Evolving concepts and emerging solutions to the problem of staphylococcal infection in dermatology

Sergeev A.Y., Burtseva G.N., Sergeeva M.A.

Sechenov University, Moscow, Russia
Central Research Dermatology Clinic, Moscow, Russia

Staphylococci, being the resident members of human skin microbiome, are potent infectious agents and play a role as inflammatory triggers in chronic skin disease. New research on interactions between various staphylococci and other skin microorganisms, keratinocytes and cells of immune system have recently widened our views on pathophysiology of impetigo, atopic dermatitis, acne and other common skin pathology. Growing antimicrobial resistance of staphylococci and especially S. aureus towards most widely used antibiotics and antiseptics increases our awareness of potentially ineffective antimicrobial chemotherapy of skin and soft tissue infections, including secondary infection in atopic dermatitis.
Certain antimicrobials, actively prescribed in dermatology for decades, may leave clinical use due to common resistance of cutaneous microbes in modern population. Among modern antibiotics, recommended for treatment of impetigo in Russia and by international advisory bodies, are the topical compositions with fusidic acid. We have conducted a study, monitoring the antimicrobial resistance to common topical antimicrobials for cutaneous staphylococci from 930 patients mostly with chronic cutaneous conditions, from outpatient dermatology clinic during 2009-2019. In ten year period, over 90% of cutaneous isolates of staphylococci appeared sensitive to fusidic acid, with increase of antimicrobial resistance not exceeding 4% for the study period. The data presented reassure us in the placement of 2% cream and ointment with fusidic acid as first-line treatment for impetigo.