title: Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study.
abstract: BACKGROUND
  Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD). The incidence of community-acquired methicillin-resistant S. aureus infection (MRSA) in the AD population is unknown.
  
  
  OBJECTIVE
  This study aimed to assess the prevalence of S. aureus and MRSA in pediatric patients with AD, to compare disease severity, and to characterize the clonal diversity of the isolates.
  
  
  METHODS
  We carried out a prospective, cross-sectional study of 200 patients with AD. The severity of AD was defined as mild, moderate, or severe depending on a composite AD severity score. A swab was taken from the nares of each patient and another from affected skin or folds. Genotyping of all S. aureus isolates was conducted by polymerase chain reaction (PCR) amplification of the S. aureus protein A (spa) gene.
  
  
  RESULTS
  According to the severity score, 66.5% of subjects were ranked as having mild AD, 29.5% as having moderate and 4% as having severe AD. Staphylococcus aureus colonization was seen in 61.5% of all patients, represented by 43.7% of skin swabs and 48% of nares swabs. Only one of the isolations represented MRSA. Older age and higher AD severity scores were associated with S. aureus colonization (P = 0.03 and P < 0.001, respectively). No significant associations were noted for attendance at day care, family members with frequent skin infections, or family members working in healthcare. Isolates from spa CC015 were cultured in 19.2% of patient samples. The single MRSA culture showed a new spa type that belonged to CC127.
  
  
  CONCLUSIONS
  The results of this study confirm a high rate of S. aureus colonization of pediatric patients with AD. The low rate of MRSA requires further proof from larger prospective studies.
authors: Division of Pediatric Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.
authors: Alexandra
authors: A
authors: Balma-Mena
authors: Irene
authors: I
authors: Lara-Corrales
authors: Jeanne
authors: J
authors: Zeller
authors: Susan
authors: S
authors: Richardson
authors: Martin J
authors: MJ
authors: McGavin
authors: Miriam
authors: M
authors: Weinstein
authors: Elena
authors: E
authors: Pope