{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:04:16Z","timestamp":1788494656677,"version":"build-2803163510"},"reference-count":67,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Cutaneous adverse reactions (CARs) are common complications of epidermal growth factor receptor (EGFR) inhibitor therapy, with papulopustular eruptions and paronychia being the most frequent. Growing scientific evidence implies that Staphylococcus aureus is involved in the pathogenesis of these reactions. This observational prospective study characterized 42 S. aureus strains isolated from CARs, analyzing antibiotic resistance, biofilm formation, soluble virulence factors, and virulence\/resistance genes using multiplex polymerase chain reaction (PCR). S. aureus was identified in 90% of lesions; in 33% of cases, nasal and skin isolates were genetically identical. High resistance rates were noted for penicillins (85%) and tetracyclines (57%), while all strains remained susceptible to fluoroquinolones, vancomycin, and rifampicin. All isolates formed biofilms, and DNase\/esculinase production significantly correlated with CAR severity. An enzymatic score based on these markers was associated with an 18-fold increased risk of severe reactions. Genotypically, clfA and clfB were prevalent (85.7%), while exotoxin genes were less common. These findings support a key role for S. aureus in exacerbating CARs via antibiotic resistance, biofilm production, and the expression of virulence factor. Additionally, we emphasize the role of routine microbial screening\u2014including nasal swabs\u2014and therapy guided by antibiograms. Furthermore, the enzymatic score may further be validated as a predictive biomarker.<\/jats:p>","DOI":"10.3390\/ijms26146595","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T12:46:33Z","timestamp":1752237993000},"page":"6595","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Virulence and Antibiotic Resistance Profiles of Staphylococcus aureus Isolated from Epidermal Growth Factor Receptor Inhibitors-Associated Skin Lesions"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1436-0088","authenticated-orcid":false,"given":"Mara-M\u0103d\u0103lina","family":"Mihai","sequence":"first","affiliation":[{"name":"Department of Oncologic Dermatology, \u201cElias\u201d Emergency University Hospital, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuliana","family":"Anghelescu","sequence":"additional","affiliation":[{"name":"Department of Histology, Titu Maiorescu University of Medicine and Pharmacy, 040441 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina Maria","family":"Holban","sequence":"additional","affiliation":[{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"},{"name":"Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Gheorghe-Barbu","sequence":"additional","affiliation":[{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"},{"name":"Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6098-1857","authenticated-orcid":false,"given":"Mariana-Carmen","family":"Chifiriuc","sequence":"additional","affiliation":[{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"},{"name":"Department of Microbiology-Immunology, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania"},{"name":"Biological Sciences Division, Romanian Academy, 010071, Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6593-255X","authenticated-orcid":false,"given":"Lia-Mara","family":"Di\u021bu","sequence":"additional","affiliation":[{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"},{"name":"Department of Botany-Microbiology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5504-5156","authenticated-orcid":false,"given":"Cornelia-Ioana","family":"Ilie","sequence":"additional","affiliation":[{"name":"Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, National University of Science and Technology POLITEHNICA Bucharest, 011061 Bucharest, Romania"},{"name":"National Centre for Micro and Nanomaterials and National Centre for Food Safety, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Anghelescu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, \u201cTitu Maiorescu\u201d University, 040441 Bucharest, Romania"},{"name":"Clinical Department 1 of Orthopedics and Traumatology, Colentina Hospital, 020125 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6652-4125","authenticated-orcid":false,"given":"Beatrice","family":"B\u0103l\u0103ceanu-Gur\u0103u","sequence":"additional","affiliation":[{"name":"Department of Oncologic Dermatology, \u201cElias\u201d Emergency University Hospital, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jaad.2006.09.005","article-title":"Cutaneous side effects of epidermal growth factor receptor inhibitors: Clinical presentation, pathogenesis, and management","volume":"56","author":"Hu","year":"2007","journal-title":"J. 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