Age-Related Prevalence and Antibiotic Resistance of Pathogenic Staphylococci and Streptococci in Children With Infected Atopic Dermatitis at a Single-Specialty Center

Arkwright, Peter D.; Daniel, Titilayo O.; Sanyal, Debasish; David, T J; Patel, Leena

doi:10.1001/archderm.138.7.939

Cited by 55 publications

(45 citation statements)

References 21 publications

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“…This age group had resistance rates of 34%, whereas patients aged 6-10 years or >10 years had rates of 71% and 69%, respectively. This is in agreement with observations by Arkwright et al [12] of age-related differences of antibiotic resistance in children with atopic dermatitis. They found that S. aureus resistance to fusidic acid, methicillin and erythromycin increased from infancy to school age.…”

Section: Discussionsupporting

confidence: 93%

Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use

Sule¹,

Brown²,

Willocks³

et al. 2007

International Journal of Antimicrobial Agents

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Section: Discussionsupporting

confidence: 93%

Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use

Sule¹,

Brown²,

Willocks³

et al. 2007

International Journal of Antimicrobial Agents

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“…It is well known that prolonged topical or systemic antibiotic therapy may cause the development of the antibiotic-resistant strains of S. aureus [125,126]. Therefore, used for the reduction of S. aureus on AD skin, the most popular topical antibiotic is fusidic acid, which is effective for the inhibition of methicillin-resistant S. aureus.…”

Section: Antibiotic Resistance Of S Aureus In Atopic Dermatitismentioning

confidence: 99%

Role of Bacterial Pathogens in Atopic Dermatitis

Lin

Wang

Chiang

2007

Clinic Rev Allerg Immunol

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The skin of atopic dermatitis (AD) patients exhibits a striking susceptibility to colonization and infection with Staphylococcus aureus. This review summarizes our understanding about the role of S. aureus in AD. Indeed, S. aureus colonization is both a cause and a consequence of allergic skin inflammation. The mechanisms that allergic skin inflammation of AD promotes the increase of S. aureus colonization include skin barrier dysfunction, increased synthesis of the extracellular matrix adhesins for S. aureus, and defective innate immune responses due to decreased production of endogenous antimicrobial peptides. On the other hand, the exotoxins secreted by S. aureus are superantigens. Staphylococcal superantigens (SsAgs) may penetrate the skin barrier and contribute to the persistence and exacerbation of allergic skin inflammation in AD through the stimulation of massive T cells, the role of allergens, direct stimulation of antigen-presenting cells and keratinocytes, the expansion of skin-homing cutaneous lymphocyte-associated antigen-positive T cells, and the augmentation of allergen-induced skin inflammation. SsAgs also induce corticosteroid resistance. In therapeutic interventions, anti-inflammatory therapy alone is very effective in reducing S. aureus colonization on the skin, but antibiotic treatment alone is unable to improve the allergic skin inflammation of AD. Therefore, we recommend the combination therapy of anti-inflammatory drugs and antibiotics in the AD patients with secondary bacterial infection, exacerbated AD, or poorly controlled AD. However, when AD is well controlled by anti-inflammatory drugs alone, we do not recommend the antibiotic therapy.

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“…However, in some cases, patients with AD are refractory to these conventional treatments, making it a difficult‐to‐treat disease. Several authors have reviewed the subject of difficult‐to‐treat or difficult‐to‐control AD, stating diverse possible explanations for the problem, such as lack of compliance,1 psychosocial factors,2, 3 skin infections,4, 5 exacerbations triggered by food and aeroallergens,6, 7, 8 and concomitant allergic contact dermatitis (ACD) 9, 10, 11. All these factors may contribute to making the disease difficult‐to‐treat.…”

Section: Introductionmentioning

confidence: 99%

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

Boonstra

Rustemeyer

Middelkamp-Hup

2018

Acad Dermatol Venereol

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BackgroundConcomitant allergic contact dermatitis (ACD) has been described as a possible cause of atopic dermatitis (AD) becoming difficult‐to‐treat. However, contact sensitization in this patient group has barely been studied.ObjectiveTo study the occurrence of ACD in a population of difficult‐to‐treat AD children and adults.MethodsClinical and patch test information of 48 patients with difficult‐to‐treat AD unresponsive to conventional outpatient treatments was gathered retrospectively. We studied prevalence and relevance of common allergens, performed dynamic patch test analysis and assessed occurrence of polysensitization.ResultsIn 48 patients with difficult‐to‐treat AD, 75% (n = 36/48) had a concomitant contact allergy, and 39% (n = 14/36) of these patients were polysensitized. ACD and polysensitization prevalences were equal amongst children and adults. The most frequent and relevant reactions were seen against wool alcohols, surfactants cocamidopropyl betaine and dimethylaminopropylamine, bichromate and fragrance mix I. Dynamic pattern analysis showed these reactions to be mostly allergic and not irritative of nature.ConclusionDifficult‐to‐treat AD patients frequently suffer from concomitant (multiple) contact allergies, and this may be a reason why the AD turns into a difficult‐to‐treat disease. Awareness of this phenomenon is necessary, as pragmatic implementation of allergen avoidance strategies may be helpful in getting disease control in this population.

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Age-Related Prevalence and Antibiotic Resistance of Pathogenic Staphylococci and Streptococci in Children With Infected Atopic Dermatitis at a Single-Specialty Center

Cited by 55 publications

References 21 publications

Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use

Fusidic acid-resistant Staphylococcus aureus (FRSA) carriage in patients with atopic eczema and pattern of prior topical fusidic acid use

Role of Bacterial Pathogens in Atopic Dermatitis

Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

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