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

Pediatr Dermatol. 2021 Jan;38(1):119-124. doi: 10.1111/pde.14444. Epub 2020 Nov 28.


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.

Keywords: cultures; epidermolysis bullosa; microbes; resistance; wound.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Canada
  • Epidermolysis Bullosa* / complications
  • Epidermolysis Bullosa* / drug therapy
  • Humans
  • Mupirocin
  • Retrospective Studies
  • Staphylococcal Infections* / drug therapy
  • Staphylococcus aureus


  • Anti-Bacterial Agents
  • Mupirocin