title: Spread of the epidemic European fusidic acid-resistant impetigo clone (EEFIC) in general practice patients in the south of The Netherlands.
abstract: OBJECTIVE
  We evaluated the susceptibility to fusidic acid, mupirocin and retapamulin of Staphylococcus aureus isolated from nasal and wound swabs.
  
  
  METHODS
  The susceptibility to the three agents of S. aureus isolated from general patients in the south of The Netherlands with a skin or soft tissue infection was determined between January 2007 and December 2008. Fusidic acid-resistant isolates were tested for the presence of fusidic acid-resistant genes and compared with the epidemic European fusidic acid-resistant impetigo clone (EEFIC).
  
  
  RESULTS
  Fusidic acid resistance was found in 23% of the nasal and 35% of the wound isolates, the majority (~90%) being fusB positive. Most of the isolates belonged to spa type t171 and were isolated from younger patients. One isolate was retapamulin resistant (MIC 8 mg/L) and two were mupirocin resistant.
  
  
  CONCLUSIONS
  The EEFIC clone was relatively highly prevalent among the isolated S. aureus. The usefulness of fusidic acid as first-line agent for the treatment of impetigo is questionable. As mupirocin is used in The Netherlands for eradication of methicillin-resistant S. aureus, it is not an alternative; retapamulin might be useful, but further in vivo studies are warranted.
authors.affiliation: Department of Medical Microbiology,  Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht,  The Netherlands.
authors.forename: M I A
authors.initials: MI
authors.lastname: Rijnders
authors.forename: P F G
authors.initials: PF
authors.lastname: Wolffs
authors.forename: R M
authors.initials: RM
authors.lastname: Hopstaken
authors.forename: M
authors.initials: M
authors.lastname: den Heyer
authors.forename: C A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: E E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D024881:Drug Resistance, Bacterial; D005260:Female; D005672:Fusidic Acid / Q000494:pharmacology*; D058006:General Practice; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D007169:Impetigo / Q000453:epidemiology* / Q000382:microbiology*; D007223:Infant; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D013205:Staphylococcal Protein A; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D013205:Staphylococcal Protein A; D005672:Fusidic Acid