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首页> 外文期刊>The Australasian journal of dermatology >Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: a New Zealand experience.
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Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: a New Zealand experience.

机译：特应性皮炎患儿的金黄色葡萄球菌患病率和抗生素耐药性：新西兰的经验。

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BACKGROUND/OBJECTIVES: Children with atopic dermatitis often have infective exacerbations which are treated with antibiotics and/or antiseptics. The most common infective cause is Staphylococcus aureus with a worldwide trend towards antibiotic resistance. This prospective observational audit aimed primarily to establish the prevalence of S. aureus colonisation in New Zealand children with atopic dermatitis attending a specialised paediatric dermatology clinic. Secondary aims were to assess whether S. aureus colonisation correlated to clinical severity, the sensitivity patterns to antibiotics (in particular methicillin-resistant S. aureus, and to identify any demographic or management risk factors. METHODS: Subjects were children aged 18 years or younger attending a tertiary public hospital dermatology clinic with a diagnosis of atopic dermatitis. Demographic and social data, as well as current and previous systemic and topical treatments, were recorded. Patients were examined and the extent of atopic dermatitis determined using a standardised scale (Scoring Atopic Dermatitis (SCORAD)). Two skin swabs were taken for culture and standard sensitivities; one from the left antecubital fossa and one from the worst area of atopic dermatitis. Microbiological cultures and density of S. aureus colonisation were recorded. SCORAD and density of S. aureus culture were correlated. Demographic and clinical data from children with S. aureus was analysed. RESULTS: One hundred children were recruited from March 2007 to May 2008. S. aureus was isolated from 68 patients. There was a positive correlation between the density of S. aureus culture and severity of SCORAD (Spearman r = 0.55, P < 0.0001). There was also a positive, though weaker, correlation between SCORAD and ethnicity with Maori /Polynesian children generally having more severe atopic dermatitis (r = 0.22, P = 0.028). Although a greater proportion of Maori or Pacific Island children were colonised by S. aureus than other ethnic groups this did not reach statistical significance (78% and 60%, respectively, P = 0.0842). There was no significant correlation between either S. aureus prevalence or its density and age (r = 0.09, P = 0.39 and r = 0.12, P = 0.23, respectively). There were no significant differences in sex or treatments (use of antibiotics, antiseptics, calcineurin inhibitors, emollients or corticosteroids) between S. aureus-positive and S. aureus-negative children. Only 12 S. aureus-positive children demonstrated antibiotic resistance, 10 to erythromycin and only two to flucloxacillin. CONCLUSIONS: Three quarters of children with atopic dermatitis have at least one positive culture, of which the vast majority is S. aureus. The density of S. aureus colonisation correlates to severity of atopic dermatitis. Children who are S. aureus culture-positive had no significant demographic or clinical features different to children who were culture-negative. Only two children grew S. aureus resistant to flucloxacillin (2% resistance rate), which remains the ideal first line of treatment in our local population.
机译：背景/目的：患有特应性皮炎的儿童通常具有感染性加重症，可使用抗生素和/或防腐剂进行治疗。最常见的感染原因是金黄色葡萄球菌，其耐药性在全球范围内呈趋势。这项前瞻性观察性审核主要旨在确定在特应性小儿皮肤科诊所就诊的新西兰特应性皮炎患儿中金黄色葡萄球菌定植的患病率。次要目的是评估金黄色葡萄球菌定植是否与临床严重程度，对抗生素（特别是耐甲氧西林的金黄色葡萄球菌）的敏感性模式相关，并确定任何人口统计学或管理风险因素。方法：受试者为18岁以下的儿童。在三级公立医院皮肤科门诊诊断为特应性皮炎，记录人口统计和社会数据，以及当前和以前的全身和局部治疗方法。对患者进行检查，并使用标准化量表（特应性皮炎）确定特应性皮炎的程度皮炎（SCORAD））：取两支拭子用于培养和标准敏感性试验;一支拭子放在左肘前窝，另一支从特应性皮炎的最坏区域采集，记录微生物培养物和金黄色葡萄球菌定植密度，SCORAD和S密度对金黄色葡萄球菌培养物进行相关分析，分析金黄色葡萄球菌患儿的人口统计学和临床​​数据。结果：从2007年3月至2008年5月招募了100名儿童。从68例患者中分离出金黄色葡萄球菌。金黄色葡萄球菌培养物的密度与SCORAD的严重程度之间存在正相关（Spearman r = 0.55，P <0.0001）。毛利族/波利尼西亚儿童通常患有较严重的特应性皮炎（r = 0.22，P = 0.028），SCORAD与种族之间也存在正相关关系，尽管较弱。尽管金黄色葡萄球菌定居的毛利人或太平洋岛屿儿童比例高于其他种族，但没有统计学意义（分别为78％和60％，P = 0.0842）。金黄色葡萄球菌患病率或其密度与年龄之间无显着相关性（分别为r = 0.09，P = 0.39和r = 0.12，P = 0.23）。金黄色葡萄球菌阳性和阴性的儿童之间在性别或治疗（使用抗生素，防腐剂，钙调神经磷酸酶抑制剂，润肤剂或皮质类固醇）方面无显着差异。仅12例金黄色葡萄球菌阳性儿童表现出抗生素耐药性，其中10例对红霉素耐药，而2例对氟氯西林耐药。结论：四分之三的特应性皮炎儿童至少具有一种阳性培养物，其中绝大多数为金黄色葡萄球菌。金黄色葡萄球菌定植的密度与特应性皮炎的严重程度相关。金黄色葡萄球菌培养阳性的儿童与培养阴性的孩子没有明显的人口统计学或临床特征。只有两个孩子长成金黄色葡萄球菌对氟氯西林耐药（耐药率2％），这仍然是我们当地居民理想的第一线治疗方法。

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