Staphylococcus aureus Carriage in Hidradenitis Suppurativa: Impact on Response to Adalimumab

Dermatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Dimitra Stergianou ◽  
Vassiliki Tzanetakou ◽  
Maria Argyropoulou ◽  
Theodora Kanni ◽  
Pantelis G. Bagos ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Response ◽  
Odds Ratio ◽  
Hidradenitis Suppurativa ◽  
Positive Culture ◽  
Nasal Carriage ◽  
Loss Of Response ◽  
Response Score ◽  
Stimulation Of

<b><i>Background:</i></b> Several patients with hidradenitis suppurativa (HS) present flare-ups during treatment with adalimumab (ADA), the cause of which is not clear. ADA is the only FDA-approved biologic for the therapy of moderate-to-severe HS. A previous study of our group has shown that <i>Staphylococcus aureus</i> stimulation of whole blood affects the production of human β-defensin 2 and modulates HS severity. It is, therefore, hypothesized, that carriage of <i>S. aureus</i> may drive HS flare-ups. <b><i>Objective:</i></b> To explore the association between carriage of <i>S. aureus</i> and loss of response to ADA. <b><i>Patients and Methods:</i></b> Among patients with moderate-to-severe HS without carriage of <i>S. aureus</i> at start of treatment with ADA, we investigated for carriage of <i>S. aureus</i> from the nares when flare-ups occurred. Flare-ups were pre-defined as at least 25% increase of inflammatory lesions (sum of inflammatory nodules and abscesses) from baseline. Samplings were also done after completion of 12 weeks of ADA treatment from all patients who did not present flare-ups. Clinical response to ADA was assessed by the HS Clinical Response score (HiSCR). <b><i>Results:</i></b> Thirty-nine patients were studied; 24 with Hurley II stage HS and 15 with Hurley III stage HS. Twenty-nine patients achieved HiSCR after 12 weeks of treatment without any flare-ups; 10 patients had flare-ups and failed HiSCR. Three (10.3%) and 5 (50%) patients, respectively, had nasal carriage of <i>S. aureus</i> (odds ratio 8.67; 95% CI 1.54–48.49; <i>p</i> = 0.014). Among 32 patients reaching follow-up week 48, 20 patients achieved HiSCR and 12 had flare-ups leading to ADA failure; 2 (10%) and 5 (41.7%) patients, respectively, had positive culture for <i>S. aureus</i> (odds ratio 6.42; 95% CI 1.00–41.20; <i>p</i> = 0.05). <b><i>Conclusion:</i></b> Nasal carriage of <i>S. aureus</i> may be associated with loss of response to ADA. Findings need confirmation in larger series of patients.

scholarly journals Amoxicillin-Clavulanate Therapy Increases Childhood Nasal Colonization by Methicillin-Susceptible Staphylococcus aureus Strains Producing High Levels of Penicillinase

2004 ◽  
Vol 48 (12) ◽  
pp. 4618-4623 ◽  
Author(s):  
Didier Guillemot ◽  
Stephane Bonacorsi ◽  
John S. Blanchard ◽  
Philippe Weber ◽  
Sylvie Simon ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Odds Ratio ◽  
Selection Process ◽  
Nasal Carriage ◽  
Penicillin G ◽  
Nasal Colonization ◽  
Factors Associated ◽  
Amoxicillin Clavulanate ◽  
Resistant Strains

ABSTRACT We examined factors associated with penicillinase production by nasal carriage Staphylococcus aureus strains in 648 children aged 3 to 6 years attending 20 randomly sampled playschools. The children were prospectively monitored for drug use and medical events for 6 months and were then screened for S. aureus carriage. Isolates were tested for their susceptibility to penicillin G and methicillin, and penicillinase production by methicillin-susceptible, penicillin-resistant strains was quantified. S. aureus was isolated from 166 children (25.6%). Exposure to amoxicillin-clavulanate during the previous 3 months was associated with higher penicillinase production by penicillin-resistant, methicillin-susceptible strains (odds ratio, 3.6; P = 0.03). These results suggest that use of the amoxicillin-clavulanate combination could induce a herd selection process of S. aureus strains producing higher levels of penicillinase.

