title: Clinical features and Staphylococcus aureus colonization/infection in childhood atopic dermatitis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and.
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and.
authors.forename: Yin Ching
authors.initials: YC
authors.lastname: Tsang
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and.
authors.forename: N H
authors.initials: NH
authors.lastname: Pong
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and.
authors.forename: Chantel
authors.initials: C
authors.lastname: Ng
authors.affiliation: b Department of Microbiology , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China.
authors.forename: Margaret
authors.initials: M
authors.lastname: Ip
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, Hong Kong SAR , China and.
authors.forename: Ting Fan
authors.initials: TF
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000523:psychology; D005260:Female; D005672:Fusidic Acid / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008712:Methicillin / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000523:psychology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005672:Fusidic Acid; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008712:Methicillin
keywords: Atopic dermatitis; SCORAD; Staphylococcus aureus; children; flexures; quality of life