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dc.contributor.authorHarkins, C. P.
dc.contributor.authorMcAleer, M. A.
dc.contributor.authorBennett, D.
dc.contributor.authorMcHugh, M.
dc.contributor.authorFleury, O. M.
dc.contributor.authorPettigrew, K. A.
dc.contributor.authorOravcová, K.
dc.contributor.authorParkhill, J.
dc.contributor.authorProby, C. M.
dc.contributor.authorDawe, R. S.
dc.contributor.authorGeoghegan, J. A.
dc.contributor.authorIrvine, A. D.
dc.contributor.authorHolden, M. T. G.
dc.identifier.citationHarkins , C P , McAleer , M A , Bennett , D , McHugh , M , Fleury , O M , Pettigrew , K A , Oravcová , K , Parkhill , J , Proby , C M , Dawe , R S , Geoghegan , J A , Irvine , A D & Holden , M T G 2018 , ' The widespread use of topical antimicrobials enriches for resistance in  Staphylococcus aureus isolated from Atopic Dermatitis patients ' , British Journal of Dermatology , vol. 179 , no. 4 , pp. 951-958 .
dc.identifier.otherBibtex: urn:4433c2051b97a43c1ed8632f1525ce12
dc.identifier.otherORCID: /0000-0002-0370-3700/work/46939700
dc.identifier.otherORCID: /0000-0002-4958-2166/work/60196364
dc.descriptionThis work was supported by grants from the Wellcome Trust (104241/z/14/z to C.P.H., and 098731/z/11/z to St Andrews University Bioinformatics Unit), and the Chief Scientists Office (SIRN10 to M.T.G.H.).en
dc.description.abstractBackground Carriage rates of Staphylococcus aureus on affected skin in atopic dermatitis (AD) are approximately 70%. Increasing disease severity during flares and overall disease severity correlate with increased burden of S. aureus. Treatment in AD therefore often targets S. aureus with topical and systemic antimicrobials. Objectives To determine whether antimicrobial sensitivities and genetic determinants of resistance differed in S. aureus isolates from the skin of children with AD and healthy child nasal carriers. Methods In this case–control study, we compared S. aureus isolates from children with AD (n = 50) attending a hospital dermatology department against nasal carriage isolates from children without skin disease (n = 49) attending a hospital emergency department for noninfective conditions. Using whole genome sequencing we generated a phylogenetic framework for the isolates based on variation in the core genome, then compared antimicrobial resistance phenotypes and genotypes between disease groups. Results Staphylococcus aureus from cases and controls had on average similar numbers of phenotypic resistances per isolate. Case isolates differed in their resistance patterns, with fusidic acid resistance (FusR) being significantly more frequent in AD (P = 0·009). The genetic basis of FusR also differentiated the populations, with chromosomal mutations in fusA predominating in AD (P = 0·049). Analysis revealed that FusR evolved multiple times and via multiple mechanism in the population. Carriage of plasmid‐derived qac genes, which have been associated with reduced susceptibility to antiseptics, was eight times more frequent in AD (P = 0·016). Conclusions The results suggest that strong selective pressure drives the emergence and maintenance of specific resistances in AD.
dc.relation.ispartofBritish Journal of Dermatologyen
dc.subjectRJ101 Child Health. Child health servicesen
dc.subjectRL Dermatologyen
dc.subjectQH426 Geneticsen
dc.titleThe widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from Atopic Dermatitis patientsen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.contributor.institutionUniversity of St Andrews. Biomedical Sciences Research Complexen
dc.contributor.institutionUniversity of St Andrews. Infection Groupen
dc.description.statusPeer revieweden

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