Prevalence and odds of Staphylococcus aureuscarriage in atopic dermatitis: a systematic review and meta-analysis

Abstract

SummaryBackground Staphylococcus aureus is increasingly implicated as a possible causal factor in the pathogenesis of atopic dermatitis (AD). However, the reported prevalence rates of skin and nasal colonization in the literature vary widely. Objectives This study evaluates the prevalence and odds of skin and nasal colonization with S. aureus in patients with AD. Methods A systematic literature search was conducted. Odds ratios (ORs) for colonization in patients vs. controls and the prevalence of colonization in patients were pooled using the random-effects model. Results Overall, 95 observational studies were included, of which 30 had a control group. The Newcastle-Ottawa Scale was used to assess study quality, with the majority of studies being of fair to poor quality. Patients with AD were more likely to be colonized with S. aureus than healthy controls [OR 19Á74, 95% confidence interval (CI) 10Á88-35Á81]. Differences were smaller in nonlesional skin (OR 7Á77, 95% CI 3Á82-15Á82) and in the nose (OR 4Á50, 95% CI 3Á00-6Á75). The pooled prevalence of S. aureus colonization among patients was 70% for lesional skin, 39% for nonlesional skin and 62% for the nose. In lesional skin, meta-regression showed that the prevalence of colonization increased with disease severity. Study heterogeneity should be taken into consideration when interpreting the results. Conclusions These results demonstrate the importance of colonization with S. aureus in AD. Further evaluation of the mechanisms by which S. aureus influences inflammation is required in addition to the development of targeted strategies to decrease skin and nasal S. aureus load.

Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care

“…6 Staphylococcus aureus (S. aureus) can be isolated from lesional skin in about 70% of patients with eczema. The odds of colonization are nearly 20 times those in people without eczema, 7 and more severe eczema is associated with higher organism density. 8 Despite the clear association between eczema and the presence of S. aureus, however, there is uncertainty about what constitutes infection and when antibiotic treatments are likely to confer benefit.…”

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

“…Some products have antimicrobial properties that may help to reduce the bacterial load on the skin, which may be important in AE. 9 However, the evidence from randomised controlled trials (RCTs) supporting the use of silk garments is limited. 10,11 To identify RCTs published prior to the CLOTHES trial, we searched the Global Resource of Eczema Trials database.…”

Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies

“…S. aureus colonizes the skin of 70–90% of patients with AD, in contrast to only 5% of normal population 14, 15. This is due to a defect in skin barrier function, repeated scratching, and deficient cutaneous antimicrobial peptides 16.…”