Huang Jennifer T, Abrams Melissa, Tlougan Brook, Rademaker Alfred, Paller Amy S
Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Pediatrics. 2009 May;123(5):e808-14. doi: 10.1542/peds.2008-2217.
The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.
A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.
The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus-positive skin cultures and 4% of our S aureus-positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%-85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.
Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.
本研究旨在确定社区获得性耐甲氧西林金黄色葡萄球菌在特应性皮炎患者中的定植率，并确定使用次氯酸钠（漂白剂）浴和鼻内莫匹罗星治疗抑制金黄色葡萄球菌生长是否能改善湿疹严重程度。
对31例年龄在6个月至17岁、患有中度至重度特应性皮炎且有继发性细菌感染临床体征的患者进行了一项随机、研究者盲法、安慰剂对照研究。所有患者口服头孢氨苄14天，并随机分为接受鼻内莫匹罗星软膏治疗和次氯酸钠（漂白剂）浴（治疗组）或鼻内凡士林软膏治疗和平水浴（安慰剂组），为期3个月。主要结局指标为湿疹面积和严重程度指数评分。
我们研究中社区获得性耐甲氧西林金黄色葡萄球菌的定植率（金黄色葡萄球菌阳性皮肤培养物的7.4%和金黄色葡萄球菌阳性鼻培养物的4%）远低于儿童纪念医院进行培养的普通人群（75%-85%）。在1个月和3个月的随访中，与安慰剂组相比，接受稀释漂白剂浴和鼻内莫匹罗星治疗的患者在湿疹面积和严重程度指数评分方面从基线的平均降低幅度显著更大。治疗组患者头颈部的湿疹面积和严重程度指数平均评分未下降，而与接受安慰剂治疗的患者相比，其他身体部位（浸泡在稀释漂白剂浴中）的评分在1个月和3个月时下降。
长期使用稀释漂白剂浴并间歇性鼻内应用莫匹罗星软膏可降低有继发性细菌感染临床体征的特应性皮炎患者的临床严重程度。特应性皮炎患者似乎对耐甲氧西林金黄色葡萄球菌耐药菌株的感染或定植易感性并未增加。
