Characterization of wound microbes in epidermolysis bullosa: Results from the epidermolysis bullosa clinical characterization and outcomes database. Issue 1 (28th November 2020) - Levin, Laura E.
Abstract: Background/Objectives: Patients with epidermolysis bullosa (EB) require care of wounds that are colonized or infected with bacteria. A subset of EB patients are at risk for squamous cell carcinoma, and bacterial‐host interactions have been considered in this risk. The EB Clinical Characterization and Outcomes Database serves as a repository of information from EB patients at multiple centers in the United States and Canada. Access to this resource enabled broad‐scale analysis of wound cultures. Methods: A retrospective analysis of 739 wound cultures from 158 patients from 13 centers between 2001 and 2018. Results: Of 152 patients with a positive culture, Staphylococcus aureus (SA) was recovered from 131 patients (86%), Pseudomonas aeruginosa (PA) from 56 (37%), and Streptococcus pyogenes (GAS) from 34 (22%). Sixty‐eight percent of patients had cultures positive for methicillin‐sensitive SA, and 47%, methicillin‐resistant SA (18 patients had cultures that grew both methicillin‐susceptible and methicillin‐resistant SA at different points in time). Of 15 patients with SA‐positive cultures with recorded mupirocin susceptibility testing, 11 had mupirocin‐susceptible SA and 6 patients mupirocin‐resistant SA (2 patients grew both mupirocin‐susceptible and mupirocin‐resistant SA). SCC was reported in 23 patients in the entire database, of whom 10 had documented wound cultures positive for SA, PA, and Proteus species in 90%, 50%, and 20% of cases, respectively. Conclusions: SA and PA were the most commonly isolated bacteria from wounds. Methicillin resistance and mupirocin resistance were reported in 47% and 40% of patients tested, respectively, highlighting the importance of ongoing antimicrobial strategies to limit antibiotic resistance.