Journal List > Allergy Asthma Respir Dis > v.5(1) > 1059260

Hwang, Kang, Kim, and Kim: Colonization of Staphylococcus aureus and sensitivity to antibiotics in children with atopic dermatitis

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).

Conclusion

MRSA frequency and mupirocin resistance tended to increase annually. We should choose the methods of managing bacterial colonization in atopic dermatitis carefully in order to prevent antibiotic resistance.

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.

aard-5-21-g001
Fig. 2

MRSA ratio in children with atopic dermatitis since 2006. SA, Staphylococcus aureus; MRSA, methicillin-resistant SA.

aard-5-21-g002
Fig. 3

Methicillin-resistant Staphylococcus aureus resistance to topical antibiotics (mupirocin, fusidic acid) in children with atopic dermatitis.

aard-5-21-g003
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.

aard-5-21-g004
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.

aard-5-21-g005

References

1. Hanifin J, Rajka G. Diagnostic features of atopic eczema. Acta Dermatol Venereol (Stockh). 1980; 92:44–47.
2. Roesch A, Linde HJ, Landthaler M, Vogt T. Elimination of a community-acquired methicillin-resistant Staphylococcus aureus infection in a nurse with atopic dermatitis. Arch Dermatol. 2005; 141:1520–1522.
crossref
3. Hon KL, Leung AK, Kong AY, Leung TF, Ip M. Atopic dermatitis complicated by methicillin-resistant Staphylococcus aureus infection. J Natl Med Assoc. 2008; 100:797–800.
crossref
4. Suh LM, Honig PJ, Yan AC. Methicillin-resistant Staphylococcus aureus skin abscesses in a pediatric patient with atopic dermatitis: a case report. Cutis. 2006; 78:113–116.
5. Foster TJ. Immune evasion by staphylococci. Nat Rev Microbiol. 2005; 3:948–958.
crossref
6. McFadden JP, Noble WC, Camp RD. Superantigenic exotoxin-secreting potential of staphylococci isolated from atopic eczematous skin. Br J Dermatol. 1993; 128:631–632.
crossref
7. Leung DY, Harbeck R, Bina P, Reiser RF, Yang E, Norris DA, et al. Presence of IgE antibodies to staphylococcal exotoxins on the skin of patients with atopic dermatitis. Evidence for a new group of allergens. J Clin Invest. 1993; 92:1374–1380.
crossref
8. Calfee DP. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and other Gram-positives in healthcare. Curr Opin Infect Dis. 2012; 25:385–394.
crossref
9. Mediavilla JR, Chen L, Mathema B, Kreiswirth BN. Global epidemiology of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA). Curr Opin Microbiol. 2012; 15:588–595.
crossref
10. Hill SE, Yung A, Rademaker M. Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: a New Zealand experience. Australas J Dermatol. 2011; 52:27–31.
crossref
11. Hoeger PH. Antimicrobial susceptibility of skin-colonizing S. aureus strains in children with atopic dermatitis. Pediatr Allergy Immunol. 2004; 15:474–477.
crossref
12. Niebuhr M, Mai U, Kapp A, Werfel T. Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp Dermatol. 2008; 17:953–957.
crossref
13. Tang CS, Wang CC, Huang CF, Chen SJ, Tseng MH, Lo WT. Antimicrobial susceptibility of Staphylococcus aureus in children with atopic dermatitis. Pediatr Int. 2011; 53:363–367.
crossref
14. Suh L, Coffin S, Leckerman KH, Gelfand JM, Honig PJ, Yan AC. Methicillin-resistant Staphylococcus aureus colonization in children with atopic dermatitis. Pediatr Dermatol. 2008; 25:528–534.
crossref
15. Chung HJ, Jeon HS, Sung H, Kim MN, Hong SJ. Epidemiological characteristics of methicillin-resistant Staphylococcus aureus isolates from children with eczematous atopic dermatitis lesions. J Clin Microbiol. 2008; 46:991–995.
crossref
16. Matlow A, Forgie S, Pelude L, Embree J, Gravel D, Langley JM, et al. National surveillance of methicillin-resistant Staphylococcus aureus among hospitalized pediatric patients in Canadian acute care facilities, 1995-2007. Pediatr Infect Dis J. 2012; 31:814–820.
crossref
17. Bath-Hextall FJ, Birnie AJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol. 2010; 163:12–26.
crossref
18. Shah M, Mohanraj M. High levels of fusidic acid-resistant Staphylococcus aureus in dermatology patients. Br J Dermatol. 2003; 148:1018–1020.
crossref
19. Ravenscroft JC, Layton A, Barnham M. Observations on high levels of fusidic acid resistant Staphylococcus aureus in Harrogate, North Yorkshire, UK. Clin Exp Dermatol. 2000; 25:327–330.
crossref
20. Andersen BM, Bergh K, Steinbakk M, Syversen G, Magnaes B, Dalen H, et al. A Norwegian nosocomial outbreak of methicillin-resistant Staphylococcus aureus resistant to fusidic acid and susceptible to other antistaphylococcal agents. J Hosp Infect. 1999; 41:123–132.
crossref
21. Brown EM, Thomas P. Fusidic acid resistance in Staphylococcus aureus isolates. Lancet. 2002; 359:803.
22. Yun HJ, Lee SW, Yoon GM, Kim SY, Choi S, Lee YS, et al. Prevalence and mechanisms of low- and high-level mupirocin resistance in staphylococci isolated from a Korean hospital. J Antimicrob Chemother. 2003; 51:619–623.
crossref
23. Park SY, Kim SM, Park SD. The prevalence, genotype and antimicrobial susceptibility of high- and low-level mupirocin resistant methicillin-resistant Staphylococcus aureus. Ann Dermatol. 2012; 24:32–38.
crossref
24. Lever R, Hadley K, Downey D, Mackie R. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy. Br J Dermatol. 1988; 119:189–198.
crossref
25. Fisher RG, Chain RL, Hair PS, Cunnion KM. Hypochlorite killing of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2008; 27:934–935.
crossref
26. Winter J, Ilbert M, Graf PC, Ozcelik D, Jakob U. Bleach activates a redox-regulated chaperone by oxidative protein unfolding. Cell. 2008; 135:691–701.
crossref
27. Lipnharski C, d'Azevedo PA, Quinto VP, Bessa G, Bonamigo RR. Colonization by S. aureus increases the EASI and the number of appointments by patients with atopic dermatitis: cohort with 93 patients. An Bras Dermatol. 2013; 88:518–521.
crossref
TOOLS
ORCID iDs

Yoonha Hwang
https://orcid.org/http://orcid.org/0000-0002-6508-8168

Similar articles