湿疹和特应性皮炎皮损处细菌定植情况及药物联合治疗的分析

目的 探讨湿疹和特应性皮炎(AD)皮损处金黄色葡萄球菌(金葡菌)及其他细菌的定植情况,评价抗菌药物与糖皮质激素联合用药的疗效。方法 采用多中心、随机、双盲试验,在筛选日及治疗后第7、14和28天对皮损评分,并在皮损和非皮损处分离细菌。试验组外用抗菌药物和糖皮质激素,对照组外用基质和糖皮质激素。结果 共入选患者327例,湿疹208例,AD119例。湿疹皮损处细菌的阳性率为70.19%,金葡菌占47.26%;非皮损部位细菌阳性率为32.69%,金葡菌占27.94%。AD皮损处细菌阳性率为74.79%,金葡菌占79.78%;非皮损部位细菌阳性率为34.45%,金葡菌占80.49%。湿疹和AD皮损部位金葡菌的定植量均高于非皮损部位(P<0.01,P<0.05),细菌的定植量与皮损的严重程度呈正相关。两组患者治疗后总体疗效无明显差异(P>0.05),但湿疹临床症状评分指数>8分者及AD评分指数>7分者,在治疗的第7天,试验组与对照组的症状评分指数改善率存在显著差异(P<0.05),在治疗的第14天和第28天,两组差异均无显著性(P>0.05)。结论 湿疹和AD患者皮损部位细菌的检出率和金葡菌的带菌率均明显增高,说明金葡菌与湿疹皮炎的关系密切,早期联用抗菌药物可提高疗效。     

特应性皮炎和湿疹皮肤金黄色葡萄球菌肠毒素及中毒休克综合征毒素-1的检测

目的 探讨皮肤金黄色葡萄球菌(金葡菌)肠毒素及中毒休克综合征毒素-1(TSST-1)在特应性皮炎及湿疹中的致病作用。方法 反向被动乳胶凝集法测定来自117例特应性皮炎和199例湿疹患者皮肤共140株金葡菌的肠毒素/TSST-1。结果 140株金葡菌中60株产生超抗原,阳性率为42.9%,其中43株只产生一种超抗原,17株产生至少两种超抗原。特应性皮炎组超抗原总阳性率为51.5%,皮损与非皮损处无差别。湿疹组超抗原总阳性率为34.7%,阳性株均为皮损处菌。特应性皮炎组超抗原总阳性率、皮损处超抗原总阳性率及中毒休克综合征毒素-1阳性率均高于湿疹组。结论 与湿疹相比,特应性皮炎与金葡菌超抗原的关系较为密切。     

特应性皮炎和湿疹患者血清金黄色葡萄球菌肠毒素B特异性抗体的检测及其意义

目的 探讨特应性皮炎(AD)和湿疹患者血清金黄色葡萄球菌肠毒素B(SEB)特异性抗体水平及其意义。方法 采用多中心、随机双盲、对照法,将118例AD和207例湿疹患者分为莫匹罗星治疗组和对照组,于治疗前和治疗28d取血清行间接酶联免疫吸附测定法测定抗SEB特异性IgG、IgM水平,采用链霉亲和素-生物素法检测抗SEBIgE水平。结果 治疗前,抗SEBIgE水平AD组显著高于正常人对照组(P=0.019)和湿疹组(P=0.048),湿疹组与正常人对照组之间差异无统计学意义(P=0.883);抗SEBIgM水平AD组(P=0.012)和湿疹组(P=0.000)均显著高于正常人对照组,AD组与湿疹组之间差异无统计学意义(P=0.088);抗SEBIgG水平各组间均差异无统计学意义(P=0.897)。临床症状评分与抗SEBIgE水平之间AD组(P=0.842)和湿疹组(P=0.134)均无显著相关性。治疗28d后,抗SEBIgM水平AD组显著下降(P=0.003),湿疹组亦显著下降(P=0.000),但治疗组与对照组间AD组(P=0.331)和湿疹组(P=0.815)差异均无统计学意义。结论 AD和湿疹患者血中抗SEBIgM、IgE升高,反映皮损处近期金黄色葡萄球菌定植并参与了皮肤变应性炎症性反应。     

特应性皮炎患儿皮损局部金黄色葡萄球菌外毒素检测

目的 了解特应性皮炎(AD)患儿皮损局部金黄色葡萄球菌(金葡菌)的带菌率及其分泌外毒素的情况,探讨金葡菌及其分泌的外毒素在AD发病中的作用.方法 AD皮损局部分离金葡菌,反向被动乳胶试验方法检测其外毒素表达,并与对照组进行统计学比较.结果 与对照组相比,AD患儿无论是皮损局部还是非皮损区金葡菌带菌率明显升高(P值均<0.01),且与疾病严重性呈正相关性(P<0.01).但AD皮损局部的金葡菌与对照组金葡菌相比,两者分泌外毒素的情况差异无显著性(P>0.05),并且皮损局部的金葡菌是否分泌外毒素与疾病严重性无直接相关性(P>0.05),但伴有血清总IgE水平升高的AD患儿,疾病相对较重(P<0.01).结论 AD患儿皮损区金葡菌带菌率为43.24%,其中47.46%分泌外毒素,以金葡菌肠毒素B(SEB)最常见.     

