Characterization of wound microbes in epidermolysis bullosa: Results from the epidermolysis bullosa clinical characterization and outcomes database

Laura E. Levin*, Leila H. Shayegan, Anne W. Lucky, Kristen P. Hook, Anna L. Bruckner, James A. Feinstein, Susan Whittier, Christine T. Lauren, Elena Pope, Irene Lara-Corrales, Karen Wiss, Catherine C. McCuaig, Julie Powell, Lawrence F. Eichenfield, Moise L. Levy, Lucia Diaz, Sharon A. Glick, Amy S. Paller, Harper N. Price, John C. BrowningKimberly D. Morel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background/Objectives: Patients with epidermolysis bullosa (EB) require care of wounds that are colonized or infected with bacteria. A subset of EB patients are at risk for squamous cell carcinoma, and bacterial-host interactions have been considered in this risk. The EB Clinical Characterization and Outcomes Database serves as a repository of information from EB patients at multiple centers in the United States and Canada. Access to this resource enabled broad-scale analysis of wound cultures. Methods: A retrospective analysis of 739 wound cultures from 158 patients from 13 centers between 2001 and 2018. Results: Of 152 patients with a positive culture, Staphylococcus aureus (SA) was recovered from 131 patients (86%), Pseudomonas aeruginosa (PA) from 56 (37%), and Streptococcus pyogenes (GAS) from 34 (22%). Sixty-eight percent of patients had cultures positive for methicillin-sensitive SA, and 47%, methicillin-resistant SA (18 patients had cultures that grew both methicillin-susceptible and methicillin-resistant SA at different points in time). Of 15 patients with SA-positive cultures with recorded mupirocin susceptibility testing, 11 had mupirocin-susceptible SA and 6 patients mupirocin-resistant SA (2 patients grew both mupirocin-susceptible and mupirocin-resistant SA). SCC was reported in 23 patients in the entire database, of whom 10 had documented wound cultures positive for SA, PA, and Proteus species in 90%, 50%, and 20% of cases, respectively. Conclusions: SA and PA were the most commonly isolated bacteria from wounds. Methicillin resistance and mupirocin resistance were reported in 47% and 40% of patients tested, respectively, highlighting the importance of ongoing antimicrobial strategies to limit antibiotic resistance.

Original languageEnglish (US)
Pages (from-to)119-124
Number of pages6
JournalPediatric dermatology
Issue number1
StatePublished - Jan 1 2021


  • cultures
  • epidermolysis bullosa
  • microbes
  • resistance
  • wound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Dermatology

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