Staphylococcus aureus nasal colonization and strain concordance in patients with community associated Staphylococcal primary pyoderma - A cross-sectional study

Ranjan Jeevannavar, Ranugha P.S.S, Jayadev B Betkerur, Madhuri Kulkarni


Background Community associated Methicillin resistant Staphylococcus aureus (MRSA) are common among Staphylococcal isolates from skin and soft tissue infections (SSTI). We intended to find the current status of SA primary skin infection and the antibiotic resistance patterns of SA isolates in India. There is a paucity of data on the significance of nasal SA carriage in the pathogenesis of skin infections. Hence, we investigated the presence and association between nasal SA carriage and staphylococcal primary pyoderma.


Methods Hundred consecutive patients of primary pyoderma of all age groups and both sexes were recruited.  Nasal swabs and pus samples from pyoderma lesions were taken for Gram’s stain and bacterial culture. Antibiotic sensitivity patterns of nasal and pyoderma isolates were compared in patients with Staphylococcal primary pyoderma.


Results Furuncle was the most common presentation seen in 56%, followed by folliculitis (17%) and impetigo (15%). Of the various organisms isolated from pus and nose, SA (58% and 50% respectively) and Coagulase negative staphylococci (CONS) (22% and 36% respectively) were the most predominant.  MRSA infection and MRSA nasal carriage were found in 35% and 25% of cases respectively. Nasal carriage of SA and MRSA were found to be significant risk factors for the development of SA (p-0.015) and MRSA pyodermas (p<0.0001) respectively. Phenotypic concordance of nasal and pus isolates were seen in 34.5% (20/58) of SA-pyodermas, 70% of which were MR.


Conclusion A high incidence of MRSA with resistance to commonly used antibiotics and high nasal SA carriage rates were observed by us, which is disturbing. Avoidance of inappropriate antibiotic usage is the need of the hour. Screening for nasal SA carriage may prevent recurrences and spread of CA-MRSA strains.



Primary pyoderma; staphylococcus aureus; MRSA; nasal carriage

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Kale P, Dhawan B. The changing face of community-acquired methicillin-resistant Staphylococcus aureus. Indian J Med Microbiol. 2016;34: 275-85.

Furtado S, Bhat RM, Rekha B, et al. The clinical spectrum and antibiotic sensitivity patterns of staphylococcal pyodermas in the community and hospital. Indian J Dermatol. 2014;59:143-50.

Kluytmans J, van Belkum A, Verbrugh H: Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997; 10: 505–20.

Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med. 2008;121: 310–5.

Chopra A, Purl R, Mittal RR. Correlation of isolates from pyoderma and carrier sites. Indian J Dermatol Venereol Leprol. 1995; 61: 273–5.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. CLSI document M100-S25. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.

World Health Organization (2009) Global Database on Body Mass Index: BMI Classification. Available at : [ Last accessed May 2017].

Sharma R. Online interactive calculator for real-time update of the Prasad's social classification. [Last accessed on 2017 May]. Available from:

Emilda JK, Shenoy SM, Chakrapani M, et al. Clinical spectrum and antimicrobial resistance pattern of skin and soft tissue infections caused by community acquired-methicillin resistant Staphylococcus aureus. Indian J Dermatol Venereol Leprol. 2014; 80:539-40.

Patil R, Baveja S, Nataraj G, et al. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol Leprol. 2006; 72:126-8.

Gandhi S, Ojha AK, Ranjan KP, et al. Clinical and bacteriological aspects of pyoderma. North Am J Med Sci. 2012; 4: 492–5.

Noble WC. Microbiology of Human Skin. London: Lloyd-Luke Medical Books, 1981.

Venniyil PV, Ganguly S, Kuruvila S, et al. A study of community-associated methicillin-resistant Staphylococcus aureus in patients with pyoderma. Indian Dermatol Online J. 2016; 7:159-63.

Bhat YJ, Hassan I, Bashir S, et al. Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study. J R Coll Physicians Edinb. 2016; 46: 8-13.

Thind P, Prakash SK, Wadhwa A, et al. Bacteriological profile of community-acquired pyodermas with special reference to methicillin resistant Staphylococcus aureus. Indian J Dermatol Venereol Leprol. 2010; 76: 572-4.

Forcade NA, Parchman ML, Jorgensen JH, et al. Prevalence, severity, and treatment of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections in 10 medical clinics in Texas: a South Texas Ambulatory Research Network (STARNet) study. J Am Board Fam Med. 2011; 24: 543-50.

Malhotra SK, Malhotra S, Dhaliwal GS, et al. Bacteriological study of pyodermas in a tertiary care dermatological center. Indian J Dermatol. 2012;57: 358–61.

Nagaraju U, Bhat G, Kuruvila M, et al. Methicillin‑resistant Staphylococcus aureus in community‑acquired pyoderma. Int J Dermatol. 2004;43: 412‑4.

Gu FF, Chen Y, Dong DP, et al. Molecular Epidemiology of Staphylococcus aureus among Patients with Skin and Soft Tissue Infections in Two Chinese Hospitals. Chin Med J. 2016; 129: 2319-24.

Millett RC, Halpern AV, Reboli AC, et al. Bacterial Diseases-(section 12, chapter 74). In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology- 3rd ed. China: Elsevier Saunders; 2012. pg 1191.

Mehndiratta PL, Vidhani S, Mathur MD. A study on Staphylococcus aureus strains submitted to a reference laboratory. Indian J Med Res. 2001; 114: 90–4.

Liu Y, Xu Z, Yang Z, et al. Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China. Emerg Microbes Infect. 2016;5: e127.

Chou YH, Lee MS, Lin RY, et al. Risk factors for methicillin-resistant Staphylococcus aureus skin and soft-tissue infections in outpatients in Taiwan. Epidemiol Infect. 2015;143:749-53.

Ellis MW, Schlett CD, Millar EV, et al. Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections. Infect Control Hosp Epidemiol. 2014;35:1251-6.

Albrecht VS, Limbago BM, Moran GJ, et al.; Emergency ID NET Study Group. Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments. J Clin Microbiol. 2015;53: 3478-84.

Yang ES, Tan J, Eells S, et al. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect. 2010;16:425-31.

Lee GC, Hall RG, Boyd NK, et al. Predictors of community associated Staphylococcus aureus, methicillin-resistant and methicillin susceptible Staphylococcus aureus skin and soft tissue infections in primary-care settings. Epidemiol Infect. 2016;144: 3198-3204.

Harbarth S, Liassine N, Dharan S, et al.: Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:1380–5.

Toshkova K1, Annemüller C, Akineden O, Lämmler C. The significance of nasal carriage of Staphylococcus aureus as risk factor for human skin infections. FEMS Microbiol Lett. 2001;202(1):17-24.

Adzitey F, Huda N, Ali GR. Molecular techniques for detecting and typing of bacteria, advantages and application to foodborne pathogens isolated from ducks. Biotech. 2013;3(2):97-107.


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