Kam Lun Hon1, Yin Ching Tsang1, N H Pong1, Chantel Ng1, Margaret Ip2, Ting Fan Leung1. 1. a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and. 2. b Department of Microbiology , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China.
Abstract
INTRODUCTION: Staphylococcus aureus (SA) colonization/infection is important in the pathophysiology of childhood atopic dermatitis (AD). This study evaluated which clinical features may predict presence of SA colonization/infection and reviewed antimicrobial sensitivity of SA in patients with AD. METHODS: The associations between bacteriologic culture results of skin swabs (taken at the most severely affected area and at the antecubital fossa) and SCORing-Atopic-Dermatitis (SCORAD), skin hydration, transepidermal water loss (TEWL), and quality of life were evaluated. RESULTS: Moderate-to-heavy growth of SA was present in 31% of the swabs of the most severe area and in 16% of the flexural (antecubital fossae) areas of 95 AD patients (12.5 ± 4.8 years). Binomial logistic regression showed moderate-to-heavy growth of SA in the severe area were associated with objective SCORAD (p = 0.004) and lesion intensity [erythema (p = 0.022) and lichenification (p = 0.035)]; and excoriation (p = 0.024) and TEWL (p = 0.009) in the antecubital fossa. The relative risk of isolating moderate-to-heavy growth of SA in the most affected area in patients with severe disease (objective SCORAD >40) is 2.73 (1.43-5.21, p = 0.001). Any growth of SA in either swab sites was associated with objective SCORAD and lesion intensity (p = 0.001-0.019). SA had no association with quality of life and other clinical parameters. All specimens of methicillin-sensitive SA were sensitive to cloxacillin. All methicillin-resistant SA (MRSA) (5.7%) was sensitive to co-trimoxazole and fusidic acid. CONCLUSIONS: Clinical features, especially severity and lesion intensity, are useful in "predicting" moderate-to-heavy SA colonization/infection in AD patients. Cloxacillin has a favorable sensitivity profile for MSSA, and co-trimoxazole and fusidic acid for MRSA. As colonization and infection are ambiguous and potentially overlapping clinical states, we recommend to abandon these terms and propose to describe quantitatively/semi-quantitatively SA isolation as none, mild, scanty, moderate or heavy growth instead in clinical trials.
INTRODUCTION:Staphylococcus aureus (SA) colonization/infection is important in the pathophysiology of childhood atopic dermatitis (AD). This study evaluated which clinical features may predict presence of SA colonization/infection and reviewed antimicrobial sensitivity of SA in patients with AD. METHODS: The associations between bacteriologic culture results of skin swabs (taken at the most severely affected area and at the antecubital fossa) and SCORing-Atopic-Dermatitis (SCORAD), skin hydration, transepidermal water loss (TEWL), and quality of life were evaluated. RESULTS: Moderate-to-heavy growth of SA was present in 31% of the swabs of the most severe area and in 16% of the flexural (antecubital fossae) areas of 95 ADpatients (12.5 ± 4.8 years). Binomial logistic regression showed moderate-to-heavy growth of SA in the severe area were associated with objective SCORAD (p = 0.004) and lesion intensity [erythema (p = 0.022) and lichenification (p = 0.035)]; and excoriation (p = 0.024) and TEWL (p = 0.009) in the antecubital fossa. The relative risk of isolating moderate-to-heavy growth of SA in the most affected area in patients with severe disease (objective SCORAD >40) is 2.73 (1.43-5.21, p = 0.001). Any growth of SA in either swab sites was associated with objective SCORAD and lesion intensity (p = 0.001-0.019). SA had no association with quality of life and other clinical parameters. All specimens of methicillin-sensitive SA were sensitive to cloxacillin. All methicillin-resistant SA (MRSA) (5.7%) was sensitive to co-trimoxazole and fusidic acid. CONCLUSIONS: Clinical features, especially severity and lesion intensity, are useful in "predicting" moderate-to-heavy SA colonization/infection in ADpatients. Cloxacillin has a favorable sensitivity profile for MSSA, and co-trimoxazole and fusidic acid for MRSA. As colonization and infection are ambiguous and potentially overlapping clinical states, we recommend to abandon these terms and propose to describe quantitatively/semi-quantitatively SA isolation as none, mild, scanty, moderate or heavy growth instead in clinical trials.
Entities:
Keywords:
Atopic dermatitis; SCORAD; Staphylococcus aureus; children; flexures; quality of life
Authors: James Q Del Rosso; Ted Rosen; Diane Thiboutot; Guy F Webster; Richard L Gallo; James J Leyden; Clay Walker; George Zhanel; Lawrence Eichenfield Journal: J Clin Aesthet Dermatol Date: 2016-06-01
Authors: Kam Lun Hon; Kathy Yin Ching Tsang; Jeng Sum C Kung; Ting Fan Leung; Christopher W K Lam; Chun Kwok Wong Journal: Molecules Date: 2017-02-14 Impact factor: 4.411