Choice of topical antibiotic--a microbiological view point.
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Biomedical subjects
Publications and source records attributed to W C Noble.
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To throw more light on the role of Protein A (a cell-wall component of most strains of S. aureus), in infection and inflammation, due to this organism the immediate inflammatory reaction has been studied in hairless and hairless/obese mice after s.c. injection of the protein into the footpad following various forms of immunization or pretreatment (described). Non-immunized mice showed an inflammatory reaction to Protein A, as judged by swelling, reaching a peak 2 h after injection. This might have been due to a nonspecific interaction between certain mouse Igs and Protein A. When specific antibody levels were raised by prior immunization or infection, the swelling was greatly increased. No delayed reaction was seen at 24 or 48 h, nor was a positive patch test obtained. The difference in results seen in mice and other animals may be due partly to the fact that intradermal injections are not possible in the mouse, or because in the mouse, unlike other subjects which have been used, histamine does not play a part. Mice do not show anaphylactic shock and this may be a function of the class of murine Igs interacting with Protein A. Further studies on these factors are required.
Topical medicaments used by patients with diseases of the skin were examined for microbial contamination. Ps. aeruginosa was isolated from stock pots of a diluted emulsifying ointment used as a soap substitute in the bath. Cross-contamination between patients and medicament was subsequently shown to have occurred.
The carriage on skin lesions, on healthy skin and in the nose, of micro-organisms that produce antibiotics active against Staphylococcus aureus has been studied. About 5% of sites (10% of all patients) yielded such organisms. No evidence could be found that the presence of producer organisms in skin lesions had a protective effect against colonisation by S. aureus.
The effect of PUVA therapy for psoriasis on the microbial flora and on levels and composition of skin surface lipid has been studied in ten patients. Samples were obtained from clinically uninvolved skin from the back and the forearm. There was no consistent significant change in the viable counts of aerobic cocci or anaerobic coryneforms during theraapy. A transient rise in Staphylococcus aureus counts was thought to be due to the use of emollients rather than no effect of PUVA. Genetic changes in the microorganisms were not sought. There was an increase in the amount of total lipid (both casual levels and replacement sums) during therapy. An increase of free fatty acids at the expense of triglycerides did not reach statistical significance. The influence of PUVA on the skin flora seems to be less in vivo than anticipated from in vitro studies.
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In a skin surface model of infection/colonization staphylococci which produce inhibitors (antibiotics) in vitro suppress the growth of indicator strains of S. aureus. In a subcutaneous model, however, strains of S. aureus are at an advantage and the effect of inhibitor production is less evident.
In an acute model of skin infection with Dermatophilus congolensis in the mouse, lesions can be prevented by simultaneous application of staphylococci which produce antibiotics; non-producer staphylococci fail to inhibit lesion formation.
Antibiotic production by dermatophyte fungi has been demonstrated in vivo in the lesions of patients with dermatomycoses. Patients infected with antibiotic-producing strains more frequently carried cocci resistant to penicillin and other antibiotics than did patients infected with non-producer strains. The total bacterial load was less in lesions caused by producer fungi. In vitro studies demonstrated the selection of penicillin-resistant S. aureus from mixed populations of resistant and sensitive cells.
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The change in carriage rates of Pilyrosporum sp. over the years before and after puberty were studied in Caucasoid and Negroid children using a semiquantitative cultural technique. Caucasoids yielded yeasts more often than did negroids; older or sexually mature children yielded yeasts more often than did prepubertal children. There appeared to be a decrease in numbers of yeasts isolated a few years after the pubertal peak.
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