Methicillin-Resistant Staphylococcus aureus Colonization in Children With Atopic Dermatitis

Abstract

Suh L, Coffin S, Leckerman KH, Gelfand JM, Honig PJ, Yan AC. Pediatr Dermatol. 2008;25(5): 528–534PURPOSE OF THE STUDY. To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in children with atopic dermatitis (AD).STUDY POPULATION. Observational cross-sectional study of 54 children seen in the dermatology clinic at the Children's Hospital of Philadelphia in October and November 2004.METHODS. Eczema severity was determined with the Eczema Area and Severity Index. Culture swabs (BBL CultureSwab [Becton, Dickinson, Sparks, MD]) were used. All cultures were plated for up to 5 days for the growth of S aureus, and methicillin-sensitivity tests were performed on positive S aureus cultures. Patients’ families provided information on medical histories, medication use, and other identifying risk factors for health care–associated MRSA, by completing a detailed, self-administered questionnaire.RESULTS. Eighty percent of the patients (43 of 54 patients) were colonized with S aureus, and 16% (7 of 54 patients) were colonized with MRSA. MRSA was associated with previous hospitalization, with an odds ratio of 26.2 (95% confidence interval: 2.1–316.0), and the combination use of calcineurin inhibitors and topical corticosteroids. Other risk factors for MRSA (health care worker in household, oral antibiotic therapy, previous skin infections, and history of previous MRSA) were not identified. Eczema severity, defined by Eczema Area and Severity Index score, was not a risk factor for S aureus or MRSA.CONCLUSIONS. AD patients have a high rate of S aureus colonization and MRSA (16%) colonization, compared with the general public (1%–3%).REVIEWER COMMENTS. The prevalence of MRSA was low in the study of patients with AD, which suggests that standard S aureus antibiotics can be used for first-line therapy. The possibility of local variation of MRSA colonization is important to consider before using oral cephalosporin treatment. Eczema severity might be a risk factor for MRSA, because the use of combination therapy or previous hospitalization as a marker for severe disease is associated with MRSA colonization.