Change in Antimicrobial Susceptibility of Skin-Colonizing Staphylococcus aureus in Korean Patients with Atopic Dermatitis during Ten-Year Period

Abstract

BackgroundA small subset of adolescents atopic dermatitis (AD) tends to persist. This also leads to get more antibiotics exposure with advancing years. Antibiotic resistance has been regarded as a serious problem during Staphylococcus aureus treatment, especially methicillin-resistant S. aureus (MRSA).ObjectiveIt was investigated the S. aureus colonization frequency in the skin lesions and anterior nares of adolescent AD patients and evaluated the changes in S. aureus antimicrobial susceptibility for years.MethodsPatients who visited our clinic from September 2003 to August 2005 were classified into group A, and patients who visited from August 2010 to March 2012 were classified into group B. To investigate the differences with regard to patients' age and disease duration, the patients were subdivided into groups according to age. Lesional and nasal specimens were examined.ResultsAmong the 295 AD patients, the total S. aureus colonization rate in skin lesions was 66.9% (95/142) for group A and 78.4% (120/153) for group B. No significant changes in the systemic antimicrobial susceptibilities of S. aureus strains isolated from adolescent AD patients were observed during about 10-year period. The increased trend of MRSA isolation in recent adolescent AD outpatients suggest that the community including school could be the source of S. aureus antibiotic resistance and higher fusidic acid resistance rates provides evidence of imprudent topical use.ConclusionRelatively high MRSA isolation and fusidic acid resistance rates in recent AD patients suggest that the community harbors antibiotic-resistant S. aureus.

The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group

“…In another study, 4–19% of children with AD from the U.K. and Ireland were found to be colonized with MRSA . The reported prevalence of MRSA colonization in patients with AD in Sri Lanka is 8%, and in Korea 3–14% . A meta‐analysis of MRSA colonization in the general population reported a prevalence of 0·2–7% worldwide .…”

“…Staphylococcus aureus also stimulates keratinocytes to increase their endogenous protease activity . Whole‐genome sequencing of S. aureus has recently revealed higher levels of antimicrobial resistance genes in S. aureus isolates from children with AD than in those from healthy control children, suggesting additional potential S. aureus virulence mechanisms in AD …”

Colonization With Staphylococcus aureus in Atopic Dermatitis Patients: Attempts to Reveal the Unknown

“…It can be diffused by autotransmission on the skin area ( Breuer et al, 2002 ). The most colonized site is lesional skin (56–96.2%) ( Matsui et al, 2000 ; Park et al, 2016 ; Totté et al, 2016 ; Alsterholm et al, 2017 ), nose (46.1–64.1%) ( Na et al, 2012 ; Park et al, 2016 ; Totté et al, 2016 ; Clausen et al, 2017 ), and non-lesional skin (28–39%) ( Matsui et al, 2000 ; Totté et al, 2016 ; Clausen et al, 2017 ). Several studies demonstrated that 65–77.3% ( Breuer et al, 2002 ; Tomi et al, 2005 ; Na et al, 2012 ) of AD patients were colonized both in the anterior nares and on the skin, whereas only 10.2% of healthy control subjects were colonized on the skin ( Matsui et al, 2000 ).…”

Interactions Between Atopic Dermatitis and Staphylococcus aureus Infection: Clinical Implications

“…A decreased diversity of the skin microbiota and increased abundance of S. aureus were observed during flares of AD 53. Additionally, MRSA colonization was significantly associated with the misuse of antibiotics and previous hospitalization 11418. The reason for this relationship is believed to be that S. aureus produces toxins, proinflammatory cytokines and proteases that cause dysregulation of skin homeostasis by affecting keratinocytes and various immune cells in AD skin 5455…”

“…It is well known that S. aureus colonizes skin in 60%–100% of AD patients as compared to 5%–30% of healthy controls 910111213. Moreover, 10%–30% of S. aureus isolated from AD patients shows methicillin-resistant S. aureus (MRSA), although there are variations according to areas and the prevalence of MRSA infection is increasing 131415161718. In this review, we discuss S .…”