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. 2023 Aug 2;78(8):2061-2065.
doi: 10.1093/jac/dkad204.

Persistence of the Staphylococcus aureus epidemic European fusidic acid-resistant impetigo clone (EEFIC) in Belgium

Ariane Deplano  1 , Marie Hallin  1   2 , Natalia Bustos Sierra  3 , Charlotte Michel  1 , Benoit Prevost  1 , Delphine Martiny  1 , Nicolas Yin  1
Affiliations

Persistence of the Staphylococcus aureus epidemic European fusidic acid-resistant impetigo clone (EEFIC) in Belgium

Ariane Deplano et al. J Antimicrob Chemother. .

Abstract

Objectives: In August 2018, a public health alert was issued in Belgium regarding clusters of impetigo cases caused by the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus. As a result, the Belgian national reference centre (NRC) was commissioned to update the epidemiology of S. aureus causing community-onset skin and soft tissues infection (CO-SSTI) to assess the proportion of EEFIC among them.

Methods: For 1 year, Belgian clinical laboratories were asked to send their first three S. aureus isolated from CO-SSTI each month. Isolates were tested for antimicrobial susceptibility to oxacillin, mupirocin and fusidic acid. Resistant isolates were also spa typed and tested for the presence of the genes encoding the Panton-Valentine leucocidin, the toxic shock syndrome toxin and the exfoliatins A and B. MLST clonal complexes were deduced from the spa types.

Results: Among the 518 S. aureus strains analysed, 487 (94.0%) were susceptible to oxacillin. Of these, 79 (16.2%) were resistant to fusidic acid, of which 38 (48.1%) belonged to the EEFIC. EEFIC isolates were mostly isolated from young patients with impetigo and showed a seasonal late summer peak.

Conclusions: These results suggest the persistence of EEFIC in Belgium. Furthermore, its prevalence may lead to reconsideration of the treatment guidelines for impetigo.

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Figures

Figure 1.
Figure 1.
Toxin gene detection and resistance to oxacillin and fusidic acid in the 518 S. aureus strains collected. CA: community-acquired; FA-S: fusidic acid susceptible. *One MSSA exhibited PVL and TSST-1 genes; one MSSA exhibited PVL genes and eta. **One MRSA exhibited PVL and TSST-1 genes.
See this image and copyright information in PMC

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