Swabs for infected atopic dermatitis
Date First Published:
July 1, 2010
Last Updated:
July 11, 2010
Report by:
Anna James, Medical Student (University of Manchester)
Three-Part Question:
IN [children with infected atopic dermatitis] WILL [a swab] INFLUENCE [the choice of antibiotic treatment]?
Clinical Scenario:
A six year old boy attends the Paediatric Emergency Department. He has area of broken eczematous skin that appears to be infected. He has been treated with Flucloxacillin but it appears to have made no difference.
You wonder if other bacteria may be present or if there is antibiotic resistance and what antibiotic to use.
You wonder if other bacteria may be present or if there is antibiotic resistance and what antibiotic to use.
Search Strategy:
Cochrane database, OVID medline< 1950 to June Week 3 2010, EMBASE < 1980 to Week 25 2010. CINAHL.
Search Details:
Cochrane database: 'atopic dermatitis' OR 'eczema'.
OVID Medline/EMBASE/CINAHL: (exp dermatitis,atopic OR exp eczema) AND (exp infection OR exp bacteria) LIMIT to child < 18 years AND human AND english language.
OVID Medline/EMBASE/CINAHL: (exp dermatitis,atopic OR exp eczema) AND (exp infection OR exp bacteria) LIMIT to child < 18 years AND human AND english language.
Outcome:
Cochrane database: 37 found. 0 relevant.
OVID Medline: 408 found. 3 relevant.
EMBASE: 619 found. 2 relevant.
CINAHL: 205 found. 0 relevant.
OVID Medline: 408 found. 3 relevant.
EMBASE: 619 found. 2 relevant.
CINAHL: 205 found. 0 relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Characterization of Staphylococcus aureus cutaneous infections in a paediatric dermatology tertiary health care outpatient facility Ortega-Loayza AG, Diamantis SA, Gilligan P and Morrell DS. May-10 United States | 93 children aged 0 to 18 years with infected skin conditions recruited from a dermatology clinic. 61 (66%) children had atopic dermatitis. | Prospective observational study. Swabs were taken from children presenting with signs of skin and soft tissue infection. | 141 cultures were analysed | 97 cultures were Staphylococcus aureus, 32% were methicillin-resistant. 31 patients had multiple cultures. 3.5% had streptococcus infections. Also found were enterococcus and diphtheroids. | Sample size not discussed. Person(s) performing skin swabs are not mentioned, results may have differed depending on the way sample was taken. |
| 97 cultures were tested for antibiotic susceptibility | Penicillin resistance 86%, erythromycin resistance 46%, methicillin 32%, clindamycin 22%, gentamicin 3% | ||||
| Methicillin-resistant Staphylococcus aureus had multiple resistance | Erythromycin resistance 71%, clindamycin 16%, gentamicin 2% | ||||
| Frequency and clinical role of Staphylococcus aureus overinfection in atopic dermatitis in children. Ricci G, Patrizi A, Neri I, Bendandi B and Masi M. September-October 2003 Italy | 81 children aged 2 months to 9 years with exudative moderate to severe atopic dermatitis recruited from a dermatology clinic. | Prospective observational cohort study. Swabs were taken from all children with exudative eczematous lesions. | 308 samples were taken | 52 (64.2%) children were colonised with Staphylococcus aureus. 5 with Streptococcus pyogenes. 1 with Candida albicans. | Sample size not mentioned. No standardisation of sample taking. No basic epidemiological data about the patients. |
| Age-related prevalence and antibiotic resistance of pathogenic staphylococci and streptococci in children with infected atopic dermatitis at a single-specialty center. Arkwright PD, Daniel TO, Sanyal D, David TJ, Patel L. Jul-02 United Kingdom | 150 records of children aged 0 to 16 years with atopic dermatitis who had skin swabs taken for suspected infection. | Retrospective cohort study. | Staphylococcus aureus identified | All samples (100%): all were resistant to at least one antibiotic | No attempt to standardise swab technique. No mention of inclusion criteria. No basic epidemiological data about the patient group. |
| Pyogenes streptococci identified | 80 samples (53%) | ||||
| Methicillin-resistant staphylococcus aureus (MRSA) identified | 15 samples (19%) |
Author Commentary:
The papers show that a range of bacteria can infect atopic dermatitis. The most common bacterium found was Staphylococcus aureus. Treatment should therefore be initiated to treat this organism. Staphylococcus aureus was found to vary in resistance including resistance to methicillin (MRSA). A skin swab should be taken to allow the identification of another organism or resistance and the most effective antibiotic treatment to be given.
Bottom Line:
A skin swab should be taken when infection of atopic dermatitis is suspected in order to provide effective antibiotic treatment.
References:
- Ortega-Loayza AG, Diamantis SA, Gilligan P and Morrell DS.. Characterization of Staphylococcus aureus cutaneous infections in a paediatric dermatology tertiary health care outpatient facility
- Ricci G, Patrizi A, Neri I, Bendandi B and Masi M.. Frequency and clinical role of Staphylococcus aureus overinfection in atopic dermatitis in children.
- Arkwright PD, Daniel TO, Sanyal D, David TJ, Patel L.. Age-related prevalence and antibiotic resistance of pathogenic staphylococci and streptococci in children with infected atopic dermatitis at a single-specialty center.