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Current resistance patterns of Staphylococcus aureus towards topical antibiotics and relevant antiseptics in patients with atopic dermatitis and impetigo

The great majority of patients with atopic dermatitis are colonized by Staphylococcus aureus [1]. Even the colonization by S. aureus on the nasal mucosa is associated with greater severity and increased presence of weeping and crusted lesions [2]. After successful eradication of S. aureus, a marked decrease of severity of atopic dermatitis can be observed [3]. At the same time S. aureus is the most frequently isolated pathogen in impetigo, being even more common than group A streptococci [4]. Experience has shown that these two diseases – atopic dermatitis and impetigo – constitute the largest group of (at least partly) bacterially induced skin diseases. Scientific Letter It was our goal to evaluate the current resistance of S. aureus strains isolated from patients with atopic dermatitis or impetigo. This was to be performed with respect to the selection of systemic standard antibiotics, the topical antibiotics retapamulin (GlaxoSmithKline), fusidic acid and mupirocin as well as the antiseptics octenidine (Schuelke & Mayr), chlorhexidine (Fagron), and triclosan (Fagron). For this purpose we recruited in the time period from December 2009 up to and including November 2011 258 patients with atopic dermatitis as well as 21 patients with impetigo, who had at least one visible skin lesion. A detailed history with respect to previous topical and systemic therapies was taken. In patients with atopic dermatitis the SCORAD (SCORing Atopic Dermatitis) was also recorded. Two bacteriologic swabs were taken from the respective skin lesion and from the nasal mucosa. The colonizing microbiologic bacterial flora was isolated on 5 % sheep blood agar plates and in the case of growth of S. aureus resistance testing was performed using a standard antibiogram (agar diffusion test) with common antibiotics relevant for staphylococci as well as determination of the minimum inhibitory concentration (MIC) towards octenidine, chlorhexidine, triclosan and retapamulin using a microdilution test.