[Carriage of Staphylococcus aureus. A severity factor of erysipelas?].
BACKGROUND
Occasional superinfection or co-infection with Staphylococcus aureus led us to search for S. aureus carriage prospectively in patients with non-necrotizing bacterial dermophypodermitis, in particular erysipelas.


METHODS
This prospective study included immunocompetent patients with bacterial dermophypodermitis without signs of toxicity or local manifestations suggesting necrotizing fasciitis. Bacteriology tests included: 1) direct immunofluorescence for streptococcus (groups A, C, G) on skin biopsies taken on day 0, 2) samples from the nasal orifices, the intergluteal fold, and potential skin portals for bacteriology culture, and 3) assay of antistreptolysine O and antistreptodornase B on day 0 and 15.


RESULTS
The study group included 42 patients (23 females, 19 males, mean age 64 +/- 3.5 yr). In 39 cases (93%) bacterial dermohypodermitis was located on the lower limb with a potential skin portal in 36 cases (86%). Sample culture, direct immunofluorescence or serology findings demonstrated presence of streptococci in 33 cases (79%). Nasal, intergluteal or potential portal were identified in 19 patients (45%) including 16 with demonstrated presence of streptococci. The rate of cure after oral pristinamycin did not vary significantly between carriers (79%) an non-carriers (91%) of Staphylococcus aureus. Drainage of a localized abscess was successful in 5 of 6 patients after initial failure of antibiotic treatment; 4 of them were carriers of S. aureus.


CONCLUSIONS
This prospective study demonstrated that cutaneous-mucosal carriage of Staphylococcus aureus is frequent in patients with non-necrotizing dermohypodermitis. This carriage is not a factor of over-morbidity as shown in this group of infections largely dominated by erysipelas.
Bernard
P
P
Service de Dermatologie, CHU Dupuytren, Limoges.
Risse
L
L
Mounier
M
M
Bonnetblanc
J M
JM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State; D004886:Erysipelas / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015575:Roxithromycin / Q000627:therapeutic use; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D015575:Roxithromycin
Portage de Staphylococcus aureus. Facteur de gravité de l'érysipèle?