scholarly journals Nasal Carriage and Methicillin Resistance of Staphylococcus Aureus Among Schoolchildren in Sana’a City, Yemen

2020 ◽  
Author(s):  
Arwa Mohammed Othman ◽  
Belques Sharaf Al-Huraibi ◽  
Rowa Mohammed Assayaghi ◽  
Huda Zaid Al-Shami
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Admission ◽  
Methicillin Resistance ◽  
Positive Culture ◽  
Nasal Carriage ◽  
Cross Sectional Study ◽  
High Morbidity ◽  
Carriage Rate ◽  
Cross Sectional ◽  
Nasal Swabs

Abstract Background: Staphylococcus aureus (S. aureus) is a frequent cause of serious health problems with high morbidity and mortality. The risk of S. aureus infections is increased with the emergence of methicillin-resistant S. aureus (MRSA). The aim of this study is to determine the nasal carriage rate of both S. aureus and MRSA among schoolchildren in Sana’a city.Methods: This is a cross-sectional study conducted from January 2018 to May 2020. Five hundred and eighty eight students were enrolled. Nasal swabs were collected from each student for culturing and methicillin susceptibility testing. Results: Out 588 nasal swab, 536 yielded bacterial growth. Students with positive culture were 271(51%) males and 265(49%) females. Their age ranged from 5 to 19 years old with mean age and standard deviation equaled to 13.3±3.5 years. S. aureus was isolated from 129 (24%) students whereas the overall prevalence of MRSA was 8(1.5%). S. aureus was significantly recovered from students at age group 10-14 years (χ2 = 7.02, p = 0.03), females than males (OR= 1.96, χ2 = 10.75, p = 0.001), and students who were admitted into hospitals (OR= 1.6, χ2 = 4.89, p = 0.03). Nevertheless, there were no significant differences between MRSA carriage and students’ age (χ2 = 2.3, p = 0.32), gender (OR= 1.02, χ2 = 0.001, p = 0.63), and hospital admission (OR= 1.4, χ2 = 0.25, p = 0.62). Conclusions: The prevalence of MRSA is low among schoolchildren in Sana’a city. Age, gender and previous hospital admission were statistically associated with nasal carriage of S. aureus but not MRSA nasal carriage.

No evident association of nasal carriage of Staphylococcus aureus or its small-colony variants with cotrimoxazole use or ANCA-associated vasculitis relapses

Rheumatology ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Boun Kim Tan ◽  
Yoann Crabol ◽  
Jason Tasse ◽  
Frédéric Laurent ◽  
Narimane Nekkab ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Microscopic Polyangiitis ◽  
Nasal Carriage ◽  
Small Colony Variant ◽  
Anca Associated Vasculitis ◽  
Small Colony ◽  
Relapse Rates

AbstractObjectiveTo identify the role of Staphylococcus aureus (SA) or its intracellular small-colony variant phenotype (SCV) with co-trimoxazole (CTX) or ANCA-associated vasculitis (AAV) activity.MethodsAll consecutive AAV patients with granulomatosis with polyangiitis (GPA), eosinophilic GPA or microscopic polyangiitis, followed at the French National Vasculitis Referral Center (09/2012–05/2013), and hospitalized non-AAV controls, exclusively for SA/SCV carriage comparisons, were enrolled. All had bilateral anterior nasal swab cultures. Nasal SA or SCV carriage was determined and associations with relapse(s), BVAS, ANCA-positivity, anti-staphylococcal and immunosuppressant use, were analysed ⩾4 years post-inclusion.ResultsNasal SA carriage rates did not differ among AAVs (P = 0.53): GPA (24/80; 30%), EGPA (7/28; 25%) and microscopic polyangiitis (3/11; 27.3%); and the rate was less frequent in controls than in GPA patients not taking CTX (P = 0.04). AAV patients taking CTX prophylaxis had less nasal SA carriage (8.7% vs 36.2%; P = 0.02). Nasal SA carriage or CTX use did not modify relapse rates, BVAS or ANCA-positivity at inclusion or during follow-up. Nasal SCV carriage, found in 15/207 (7.2%) patients, was similar for GPA (10/24; 41.7%), microscopic polyangiitis (2/7; 28.6%) and eosinophilic GPA (2/3; 66.7%), but higher (P = 0.02) than controls (1/14; 7.1%). SCV carriage by AAV groups did not modify relapse rates or ANCA positivity at inclusion or during follow-up; a trend towards higher BVAS was observed only for anti-PR3 ANCA patients.ConclusionNasal SA or SCV carriage was comparable among AAVs but more frequent than in controls. Nasal SA or SCV carriage and CTX use did not modify AAV relapse rates.

