Colonization by S. Aureusincreases the EASI and the number of appointments by patients with atopic dermatitis: cohort with 93 patients

Abstract

BACKGROUNDAtopic dermatitis leads to epidermal barrier dysfunction and bacteria colonization. The relationship of the last factor with the severity of the disease and the frequency of exacerbation is not fully known. OBJECTIVESVerify the severity of the atopic dermatitis and the number of appointments generated by dermatosis, comparing patients colonized with patients not colonized by S. aureus. Verify the frequency of colonization by methicillin resistant Staphylococcus aureus acquired in the community. METHODSCohort study with a 12 months follow-up, in a sample of patients from Porto Alegre, RS public network. Cultures in active injuries and nasal cavities were carried out as well as methicillin sensitivity tests to S. aureus. The severity of atopic dermatitis was defined by Eczema Area and Severity Index (EASI). RESULTSWe included 93 patients, 43% female and 56% male, 26 colonized by S. aureus in the nasal orifices, 56 in the skin damage. The mean of initial Eczema Area and Severity Index was 5.5 and final 3.9. The initial Eczema Area and Severity Index of patients colonized by S. aureus in the skin and nasal cavity was larger than the number of patients without colonization(p< 0.05). During the period of one year, in average, there were six appointments/patient. There was linear correlation between the number of appointments during one year and the inicial Eczema Area and Severity Index (r = 0,78). There were no patients with methicillin resistant Staphylococcus aureus acquired in the community. CONCLUSIONThere is a relevant influence of staphylococcal colonization on the severity of atopic dermatitis and the number of appointments required by its exacerbation. Methicillin resistance among those affected by S. aureus does not seem to be an emergent problem, in this Brazilian sample.

Community-acquired methicillin-resistant Staphylococcus aureus colonization in atopic dermatitis patients in Mansoura, Egypt

“…This could interpret the high rate of colonization in our study as more than half of our cases were severe AD. Patient with AD has increased risk of increasing antibiotic resistance due to the frequent use of topical and systemic antibiotics (Lipnharski et al 2013). In this study, a high rate of antibiotic resistance was reported.…”

Associations between atopic dermatitis and other disorders

“…There are a number of potential risk factors for infections to occur in AD patients, including skin-barrier dysfunction secondary to decreased expression of epidermal lipids and mechanical disruption from scratching 21 , decreased expression of anti-microbial peptides 22 , aberrant Toll-like receptor signaling and innate immunity 23 , 24 , increased colonization with Staphylococcus aureus in lesional and non-lesional skin 25 , 26 , and use of topical and/or systemic immunosuppressing medications (e.g. corticosteroids, calcineurin inhibitors, etc.).…”

Temporal variation of Staphylococcus aureus clonal complexes in atopic dermatitis: a follow‐up study

“…Skin barrier defects are a hallmark in AD and facilitate penetration and entry of microbes, giving patients with AD a predisposition to microbial skin infections . Up to 90% of patients with AD are colonized with Staphylococcus aureus , and despite a strong link between disease severity and S. aureus colonization, the precise role of S. aureus in the pathogenesis of AD is still unclear …”