Staphylogene Pyodermie bei Tropenrückkehrern – Reisende importieren virulente und resistente Stämme

Tropenreisende erkranken häufig an Pyodermien und tragen zu einer Verbreitung virulenter Staphylokokken in der gemäßigten Klimazone bei. Bei der antibiotischen Behandlung S. aureus-positiver Hautinfektionen des Tropenrückkehrers muss mit ungewöhnlichen Resistenzmustern gerechnet werden. Der Nachweis des Virulenzfaktors Panton-Valentine Leukozidin in importierten S. aureus-Isolaten ist häufig, zeigt ein erhöhtes Risiko für Krankheitsrezidive und Sekundärfälle an und rechtfertigt Maßnahmen zur Dekoloni-sation besiedelter Hautregionen und Kontaktpersonen. Eine genetische Rekombination zwischen importierten S. aureus-Stämmen und heimischen, multiresistenten S. aureus-Klonen muss durch geeignete Hygienemaßnahmen während der stationären Behandlung an Pyodermie erkrankter Reiserückkehrer verhindert werden.

Travelers to the tropics frequently suffer from purulent skin infections and contribute to the dissemination of virulent Staphylococcus aureus in the temperate zone. The empiric use of antimicrobials has to take account of uncommon resistance patterns in S. aureus isolated from travel associated skin infections. Panton-Valentine leukocidin is frequently present in imported S. aureus, is a marker for recurrent disease and secondary transmission, and justifies measures to decolonize patients and close contacts. Infection control measures are crucial to prevent genetic recombination between imported S. aureus and health-care associated multi-resistant clones.

Key words

Staphylococcus aureus - Panton-Valentine leukocidin - staphylococcal skin infections - travel medicine - epidemiology

• Literatur

• 1 Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000; 7: 259-66
• 2 Freedman DO, Weld LH, Kozarsky PE et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 2006; 354: 119-30
• 3 Zanger P. Staphylococcus aureus positive skin infections and international travel. Wien Klin Wochenschr 2010; 122 (Suppl. 01)
• 4 Zanger P, Holzer J, Schleucher R et al. Constitutive expression of the antimicrobial peptide RNase 7 is associated with Staphylococcus aureus infection of the skin. J Infect Dis 2009; 200: 1907-15
• 5 Zanger P, Holzer J, Schleucher R et al. Severity of Staphylococcus aureus Infection of the Skin is Associated with Inducibility of Human {beta}-Defensin 3, but not Human {beta}-Defensin 2. Infect Immun 2010; 78: 3112-7
• 6 Zanger P, Nurjadi D, Vath B et al. Persistent nasal carriage of Staphylococcus aureus is associated with deficient induction of human beta-defensin 3 after sterile wounding of healthy skin in vivo. Infect Immun 2011; 79: 2658-62
• 7 Chambers HF, Deleo FR. Waves of resistance: Staphylococcus aureus in the antibiotic era. Nat Rev Microbiol 2009; 7: 629-41
• 8 Nübel U, Roumagnac P, Feldkamp M et al. Frequent emergence and limited geographic dispersal of methicillin-resistant Staphylococcus aureus. Proc Natl Acad Sci USA 2008; 105: 14130-5
• 9 Lina G, Piemont Y, Godail-Gamot F et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29: 1128-32
• 10 Robinson DA, Kearns AM, Holmes A et al. Re-emergence of early pandemic Staphylococcus aureus as a community-acquired meticillin-resistant clone. Lancet 2005; 365: 1256-8
• 11 Otto M. Basis of virulence in community-associated methicillin-resistant Staphylococcus aureus. Annu Rev Microbiol 2010; 64: 143-62
• 12 Jappe U, Heuck D, Strommenger B et al. Staphylococcus aureus in dermatology outpatients with special emphasis on community-associated methicillin-resistant strains. J Invest Dermatol 2008; 128: 2655-64
• 13 Breurec S, Fall C, Pouillot R et al. Epidemiology of methicillin-susceptible Staphylococcus aureus lineages in five major African towns: high prevalence of Panton-Valentine leukocidin genes. Clin Microbiol Infect 2011; 17: 633-9
• 14 Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains?. Clin Infect Dis 2008; 46: 787-94
• 15 Stenhem M, Ortqvist A, Ringberg H et al. Imported methicillin-resistant Staphylococcus aureus, Sweden. Emerg Infect Dis 2010; 16: 189-96
• 16 Zanger P, Nurjadi D, Schleucher R et al. Import and spread of Panton-Valentine Leukocidin-positive Staphylococcus aureus through nasal carriage and skin infections in travelers returning from the tropics and subtropics. Clin Infect Dis 2012; 54: 483-92
• 17 Liu C, Bayer A, Cosgrove SE et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011; 52: 285-92
• 18 StaphTrav – European network on imported Staphylococcus aureus. Im Internet: http://www.staphtrav.eu
• 19 HPA. Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. 2nd Ed. 2008. Im Internet: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1218699411960