Goh C L, Wong J S, Giam Y C
National Skin Centre, Singapore.
Int J Dermatol. 1997 Sep;36(9):653-7. doi: 10.1046/j.1365-4362.1997.00290.x.
This prospective study sought to determine the bacterial colonization rates on eczematous and non-eczematous skin and nasal mucosa of patients with atopic dermatitis attending a tertiary dermatologic referral clinic in Singapore. The colonization rates were evaluated according to age, sex, race, and severity of dermatitis compared with controls. The results may help to determine whether antibiotics should be considered in the treatment of atopic dermatitis.
Patients, of any age, presenting with atopic dermatitis at the subsidized clinic of the National Skin Centre, Singapore, between 23 August 1996 and 14 September 1996, were included in the study.
Thirty-three patients with atopic dermatitis were seen at the outpatient clinic during the study period. Staphylococcus aureus was isolated in 69.7% of the eczematous lesions and in 42.4% of non-eczematous skin of patients with atopic dermatitis. S. aureus was isolated in 53% of patients with mild dermatitis, and in 100% with moderate and severe dermatitis. The nasal carriage rate of S. aureus was higher in atopic dermatitis patients (51.5%) than in non-atopics (35%) (not significant). S. aureus was isolated in 42% of non-eczematous skin in atopics compared with only 5% in the control group (p = 0.003). In patients with atopic dermatitis, all S. aureus isolated was sensitive to cloxacillin, cephalexin, clindamycin, and co-trimoxazole; 92% was sensitive to erythromycin, but only 13% was sensitive to penicillin and ampicillin. In the control group, all S. aureus isolated was sensitive to cloxacillin, cephalexin, erythromycin, clindamycin, and co-trimoxazole, but only 13% was sensitive to penicillin and ampicillin, and 87% to tetracycline.
This study confirmed that the skin of patients with atopic dermatitis was more frequently colonized with S. aureus than that of non-atopics. The more severe the dermatitis, the higher the rate of colonization. S. aureus is also more of than present in non-eczematous skin of atopics than of non-atopics. There is also a higher percentage of S. aureus nasal carriage in patients with atopic dermatitis than in non-atopics. Hence antibiotics may have a role in the treatment of atopic dermatitis. Because 87% of S. aureus is resistant to penicillin and ampicillin, antibiotics such as cloxacillin and cephalexin should be used to eradicate S. aureus in the skin of atopic dermatitis individuals.
本前瞻性研究旨在确定在新加坡一家三级皮肤科转诊诊所就诊的特应性皮炎患者的湿疹性和非湿疹性皮肤及鼻黏膜上的细菌定植率。将根据年龄、性别、种族和皮炎严重程度与对照组比较定植率。结果可能有助于确定在特应性皮炎治疗中是否应考虑使用抗生素。
1996年8月23日至1996年9月14日期间在新加坡国立皮肤中心补贴诊所就诊的任何年龄的特应性皮炎患者纳入本研究。
研究期间门诊共诊治33例特应性皮炎患者。金黄色葡萄球菌在特应性皮炎患者的69.7%的湿疹性皮损和42.4%的非湿疹性皮肤中分离到。轻度皮炎患者中金黄色葡萄球菌分离率为53%，中度和重度皮炎患者中为100%。特应性皮炎患者金黄色葡萄球菌的鼻腔携带率（51.5%）高于非特应性皮炎患者（35%）（无显著性差异）。特应性皮炎患者非湿疹性皮肤中金黄色葡萄球菌分离率为42%，而对照组仅为5%（p = 0.003）。在特应性皮炎患者中，分离出的所有金黄色葡萄球菌对氯唑西林、头孢氨苄、克林霉素和复方新诺明敏感；92%对红霉素敏感，但仅13%对青霉素和氨苄西林敏感。在对照组中，分离出的所有金黄色葡萄球菌对氯唑西林、头孢氨苄、红霉素、克林霉素和复方新诺明敏感，但仅13%对青霉素和氨苄西林敏感，87%对四环素敏感。
本研究证实特应性皮炎患者的皮肤比非特应性皮炎患者更易被金黄色葡萄球菌定植。皮炎越严重，定植率越高。特应性皮炎患者非湿疹性皮肤中金黄色葡萄球菌的存在也比非特应性皮炎患者更常见。特应性皮炎患者金黄色葡萄球菌的鼻腔携带率也高于非特应性皮炎患者。因此抗生素可能在特应性皮炎治疗中起作用。由于87%的金黄色葡萄球菌对青霉素和氨苄西林耐药，应使用氯唑西林和头孢氨苄等抗生素根除特应性皮炎患者皮肤中的金黄色葡萄球菌。
