Gupta Aditya K, Wang Tong, Lincoln Sara A, Foreman Hui-Chen, Bakotic Wayne L
Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada.
Mediprobe Research Inc., London, ON N5X 2P1, Canada.
Infect Dis Rep. 2024 Nov 18;16(6):1075-1083. doi: 10.3390/idr16060087.
: Cutaneous infections of fungal and bacterial origins are common. An accurate diagnosis-especially concerning pathogens that are difficult to isolate on culture-can be achieved using molecular methods (PCR) with a short turnaround time. : We reviewed records of skin specimens (superficial scrapings) submitted by dermatologists across the United States with a clinically suspected dermatitis. As per physician's order, specimens were tested for infections either fungal (N = 4262) or bacterial (N = 1707) in origin. All unique specimens (one per patient) were subjected to real-time PCR assays where cases suspected of a fungal etiology were tested for dermatophytes, and , and cases suspected of a bacterial etiology were tested for , , and the gene potentially conferring β-lactam resistance. : Fungal agents were detected in 32.8% (SD: 4.5) of the submitted specimens, with most attributed to dermatophytes (19.3% (SD: 4.9)), followed by (8.7% (SD: 2.8)) and (2.9% (SD: 1.0)). Dermatophyte detection was more common in the elderly (≥65 years) compared to young adults (18-44 years) (OR: 1.8 (95% CI: 1.5, 2.2)), whereas was more commonly detected in younger age groups (12.1-13.6%) than the elderly (5.6%). was more frequently observed in females while dermatophytes and were more frequently observed in males. Approximately one quarter of the submitted skin specimens tested positive for (23.6% (SD: 3.4)), of which 34.4% (SD: 9.8) exhibited concurrent detection of the gene. An detection was more frequently observed in males (OR: 1.5 (95% CI: 1.2, 1.9)) and in children (OR: 1.7 (95% CI: 1.2, 2.5)). was rarely detected. Among specimens positive for dermatophytes, 12.0% (20/166) showed co-detection of and , which is in contrast to 6.8% (70/1023) detected in samples without a fungal co-detection and 6.2% (8/130) in samples positive for . : PCR testing, when available, can be valuable as a part of routine care for diagnosing patients with clinically suspected skin infections. Further studies are warranted to survey the prevalence of resistant isolates in dermatology outpatients, in particular with regard to the association with dermatophyte infections.
真菌和细菌引起的皮肤感染很常见。使用分子方法（PCR）可以在短时间内实现准确诊断，尤其是对于难以通过培养分离的病原体。
我们回顾了美国皮肤科医生提交的临床疑似皮炎的皮肤标本（浅表刮屑）记录。根据医生的指示，对标本进行真菌（N = 4262）或细菌（N = 1707）感染检测。所有独特的标本（每位患者一份）都进行了实时PCR检测，其中疑似真菌病因的病例检测皮肤癣菌、马拉色菌，疑似细菌病因的病例检测金黄色葡萄球菌、酿脓链球菌以及可能赋予β-内酰胺抗性的mecA基因。
在提交的标本中，32.8%（标准差：4.5）检测到真菌病原体，其中大多数归因于皮肤癣菌（19.3%（标准差：4.9）），其次是马拉色菌（8.7%（标准差：2.8））和念珠菌（2.9%（标准差：1.0））。与年轻人（18 - 44岁）相比，皮肤癣菌感染在老年人（≥65岁）中更常见（比值比：1.8（95%置信区间：1.5，2.2）），而马拉色菌在较年轻年龄组（12.1 - 13.6%）中比老年人（5.6%）更常见。念珠菌在女性中更常被观察到，而皮肤癣菌和金黄色葡萄球菌在男性中更常被观察到。大约四分之一的提交皮肤标本检测到金黄色葡萄球菌呈阳性（23.6%（标准差：3.4）），其中34.4%（标准差：9.8）同时检测到mecA基因。mecA基因的检测在男性（比值比：1.5（95%置信区间：1.2，1.9））和儿童（比值比：1.7（95%置信区间：1.2，2.5））中更常被观察到。酿脓链球菌很少被检测到。在皮肤癣菌阳性的标本中，12.0%（20/166）显示同时检测到金黄色葡萄球菌和酿脓链球菌，相比之下，在无真菌共检测的样本中为6.8%（70/1023），在念珠菌阳性样本中为6.2%（8/130）。
PCR检测在可用时，作为诊断临床疑似皮肤感染患者常规护理的一部分可能很有价值。有必要进行进一步研究以调查皮肤科门诊患者中耐甲氧西林金黄色葡萄球菌分离株的流行情况，特别是关于与皮肤癣菌感染的关联。
