trimethoprim--sulfamethoxazole-drug-combination and Dermatitis--Atopic

Staphylococcus aureus is the most prevalent bacterial pathogen in atopic dermatitis (AD) patients presenting with skin infections. Despite the known association between S aureus and AD, guidance on empiric antibiotics for skin infections in pediatric AD patients is limited.. We conducted a retrospective study over a five-year period to characterize the S aureus strains recovered from pediatric AD patients with clinically apparent bacterial skin infections treated in an academic medical center. We assessed patient demographics and dilute bleach bath usage to determine whether these factors were correlated with methicillin resistance. Culture results from our AD cohort were also compared to those from pediatric patients presenting to the Saint Louis Children's Hospital emergency department (ED) with S aureus skin abscesses from 2013 to 2015.. Methicillin-sensitive S aureus (MSSA) was more prevalent (77.8%) than methicillin-resistant S aureus (MRSA) (22.2%). There was no correlation between MRSA and age, sex, race, or dilute bleach bath use. In comparison with pediatric patients presenting to the ED, AD patients had lower rates of MSSA susceptibility to doxycycline and MRSA susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX).. First-generation cephalosporins remain appropriate empiric therapy for most pediatric AD patients. In patients with a history of MRSA, empiric doxycycline or TMP-SMX could be considered, given their high MRSA susceptibility rates.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Dermatitis, Atopic; Emergency Service, Hospital; Female; Hospitals, Pediatric; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Sex Factors; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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.. 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.. 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.. 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.

Topics: Adolescent; Anti-Bacterial Agents; Child; Dermatitis, Atopic; Female; Fusidic Acid; Humans; Male; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Quality of Life; Severity of Illness Index; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotics, Antitubercular; Community-Acquired Infections; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Triclosan; Trimethoprim, Sulfamethoxazole Drug Combination