Study finds high rates of antibiotic-resistant bacteria in EB wounds
Researchers say findings show need for vigilance on antibiotic use, guidance
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Wounds of people with epidermolysis bullosa (EB) are frequently colonized by antibiotic-resistant bacteria, which may contribute to poorer wound healing, according to a study from Australia.
The scientists said their study, the first of its kind done in Australia, “provides valuable descriptive data on microbial composition and resistance patterns of EB wound isolates in Australian clinical context.” The researchers said clinicians need to be vigilant in providing EB families with appropriate guidance on antibiotic use to prevent wound infections.
The study, “Characterisation of the wound microbiome and antimicrobial resistance profiles in clinical isolates from epidermolysis bullosa patients,” was published in the Orphanet Journal of Rare Diseases.
EB encompasses a group of disorders marked by unusually fragile skin that’s prone to blisters and poorly healing wounds. Bacterial infections in these wounds may contribute to poor healing. A few studies have identified wound-associated bacteria in people with EB in other countries, and the researchers in this study isolated bacteria from 15 wounds, mostly on the legs, in 10 EB patients.
“This study aimed to characterise, for the first time, the wound microbiome and [antibiotic resistance] profiles in ten Australian EB patients,” the researchers wrote. “Antimicrobial resistance is recognised [as] a contributing factor to delayed wound healing, persistent infection, and treatment failure in chronic wounds, including those associated with EB.”
Bacteria and inflammation
Participants ranged in age from 17 to 66. Four had junctional EB, three had EB simplex, and another three had dystrophic EB.
In addition to characterizing the microbiome (the composition of microbial species), the researchers isolated about two dozen bacterial species from the patients and tested them for resistance to several common antibiotics.
The scientists found that the most common type of bacteria in EB wounds belonged to a group called Staphylococcus. In particular, they noted a high prevalence of Staphylococcus aureus, a type that’s been associated with inflammation and poor wound healing.
“The predominance of Staphylococcus, particularly S. aureus, is clinically relevant in the context of EB wound infections given its known association with delayed healing, persistent inflammation and antibiotic resistance,” the researchers wrote.
Tests of antibiotic resistance showed that most (81.5%) of the isolated bacterial species were resistant to at least one antibiotic, with 22.2% showing resistance to more than one. Most commonly, bacterial were resistant to penicillin and amoxicillin (76.9%), followed by resistance to clindamycin (38.5%).
Genetic sequencing of a few strains revealed that these bacteria harbor several genes shown to help them fight antibiotics.
“These findings suggest that EB wounds may serve as reservoirs for resistance genes, particularly in chronic or recurrently infected wounds,” the scientists wrote.
The researchers stressed that their analysis was limited to data from a small number of patients, so caution is needed in interpreting the results. They also noted that this type of study needs to be extended to children.
Still, they said, the results underscore the importance of close monitoring to prevent wound infections in EB.
“Together, these findings suggest that stronger engagement within EB multidisciplinary teams regarding appropriate use of oral and topical antibiotics and dressings from birth onwards is required to decrease high levels of antimicrobial resistance in EB patients,” the scientists wrote.
