Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.
Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México.
JAMA Dermatol. 2024 Nov 1;160(11):1171-1181. doi: 10.1001/jamadermatol.2024.3360.
Individuals with atopic dermatitis are frequently colonized and infected with Staphylococcus aureus. Empirical antibiotic therapy for individuals with atopic dermatitis is common, but data about the antimicrobial susceptibility profiles of S aureus strains isolated from these individuals are scarce for those living in particular geographic areas.
To determine the antimicrobial susceptibility of S aureus from individuals with atopic dermatitis and analyze differences according to the income level of the country of origin and the data collection period.
A meta-analysis of the literature was performed from the inception of the included databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane) to June 20, 2023, using predetermined Medical Subject Headings.
Studies were included if they reported antibiotic susceptibility profiles of 1 or more S aureus cutaneous isolates from individuals with atopic dermatitis. Articles written in English, Spanish, French, or German were included.
Working in pairs, 6 of the authors conducted the data extraction. The guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.
The outcome of interest was antimicrobial susceptibility.
A total of 61 studies reported 4091 S aureus isolates from individuals with atopic dermatitis. For 4 of the 11 commonly used antibiotics (36.4%), antimicrobial susceptibility was 85% or less, including for methicillin (binomial proportion, 0.85 [95% CI, 0.76-0.91]), erythromycin (binomial proportion, 0.73 [95% CI, 0.61-0.83]), fusidic acid (binomial proportion, 0.80 [95% CI, 0.62-0.91]), and clindamycin (binomial proportion, 0.79 [95% CI, 0.65-0.89]). Most studies (46; 75.4%) were conducted in high-income countries. Antimicrobial susceptibility to erythromycin, methicillin, and trimethoprim and sulfamethoxazole was significantly lower in lower middle-income countries and upper middle-income countries. Regarding the temporal trends, 33 studies (54.1%) reported data collected from 1998 to 2010. Antimicrobial susceptibility patterns have not changed over time.
In this systematic review and meta-analysis, antimicrobial susceptibility of S aureus to β-lactams, erythromycin, clindamycin, and fusidic acid may be suboptimal for empirical use in individuals with atopic dermatitis. Significant differences in antimicrobial susceptibility patterns were found in high-income countries and in lower middle-income countries and upper middle-income countries for some antibiotics.
特应性皮炎患者常被金黄色葡萄球菌定植和感染。特应性皮炎患者的经验性抗生素治疗很常见，但对于来自这些患者的金黄色葡萄球菌分离株的抗菌药敏谱数据，在特定地理区域内的相关信息仍然缺乏。
确定特应性皮炎患者的金黄色葡萄球菌的抗菌药敏性，并分析根据原籍国的收入水平和数据收集时间的差异。
从纳入数据库（MEDLINE、Embase、Web of Science、Scopus 和 Cochrane）的初始时间到 2023 年 6 月 20 日，使用预先确定的医学主题词进行了文献的荟萃分析。
如果研究报告了 1 例或多例特应性皮炎患者的金黄色葡萄球菌皮肤分离株的抗生素药敏谱，则纳入研究。纳入了英文、西班牙语、法语或德语撰写的文章。
6 位作者成对进行数据提取。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
感兴趣的结果是抗菌药敏性。
共有 61 项研究报告了 4091 例来自特应性皮炎患者的金黄色葡萄球菌分离株。对于 11 种常用抗生素中的 4 种（36.4%），抗菌药敏性低于 85%，包括甲氧西林（二项比例，0.85[95%CI，0.76-0.91]）、红霉素（二项比例，0.73[95%CI，0.61-0.83]）、夫西地酸（二项比例，0.80[95%CI，0.62-0.91]）和克林霉素（二项比例，0.79[95%CI，0.65-0.89]）。大多数研究（46 项；75.4%）是在高收入国家进行的。中低收入国家和中高收入国家的红霉素、甲氧西林和磺胺甲噁唑/甲氧苄啶的抗菌药敏性明显较低。关于时间趋势，33 项研究（54.1%）报告了 1998 年至 2010 年收集的数据。抗菌药敏模式并没有随时间而改变。
在这项系统评价和荟萃分析中，β-内酰胺类、红霉素、克林霉素和夫西地酸对金黄色葡萄球菌的抗菌药敏性可能不适合特应性皮炎患者的经验性使用。对于一些抗生素，在高收入国家以及中低收入国家和中高收入国家发现了抗菌药敏模式的显著差异。
