in southern Taiwan from 2000 to 2019. J Microbiol Immunol Infect 2021; 54 (06) 1086-1093
    CrossrefPubMedGoogle Scholar
  • 20 Del Giacomo P, Losito AR, Tumbarello M. The role of carbapenem-resistant pathogens in cSSTI and how to manage them. Curr Opin Infect Dis 2019; 32 (02) 113-122
    CrossrefPubMedGoogle Scholar
  • 21 Veeraraghavan B, Pragasam AK, Bakthavatchalam YD. et al. Newer β-Lactam/β-Lactamase inhibitor for multidrug-resistant gram-negative infections: challenges, implications and surveillance strategy for India. Indian J Med Microbiol 2018; 36 (03) 334-343
    CrossrefPubMedGoogle Scholar
  • 22 Bakthavatchalam YD, Routray A, Mane A. et al. In vitro activity of Ceftazidime-Avibactam and its comparators against Carbapenem resistant Enterobacterales collected across India: results from ATLAS surveillance 2018 to 2019. Diagn Microbiol Infect Dis 2022; 103 (01) 115652
    CrossrefPubMedGoogle Scholar
  • 23 Fröhlich C, Sørum V, Tokuriki N, Johnsen PJ, Samuelsen Ø. Evolution of β-lactamase-mediated cefiderocol resistance. J Antimicrob Chemother 2022; 77 (09) 2429-2436
    CrossrefPubMedGoogle Scholar