A RECENT systematic review and meta-analysis highlights concerns about antibiotic resistance in Staphylococcus aureus strains found in individuals with atopic dermatitis. People with this chronic inflammatory skin condition are frequently colonised by S. aureus, which often prompts empirical antibiotic treatments. However, the study reveals that antimicrobial susceptibility patterns vary significantly based on the country’s income level, with suboptimal effectiveness for several commonly prescribed antibiotics.
The research analysed data from 61 studies, which collectively reported on 4,091 S. aureus isolates from individuals with atopic dermatitis. The review identified that for four widely used antibiotics—methicillin, erythromycin, fusidic acid, and clindamycin—susceptibility rates were 85% or lower. Specifically, susceptibility to methicillin was found to be 85%, erythromycin 73%, fusidic acid 80%, and clindamycin 79%. These findings indicate that some strains of S. aureus are increasingly resistant to antibiotics commonly used in the treatment of skin infections in atopic dermatitis patients.
The study also analysed differences in susceptibility based on geographical economic status. The majority of studies (75.4%) originated from high-income countries, where access to healthcare and antibiotic treatment options are generally better. However, resistance to erythromycin, methicillin, and the combination of trimethoprim and sulfamethoxazole was notably higher in low to middle-income countries. This disparity could reflect differences in antibiotic availability, usage patterns, and healthcare infrastructure, which may influence resistance development.
Data collection in these studies spanned several decades, with over half of the studies gathering information between 1998 and 2010. Despite the time frame, trends in antimicrobial susceptibility have shown little change, suggesting persistent resistance patterns across regions.
The study’s conclusions suggest that reliance on certain antibiotics for empirical treatment in atopic dermatitis may be less effective, particularly in specific economic regions. The findings highlight the need for localised data on S. aureus resistance to guide better antibiotic stewardship and inform empirical treatment choices for patients with atopic dermatitis. Improved monitoring and tailored treatment plans are recommended to combat resistance, especially in resource-limited settings where antibiotic resistance may be more prevalent.
Reference
Elizalde-Jiménez IG et al. Global antimicrobial susceptibility patterns of staphylococcus aureus in atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol. 2024;DOI:10.1001/jamadermatol.2024.3360.