P338Combined assessment using clinical and imaging parameters to predict response to pharmacotherapy in patients with dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Ikeda ◽  
T Inomata ◽  
K Maemura ◽  
M Yazaki ◽  
T Oki ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Odds Ratio ◽  
Predictive Accuracy ◽  
Surrogate Marker ◽  
Scoring Systems ◽  
Left Ventricular ◽  
Imaging Parameters ◽  
The Individual ◽  
Response Score

Abstract Background Normalization of left ventricular (LV) contraction is a strong surrogate marker of favorable prognosis in patients with dilated cardiomyopathy (DCM). Although several studies have reported the individual predictive significance of clinical and imaging parameters for LV recovery in patients with DCM, there have been no reports on the scoring systems that combine these multifactorial parameters. Methods and results In 406 idiopathic patients with DCM, there were 185 (46%) with LV recovery at 1-year follow-up after pharmacotherapy, which was defined as improvements in LV ejection fraction of ≥+10% together with absolute values of ≥50%. Multivariate analysis demonstrated that eight baseline clinical factors and the absence of late gadolinium enhancement (negative LGE) on magnetic resonance imaging were independently associated with LV recovery. The highest odds ratio for the prediction of LV recovery was negative LGE (odds ratio: 5.62, 95% confidence interval: 2.97–10.6; p<0.0001). Response score for the prediction of LV recovery that included these nine parameters had a predictive accuracy of 0.76 for LV recovery (Figure). Conclusion Combined assessment using clinical and imaging parameters has a high prognostic value for predicting response to pharmacotherapy in patients with DCM.

scholarly journals Nasal Carriage and Methicillin Resistance of Staphylococcus aureus among Schoolchildren in Sana’a City, Yemen

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Arwa Mohammed Othman ◽  
Belques Sharaf Al-Huraibi ◽  
Rowa Mohammed Assayaghi ◽  
Huda Zaid Al-Shami
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Admission ◽  
Methicillin Resistance ◽  
Positive Culture ◽  
Nasal Carriage ◽  
Cross Sectional Study ◽  
High Morbidity ◽  
Carriage Rate ◽  
Cross Sectional ◽  
Nasal Swabs

Background. Staphylococcus aureus (S. aureus) is a frequent cause of serious health problems with high morbidity and mortality. The risk of S. aureus infections is increased with the emergence of methicillin-resistant S. aureus (MRSA). This study aims to determine the nasal carriage rate of both S. aureus and MRSA among schoolchildren in Sana’a city. Methods. This is a cross-sectional study conducted from January 2018 to May 2020. Five hundred and thirty-six students were enrolled. Their age ranged from 5 to 19 years with the mean age and standard deviation equal to 13.3 ± 3.5 years. Nasal swabs were collected from each student for culturing and methicillin susceptibility testing. Results. Students with positive culture were 271 (51%) males and 265 (49%) females. S. aureus was isolated from 129 (24%) students whereas the overall prevalence of MRSA was 8 (1.5%). S. aureus was significantly recovered from students at the age group of 10–14 years (χ2 = 7.02; p = 0.03 ), females than males (OR = 1.96; χ2 = 10.75; p = 0.001 ), and students who were admitted into hospitals (OR = 1.6; χ2 = 4.89; p = 0.03 ). Nevertheless, there were no significant differences between MRSA carriage and students’ age (χ2 = 2.3; p = 0.32 ), gender (OR = 1.02; χ2 = 0.001; p = 0.63 ), and hospital admission (OR = 1.4; χ2 = 0.25; p = 0.62 ). Conclusions. The prevalence of MRSA is low among schoolchildren in Sana’a city. Age, gender, and previous hospital admission were statistically associated with nasal carriage of S. aureus but not MRSA nasal carriage.

