Bacterial skin colonization and infections in patients with atopic dermatitis

Impetigo is a common cutaneous infection that is especially prevalent in children. Historically, impetigo is caused by either group A β-hemolytic streptococci or Staphylococcus aureus. Currently, the most frequently isolated pathogen is S. aureus. This article discusses the microbiologic and virulence factors of group A β-hemolytic streptococci and Staphylococcus aureus, clinical characteristics, complications, as well as the approach to diagnosis and management of impetigo. Topical agents for impetigo therapy are reviewed.

Section: Treatment Evolution Of Bacterial Resistancementioning

confidence: 99%

Impetigo - review

Pereira

2014

“…This pathogen potentially exacerbates or contributes to a persistent inflammation in the skin of AD patients by secreting toxins with super antigenic properties, leading to the activation of T cells and other immune cells. 5,19 …”

Section: Etiopathogenesismentioning

confidence: 99%

Atopic dermatitis and vitamin D: facts and controversies

Mesquita

Igreja

Costa

2013

Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved.

“…3 Atopic dermatitis (AD) is a chronic skin condition that has been strongly linked to the presence of S. aureus , while cutaneous infection constitutes an important mechanism of worsening disease. 4 Thus, patients are frequently prescribed or self-prescribe antimicrobial medication, often topical preparations of antimicrobials associated with corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis

Bessa

Quinto

Machado

et al. 2016

Self Cite

BackgroundTopical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization.ObjectiveTo evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients.MethodsWe conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin.ResultsA total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin.ConclusionsOur data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.