Krasagakis Konstantin, Samonis George, Maniatakis Panagiotis, Georgala Sophia, Tosca Androniki
Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece.
Dermatology. 2006;212(1):31-5. doi: 10.1159/000089019.
Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease.
To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas.
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.
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.
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.
丹毒是一种真皮和皮下组织的细菌感染，大多由链球菌引起。大疱性丹毒是该病的一种严重形式。
评估大疱性丹毒的临床和微生物学特征及治疗方法。
对1996年至2001年间在希腊克里特岛伊拉克利翁大学医院皮肤科接受治疗的大疱性丹毒患者进行回顾性研究。
对14例大疱性丹毒患者（11例女性，3例男性）进行了评估。9例和4例患者的皮损分别位于腿部和面部。入院前疾病的中位持续时间为4天。8例患者就诊时伴有发热。局部创伤和各种皮损是病原体侵入的常见原因。初始经验性抗生素治疗包括静脉注射β-内酰胺类药物，并根据分离菌株的敏感性进行调整。7例（50%）患者分离出金黄色葡萄球菌，另外3例患者的皮损中培养出沃纳葡萄球菌、化脓性链球菌和大肠杆菌。7株金黄色葡萄球菌中有6株对甲氧西林耐药（MRSA），但对喹诺酮类、万古霉素、利福平和甲氧苄啶/磺胺甲恶唑等其他几种非β-内酰胺类抗生素敏感。
我们的研究结果表明，金黄色葡萄球菌经常参与大疱性丹毒的复杂病程，可能与β-溶血性链球菌协同作用。MRSA分离的频率表明，β-内酰胺类抗生素可能不再足以治疗大疱性丹毒，至少在MRSA菌株高发地区如此。其他类抗生素对MRSA的充分覆盖作用必须在前瞻性临床试验中进行评估。
