The Association of Skin and Nasal Colonisations of Staphylococcus aureus in Children with Atopic Dermatitis with Disease Severity and Its Impact on Quality of Life

ABSTRACT

Background@#Atopic dermatitis (AD) is a chronic, recurrent, pruritic inflammatory skin disease that causes significant burden to affected children. Staphylococcus aureus plays a vital role in AD, and its resistance to current topical antibiotics is worrying. This study aims to determine the frequency of Staphylococcus aureus colonisation and its resistance pattern. It further assesses the association between Staphylococcus aureus colonisation and disease severity; as well as its impact on quality of life.@*Methods@#A cross-sectional study was conducted among 153 children with AD. Skin and nasal swabs were collected. Antibiotic sensitivity to penicillin, cefoxitin, erythromycin, methicillin, clindamycin, gentamicin, trimethoprim/sulfamethoxazole, tetracycline, rifampicin, fusidic acid and linezolid were tested. Clinical evaluation was performed using the SCORing Atopic Dermatitis index (SCORAD). Quality of life was assessed with the Dermatological Life Quality Index (DLQI).@*Results@#Twenty-nine patients had positive skin swab results. One patient had methicillin-resistant Staphylococcus aureus isolated from nasal swab. Skin colonisation with Staphylococcus aureus (p=0.03) and DLQI (p<0.01) were significantly associated with disease severity. The resistant rate is highest in penicillin, followed by fusidic acid, tetracycline, and erythromycin.@*Conclusion@#Skin colonisation with Staphylococcus aureus is an indicator of disease severity in children with AD. Patients with severe disease have lower quality of life. Clinicians need to be aware of high resistance rates towards penicillin and fusidic acid and be prudent in the choice of antibiotics. Antiseptic wash can be considered in patients with Staphylococcus aureus colonisation.