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Microbiologic characterisation of bacterial infections in children with atopic dermatitis
Nkosinathi O Zwane1, Josiah T Masuka1, Antoinette V Chateau1
1Department of Dermatology, Faculty of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Insights
Staphylococcus aureus is the most common bacterial cause of skin infections in children with atopic dermatitis (AD). Amoxicillin-clavulanic acid and cloxacillin are the most effective treatments, though further research on resistance is needed.
Area of Science:
- Dermatology
- Microbiology
- Pediatrics
Background:
- Atopic dermatitis (AD) is a common chronic inflammatory skin condition.
- Patients with AD are frequently colonized and infected by Staphylococcus aureus.
- Identifying causative bacteria and their antibiotic sensitivities is crucial for effective treatment.
Purpose of the Study:
- To determine the types of bacteria infecting eczematous lesions in children with AD.
- To assess the antibiotic sensitivities of these bacteria.
- To recommend appropriate first-line antibiotic therapies for pediatric AD skin infections.
Main Methods:
- A prospective study was conducted from June 2020 to June 2021.
- Children with AD and cutaneous infections were recruited from an outpatient dermatology clinic.
- Microbial cultures and antibiotic sensitivity testing were performed on swabs from infected sites.
Main Results:
- Staphylococcus aureus was the most common pathogen, identified in 77.1% of cases.
- Co-infection with Group A Streptococcus (GAS) occurred in 22.9% of cases.
- Amoxicillin-clavulanic acid (77.0%) and cloxacillin (71.6%) showed high sensitivity against S. aureus; GAS was sensitive to ampicillin (45.5%).
Conclusions:
- Staphylococcus aureus is the predominant bacterial cause of skin infections in children with AD in this setting.
- Amoxicillin-clavulanic acid and cloxacillin are recommended as sensitive therapeutic options.
- Further studies are needed to investigate potential antibiotic resistance patterns.
Background:
Patients with atopic dermatitis (AD), the commonest chronic inflammatory skin disease are often colonised and infected by Staphylococcus aureus. In this study, we aimed to determine the type and antibacterial sensitivities of the bacteria infecting eczematous lesions in children with AD and to recommend first-line antibiotic therapy.
Methods:
A prospective study was conducted from June 2020 to June 2021 in children with AD presenting with a cutaneous infection at the King Edward hospital VIII outpatient dermatology clinic. Swabs were collected for microbial culture, confirming infections and assessing antibiotic sensitivity for infected sites.
Results:
Ninety six children were recruited during the study period with a mean age of 4.3 ± 3.4 years. The commonest cause of bacterial infection was Staphylococcus aureus seen in 74 (77.1%) cases, followed by Staphylococcus aureus and Group A β-haemolytic streptococcus (GAS) co-infection in 22 (22.9%) cases. The majority of these infections were observed on the lower limbs in 50 (52.08%) cases and in moderate 37 (38.5%) cases and severe eczema cases of 38 (39.6%) in AD. There was no gender predilection. Staphylococcus aureus was sensitive to amoxicillin-clavulanic acid in 57 (77.0%) cases, cloxacillin in 53 (71.6%) cases and clindamycin in 24 (32.4%) cases, whereas GAS was mostly sensitive to ampicillin in 10 (45.5%) cases. No swabs retained a resistant strain.
Conclusion:
Staphylococcus aureus is the commonest bacterial cause of cutaneous infection in children with AD in our setting. Amoxicillin-clavulanic acid and cloxacillin remain the most sensitive therapeutic options for this infection, however, a larger study is required to explore resistance strains, if any, in our setting.
