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Yoonha Hwang
, Joon Seok Kang, Byoung Kuk Kim, Sung Won Kim
, Joon Seok Kang, Byoung Kuk Kim, Sung Won Kim
Abstract
Purpose
Staphylococcus aureus colonization exacerbates atopic dermatitis. Local or systemic antibiotics can increase difficulty in controlling skin colonization and the possibility of methicillin-resistant S. aureus (MRSA). Choosing appropriate antibiotics has become more challenging. We investigated the frequency of S. aureus and MRSA colonization and susceptibility to antimicrobial agents.
Methods
We collected and cultivated the skin colonization samples of atopic dermatitis children less than 20 years old from June 2006 to May 2016, and tested the antibiotic sensitivity. We also checked the severity of atopic dermatitis by SCORing Atopic Dermatitis (SCORAD) index and analyzed.
Results
Out of 2,355 subjects, 1,935 (82.2%) had S. aureus and 762 (39.4%) had MRSA. The frequency of MRSA increased from 13.3% in 2006 to 26.6% in 2007, 18.4% in 2008, 27.1% in 2009, 38.3% in 2010, 42.6% in 2011, 42.4% in 2012, 48.3% in 2013, 44.5% in 2014, 38.1% in 2015, and 37.5% in 2016. Mupirocin resistance started with 0% in 2009, and gradually increased annually to 13.7% in 2010, 14.7% in 2011, 25.4% in 2012, 35.2% in 2013, 34.9% in 2014, 39.8% in 2015, and 35.6% in 2016. The mupirocin resistant group has a higher SCORAD index than the other groups (P<0.05).
Figures and Tables
Fig. 1
Age differences of cultured bacteria from the skin with atopic dermatitis. Out of 2,355 subjects, 1,935 (82.2%) had Staphylococcus aureus, 1,108 (44.4%) had methicillin-susceptible, and 762 (39.4%) had methicillin-resistant. SA, Staphylococcus aureus; MRSA, methicillin-resistant SA.
Fig. 2
MRSA ratio in children with atopic dermatitis since 2006. SA, Staphylococcus aureus; MRSA, methicillin-resistant SA.
Fig. 3
Methicillin-resistant Staphylococcus aureus resistance to topical antibiotics (mupirocin, fusidic acid) in children with atopic dermatitis.
Fig. 4
Methicillin-resistant Staphylococcus aureus resistance to systemic antibiotics (erythromycin, clindamycin, ciprofloxacin, Trimethoprim-sulfamethoxazole, and vancomycin) in children with atopic dermatitis. TMP-SMX, trimethoprim-sulfamethoxazole.
Fig. 5
Severity differences by antibiotic resistance. MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible Staphylococcus aureus; SCORAD, SCORing Atopic Dermatitis. (A) Severity difference with or without S. aureus colonization, (B) Severity difference between MRSA and MSSA, (C) Severity difference by mupirocin sensitivity, and (D) Severity difference by fusidic acid sensitivity.
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