scholarly journals P498 Loss of response of anti-TNF in Crohn’s disease patients single-centre experience

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S434-S434
Author(s):  
A Atanassova ◽  
A C Georgieva ◽  
M Mirchev
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Response ◽  
Biological Treatment ◽  
Phenotypic Expression ◽  
Faecal Calprotectin ◽  
Loss Of Response

Abstract Background Despite the timely commencement of the biological treatment, only about 30% will respond to it, and about 1/3 will lose the initial anti-TNF (tumour necrosis factor) response. Methods We retrospectively studied the data of 69 Crohn’s disease (CD) patients who started biological treatment with anti-TNF-ADA/ IFX. We excluded patients who are primary nonresponders to IFX/ADA. In patients with induction of clinical response, we investigated and analysed the frequency of subsequent loss of response (LOR) to IFX/ADA. We analysed the possible risk factors that have led to LOR. Results Of the 69 patients undergoing biological treatment, 71.01% achieved a clinical response during the course of the follow-up. There is a correlation between the presence of a clinical response and the CD course- x2 = 10.78, p = 0.013, ρ = 0.241, (p = 0.046). Inflammatory phenotype (В1) manifestation among our patients is a factor for achieving a clinical response OR = 3.68 (1.116–11.73), p = 0.021, whereas the presence of a penetrating form is a risk factor for the lack of response OR = 6.13 (1.29–29.01), p = 0.019. The presence of intestinal complications is a risk factor for the lack of response- OR = 3.2 (1.61–6.37), p = 0.001. During the course of the follow-up in 30.61% of cases, we observed LOR (men/women - 86.66%/13.33%, p &lt; 0.05 (p = 0.02), in 60.00 % this was between 1–2 years, on average 20.62 ± 13.07 months from the start of the biological treatment. A total of 46.66% of patients required treatment with another anti-TNF drug due to secondary loss of response. A total of 50% of patients needed a reduction of the dose interval. Over 50.00% of those with LOR have an extensive disease (L3). A total of 40% have В1 and 33% have stricturing (В2) and penetrating (В3) phenotypic expression. In 26.66%, we observed progression of the disease range, and in 46.66% of patients - intestinal complications, none of whom had subsequent surgery. In 21.42% of LOR patients there is a combination of intestinal complications and progression according to disease localisation. 93.33% of CD patients with LOR have a persistence of extraintestinal manifestations (EIMs); those with two or three EIMs predominate. We discovered that gender was a risk factor for loss of response, OR = 8.36 (1.16–60.26), p = 0.005, as is the combination of В2 and В3 form of the disease OR = 14.72 (2.47–87.79), p = 0.003. Patients who lost response during the course of treatment had higher mean faecal calprotectin, CDAI and CRP prior to the initiation of the anti-TNF therapy. Conclusion The high activity of the disease measured with CDAI, faecal calprotectin and CRP, male gender, the combination of penetrating and stricturing form during the course of the disease are all risk factors for the loss of response.

Nose Picking and Nasal Carriage of Staphylococcus aureus

2006 ◽  
Vol 27 (08) ◽  
pp. 863-867 ◽  
Author(s):  
Heiman F. L. Wertheim ◽  
Menno van Kleef ◽  
Margreet C. Vos ◽  
Alewijn Ott ◽  
Henri A. Verbrugh ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Positive Culture ◽  
Nasal Carriage ◽  
Study Cohort ◽  
Care Hospital ◽  
Hospital Employees ◽  
Nose And Throat

