Microbiology Impetigo

Most cases of impetigo and cellulitis are attributed to S. aureus and GABHS alone or in combination (Table 2) (19). A retrospective study investigated both the aerobic and anaerobic

TABLE 2 Bacterial Etiology

Impetigo and cellulitis, diabetic, and chronic skin ulcers Streptococcus group A Staphylococcus aureus

Anaerobic oral flora (Prevotella, Fusobacterium, and Peptostreptococcus spp.) around oral area and head and neck

Colonic flora: Enterobacteriaceae and anaerobes (i.e., Escherichia coli and Bacteroides fragilis group) around rectum and lower extremity Necrotizing fasciitis Streptococcus group A (rarely also group C or E) S. aureus Enterobacteriaceae Enteric or oral anaerobes Gas gangrene and crepitus cellulitis

Clostridium perfringens and other Clostridium spp. Progressive bacterial gangrene Peptostreptococcus spp. Microaerophilic streptococci Proteus spp. Myositis S. aureus

Streptococcus groups A, B, C, and G Enterobacteriaceae Yersinia entercolitica Pseudomonas spp. Aeromonas spp.

Clostridium spp. (especially perfringens) Peptostreptococcus spp. Bacteroides spp.

microbiology of nonbullous impetigo in 40 children (20). Aerobic or facultative anaerobic bacteria only were present in 24 patients (60%), strict anaerobic bacteria only in 5 patients (12.5%), and mixed anaerobic-aerobic flora was present in 11 patients (27.5%). Sixty-four isolates were recovered: 43 aerobic or facultative and 21 anaerobic. The predominant aerobic and facultative bacteria were S. aureus (29 isolates) and GABHS (13). The predominant anaerobes were Peptostreptococcus spp. (12), pigmented Prevotella spp. (5), and Fusobacterium spp. (2). Single bacterial isolates were recovered in 17 patients (42.5%), 13 of which were S. aureus. S. aureus alone or mixed with GABHS or Peptostreptococcus spp. were isolated from all body sites. Mixed flora of Peptostreptococcus spp. with Prevotella or Fusobacterium spp. was mostly found in infections of the head and neck, while Escherichia coli mixed with Bacteroides fragilis and Peptostreptococcus spp. were isolated from infection of the buttocks area.

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