title: Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance.
abstract: BACKGROUND
  Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease.
  
  
  OBJECTIVE
  To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas.
  
  
  METHODS
  Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied.
  
  
  RESULTS
  Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous beta-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-beta-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole.
  
  
  CONCLUSIONS
  Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with beta-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that beta-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.
authors.affiliation: Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece. krasagak@med.uoc.gr
authors.forename: Konstantin
authors.initials: K
authors.lastname: Krasagakis
authors.forename: George
authors.initials: G
authors.lastname: Samonis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Maniatakis
authors.forename: Sophia
authors.initials: S
authors.lastname: Georgala
authors.forename: Androniki
authors.initials: A
authors.lastname: Tosca
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002444:Cefuroxime / Q000627:therapeutic use; D003023:Cloxacillin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004886:Erysipelas / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008712:Methicillin / Q000494:pharmacology / Q000627:therapeutic use; D016106:Methicillin Resistance; D008875:Middle Aged; D009428:Netilmicin / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D012867:Skin / Q000187:drug effects / Q000382:microbiology / Q000473:pathology*; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D009428:Netilmicin; D014640:Vancomycin; D002444:Cefuroxime; D003023:Cloxacillin; D008712:Methicillin