Objective.Nasal carriage ofStaphylococcus aureusis an important risk factor forS. aureusinfection and a reservoir for methicillin-resistantS. aureus. We investigated whether nose picking was among the determinants ofS. aureusnasal carriage.Setting and Participants.The study cohort comprised 238 patients who visited the ear, nose, and throat (ENT) disease outpatient clinic of a tertiary care hospital and did not have a nose-specific complaint (defined as ENT patients) and 86 healthy hospital employees (including medical students and laboratory personnel).Measurements.All participants completed a questionnaire on behavior regarding the nose and were screened forS. aureusnasal carriage; only ENT patients underwent nasal examination by an ear, nose, and throat physician for clinical signs of nose picking.Results.Among ENT patients, nose pickers were significantly more likely than non–nose pickers to carryS. aureus(37 [53.6%] of 69 vs 60 [35.5%] of 169 patients; relative risk, 1.51 [95% confidence interval, 1.03-2.19]). Among healthy volunteers, there was a statistically significant positive correlation between the self-perceived frequency of nose picking and both the frequency of positive culture results (R= 0.31;P= .004) and the load ofS. aureuspresent in the nose (R= 0.32;P= .003).Conclusion.Nose picking is associated withS. aureusnasal carriage. The role of nose picking in nasal carriage may well be causal in certain cases. Overcoming the habit of nose picking may aidS. aureusdecolonization strategies.

scholarly journals A229 USTEKINUMAB FOR THE TREATMENT OF REFRACTORY PEDIATRIC CROHN’S DISEASE: A SINGLE CENTRE EXPERIENCE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 104-106
Author(s):  
A Cohen ◽  
A Sant’Anna ◽  
N Ahmed
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Response ◽  
Clinical Remission ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
The Other ◽  
Secondary Loss ◽  
Loss Of Response

Abstract Background Despite the well-established efficacy of Tumor Necrosis Factor (TNF) antagonists as treatment options for Crohn’s Disease, many pediatric patients need a change in therapy due to adverse events, as well as primary and secondary loss of response, highlighting the necessity for medications with a different mechanism of action. Ustekinumab, a monoclonal antibody targeting IL-12 and IL-23, has been approved to treat psoriatic arthritis, plaque psoriasis, and adults with Crohn’s disease. While utekinumab has been shown to be effective in inducing clinical remission in adults with Crohn’s disease refractory to anti-TNF agents, minimal data exists in the pediatric population. Aims We retrospectively describe 11 pediatric patients who received ustekinumab at the Montreal Children’s Hospital with the goal of assessing its efficacy in inducing clinical, biochemical, and endoscopic remission. Methods We abstracted baseline data, prior treatment and response, indications for starting ustekinumab, clinical response, endoscopic data, and laboratory parameters pre- and post- therapy. Clinical response was defined as decrease in abbrPCDAI (Pediatric Crohn’s Disease Activity Index) score. Results Patients ranged in age from 12–17 years old upon initiation of treatment with ustekinumab and had all previously failed either one (N=8) or both (N=3) anti-TNF therapies. Follow-up ranged from 6 to 22 months. We examined three indices of response to ustekinumab: symptomatic improvement, biomarker normalization, and endoscopic changes. Five of eleven patients demonstrated a clinical response – two maintained clinical remission across available follow-up data, while the remaining three experienced a secondary loss of response. The other six patients studied were primary non-responders. Two of these patients had normal abbrPCDAI scores upon initiation of ustekinumab and terminated therapy due to persistent stricturing disease. The other four non-responders either remained unwell or demonstrated clinical worsening, as measured by the abbrPCDAI. Of the clinical responders, 3/5 had elevated CRP values prior to initiating ustekinumab therapy, all of which normalized within one month of clinical improvement. Endoscopic data both pre- and post- ustekinumab was available in two responders and two non-responders, with endoscopic improvement seen in both of the responders and in one of the two non-responders. Conclusions These results demonstrate that ustekinumab has the potential ability to induce not only clinical and biochemical remission, but also endoscopic improvement, in the pediatric population. An area of concern is the fact that only one patient maintained remission for longer than one year. Future research should focus on maximizing and lengthening the effect of ustekinumab, as well as determining factors that influence response to therapy. Funding Agencies None

Sign in / Sign up

Export Citation Format

Share Document