Characteristics of <i>Staphylococcus aureus</i> colonization in patients with atopic dermatitis in Sri Lanka

Gomes, P.L.R.; Malavige, Gathsaurie Neelika; Fernando, Neluka; Mahendra, M. H. R.; Kamaladasa, S. D.; Seneviratne, Jayamini; Karunatilaka, D.H.; Ogg, Graham S.

doi:10.1111/j.1365-2230.2010.03962.x

Cited by 26 publications

(20 citation statements)

References 25 publications

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“…Although only a small percentage of the general population has been reported to be either colonized or infected by the bacteria, the prevalence increases to up to 90% in patients suffering from atopic skin disease (Goh et al, 1997;Chiu et al, 2009;Gomes et al, 2011). First, Strange et al (1994) observed KC-mediated activation of allogeneic T cells in the presence of IFN-g and staphylo-enterotoxin B that was reduced by the addition of HLA-DR antibodies.…”

Section: Direct Activation Of Antigen-specific T Cellsmentioning

confidence: 92%

The Epidermis as an Adjuvant

Gutowska-Owsiak

Ogg

2012

Journal of Investigative Dermatology

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It is now clear that the epidermis has an active role in local immune responses in the skin. Keratinocytes are involved early in inflammation by providing first-line innate mechanisms and, in addition, can contribute to adaptive immune responses that may be associated with clinical disease. Moreover, keratinocytes are capable of enhancing and shaping the outcome of inflammation in response to stimuli and promoting particular types of immune bias. Through understanding the underlying mechanisms, the role of keratinocytes in disease pathogenesis will be further defined, which is likely to lead to the identification of potential targets for prophylactic or therapeutic intervention.

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Section: Direct Activation Of Antigen-specific T Cellsmentioning

confidence: 92%

The Epidermis as an Adjuvant

Gutowska-Owsiak

Ogg

2012

Journal of Investigative Dermatology

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“…Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol 2010;163: [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Section: Scientific Summary Backgroundmentioning

confidence: 99%

“…21,23 Furthermore, more severe eczema is associated with higher densities of the organisms 21,23,24 and more resistant strains. 25 There is evidence that a number of factors contribute to this propensity for colonisation and infection, including dysregulation of the adaptive immune response, reduced antimicrobial peptide levels, diminished recruitment of cells to the skin, toll-like receptor defects and epidermal barrier abnormalities. 26 The exact role of S. aureus in the maintenance or exacerbation of eczema is not clear.…”

Section: Infected Eczemamentioning

confidence: 99%

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Francis

Ridd

Thomas-Jones

et al. 2016

Health Technol Assess

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BackgroundSecondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice.ObjectiveTo determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema.DesignMulticentre randomised, double-blind, placebo-controlled trial.SettingGeneral practices and dermatology clinics in England, Wales and Scotland.ParticipantsChildren (aged 3 months to < 8 years) with a diagnosis of eczema (according to U.K. Working Party definition) and clinical suspicion of infection.Interventions(1) Oral flucloxacillin and topical placebo; (2) topical fusidic acid (Fucidin®, Leo Laboratories Limited) and oral placebo; and (3) oral and topical placebos, all for 1 week.Main outcome measuresPatient-Orientated Eczema Measure (POEM) at 2 weeks (assessing subjective severity in the week following treatment).ResultsWe randomised 113 children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children hadStaphylococcus aureuscultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) –1.35 to 4.40] and 1.49 (95% CI –1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI –0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings.ConclusionsOur data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection andS. aureuson their skin, participants primarily had mild–moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of ‘severe infection’. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2011-003591-37 and Current Controlled Trials ISRCTN96705420.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…However, the benefit of antibiotic use in AD is still disputed with a Cochrane review presenting studies showing no significant difference in global outcome for clinically infected eczema when oral antibiotics were compared with placebo or when topical steroid antibiotic combinations were compared with steroid alone [50]. Given the contradictory results available, it would be prudent to be restrictive in prescribing antibiotics, mainly because of an increasing resistance problem worldwide [55, 56, 57, 58]. …”

Section: The Rationale For Antiseptic Use In Atopic Eczemamentioning

confidence: 99%

The role of antiseptic agents in atopic dermatitis

Lee¹,

Bever²

2014

Asia Pacific Allergy

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The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

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Characteristics of Staphylococcus aureus colonization in patients with atopic dermatitis in Sri Lanka

Abstract: SA colonization rates were significantly associated with increasing age and severity of AD, and particularly with duration of lesions. Patients with severe disease were also more likely to be colonized with SA strains resistant to conventional antibiotics.

Cited by 26 publications

References 25 publications

The Epidermis as an Adjuvant

The Epidermis as an Adjuvant

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

The role of antiseptic agents in atopic dermatitis

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