巴西阿雷格里港特应性皮炎患者中社区获得性耐甲氧西林金黄色葡萄球菌的患病率及抗生素耐药性

Prevalence of community-acquired methicillin-resistant Staphylococcus aureus and antibiotic resistance in patients with atopic dermatitis in Porto Alegre, Brazil.

作者信息

Petry Vanessa, Lipnharski Caroline, Bessa Giancarlo R, Silveira Vera B, Weber Magda B, Bonamigo Renan R, d'Azevedo Pedro A

机构信息

Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

出版信息

Int J Dermatol. 2014 Jun;53(6):731-5. doi: 10.1111/ijd.12020. Epub 2013 Oct 29.

DOI:10.1111/ijd.12020

PMID:24168078

Abstract

BACKGROUND

Atopic dermatitis (AD) is a skin manifestation of atopy caused by hyperreactivity to various antigens. Studies have shown that 60-100% of patients with this condition present with colonization by Staphylococcus aureus. Given increasing rates of antimicrobial resistance, the sensitivity to antimicrobials of S. aureus colonizing atopic patients has been investigated. Cross-sectional studies worldwide suggest that the prevalence of methicillin-resistant S. aureus infection (MRSA) in the AD population varies from 0% to 30.8%.

OBJECTIVES

The objectives of this study were to determinate the prevalence of S. aureus and MRSA in patients with AD in two dermatologic centers in Porto Alegre, Brazil.

METHODS

A total of 91 patients with AD attending two dermatologic centers in Porto Alegre were enrolled in this study from December 2009 to July 2011. Two skin swabs were taken from each patient, one from the nares and the other from a non-infected eczematous skin lesion. The swabs were sent to the laboratory, where standard procedures to isolate bacteria and identify S. aureus, antimicrobial resistance, and sensitivity patterns were carried out. The severity of AD was defined using the Eczema Area and Severity Index (EASI).

RESULTS

Of the 91 patients sampled, 67 (73.6%) patients were found to be positive for S. aureus colonization. Nasal swabs were positive in 55 (60.4%) patients, lesional swabs in 44 (48.4%) patients, and both lesional and nasal swabs were positive in 32 (35.2%) patients. Patients with positive swabs had a higher mean ± standard deviation EASI score [mean (9.1 ± 8.8)] compared with patients with negative swabs (3.9 ± 3.6) (P = 0.002). None of the 91 patients showed any evidence of MRSA infection. Overall, nearly 32% of the S. aureus isolated from nasal swabs and 36.40% of the S. aureus isolated from lesional swabs was resistant to erythromycin.

CONCLUSIONS

The results of this study confirm a high rate of S. aureus colonization in pediatric patients with AD and indicate a relevant association between colonization and high EASI score. No MRSA was found in cultures from this sample of patients in southern Brazil. Nearly one-third of isolates were identified as resistant to erythromycin, an antibiotic that is commonly used in pediatric patients.

摘要

背景

特应性皮炎（AD）是一种由对多种抗原反应过度引起的特应性皮肤表现。研究表明，60%-100%的该疾病患者存在金黄色葡萄球菌定植。鉴于抗菌药物耐药率不断上升，已对定植于特应性患者的金黄色葡萄球菌对抗菌药物的敏感性进行了研究。全球范围内的横断面研究表明，AD人群中耐甲氧西林金黄色葡萄球菌感染（MRSA）的患病率在0%至30.8%之间。

目的

本研究的目的是确定巴西阿雷格里港两个皮肤科中心AD患者中金黄色葡萄球菌和MRSA的患病率。

方法

2009年12月至2011年7月，共有91例在阿雷格里港两个皮肤科中心就诊的AD患者纳入本研究。从每位患者身上采集两份皮肤拭子，一份来自鼻腔，另一份来自未感染的湿疹性皮肤病变处。拭子被送往实验室，在那里进行分离细菌、鉴定金黄色葡萄球菌、抗菌药物耐药性和敏感性模式的标准程序。使用湿疹面积和严重程度指数（EASI）定义AD的严重程度。

结果

在91例采样患者中，67例（73.6%）患者金黄色葡萄球菌定植呈阳性。鼻腔拭子阳性的患者有55例（60.4%），皮损拭子阳性的患者有44例（48.4%），皮损和鼻腔拭子均阳性的患者有32例（35.2%）。拭子阳性的患者平均±标准差EASI评分[平均值（9.1±8.8）]高于拭子阴性的患者（3.9±3.6）（P=0.002）。91例患者中均未显示出MRSA感染的任何证据。总体而言，从鼻腔拭子分离出的金黄色葡萄球菌中近32%以及从皮损拭子分离出的金黄色葡萄球菌中36.40%对红霉素耐药。