特应性皮炎皮损微生物与外用药对比治疗研究

目的 研究特应性皮炎(AD)皮损微生物感染、金黄色葡萄球菌(金葡菌)耐药与外用药的疗效.方法 2001年11月至2002年3月在北京中日友好医院及北京市儿童医院皮肤科门诊,按照Hanifin-Rajka诊断标准,共诊断AD患者71例.治疗前后于皮损处取材进行真菌直接镜检、真菌培养、细菌培养及药敏试验,以SCORAD方法计分,将其中66例患者随机分成两组,分别采用1%硝酸益康唑+0.1%曲安奈德霜与0.1%丁酸氢化可的松软膏外用对比治疗AD患者.结果 AD患者以婴幼儿、儿童为主(≤12岁者占73.24%);皮损细菌培养阳性率为53.51%(金葡菌阳性率为35.21%),真菌阳性率为1.41%;药敏结果显示金葡菌对利福平、万古霉素、丁胺卡那霉素、环丙沙星、头孢唑啉、头孢呋辛等敏感性好;1%硝酸益康唑+0.1%曲安奈德霜与0.1%丁酸氢化可的松软膏外用治疗AD4周时,前者疗效优于后者(P<0.05),细菌阴转率前者高于后者(P<0.01).两组外用药治疗的患者均未见不良反应.结论 具有抗感染与抗炎双重作用的1%硝酸益康唑+0.1%曲安奈德霜治疗AD的疗效优于0.1%丁酸氢化可的松软膏.     

高强度窄谱蓝光对寻常痤疮表皮分离菌的抗菌作用研究

目的 评价高强度窄谱蓝光对寻常痤疮致病菌的抗菌作用.方法 取67例轻、中度痤疮患者皮损内容物进行细菌培养、分离并鉴定菌种.用高强度窄谱蓝光对培养所得的各种细菌进行照射,观察照光前后细菌数量、形态及超微结构的变化.结果 皮损处检出痤疮丙酸杆菌(32.4%)、颗粒丙酸杆菌(6.9%)、表皮葡萄球菌(35.3%)、金黄色葡萄球菌(4.9%)、溶血葡萄球菌(7.8%)、孔氏葡萄球菌(1.0%)、棒状杆菌(9.8%)及肺炎克雷伯菌(1.0%)和B群链球菌(1.0%).照光后痤疮丙酸杆菌和表皮葡萄球菌较未照光组菌量显著减少(P<0.05),菌落明显变小.结论 高强度窄谱蓝光有抗痤疮表皮分离菌作用.     

特应性皮炎皮损金黄色葡萄球菌检出情况的研究

目的 :　探讨特应性皮炎 (AD)皮损微生物定植情况 ,为临床合理选用抗菌药物有效控制该病提供依据。方法 :　无菌生理盐水浸湿的棉拭子于 4 3例AD患者皮损处取标本 ,同时对 39例患者非皮损处及 10例健康人取标本作对照 ,进行细菌培养及菌落计数 ,金葡菌予常规药敏试验。结果 :　AD患者皮损细菌阳性率为 74 .4 2 % ,金葡菌为主要的致病菌 ,占 6 5 .6 3% ;非皮损处也可分离出细菌 ,但金葡菌阳性率及密度均明显低于皮损处 (P <0 .0 0 1)。结论 :　微生物感染因素 ,尤其金葡菌感染或定植 ,在AD的发病中起着重要的作用     

成人期特应性皮炎临床的动态分析

目的 了解近10余年来,成人期(≥15岁)特应性皮炎(AD)患者在临床表现方面的变化.方法 随机选择90年代中期(A组)和80年代初期(B组)成人期AD共323例,进行观察、比较.结果 两组的皮疹形态均以湿疹型和苔藓样型为主的皮损较多见,痒疹型较少(A组4.9%,B组2.5%).A组湿疹型(49.4%)比苔藓样型(45.7%)稍多;B组湿疹型(39.1%)少于苔藓样型(58.4%).两组的皮疹分布较多表现在四肢,且皮疹范围<体表面积25%者为多.两组在皮损形态、分布和范围等临床表现上无显著性差异.结论 近10余年中,成人期AD的临床表现虽无显著改变,病情大多较轻,但对湿疹型患者的增加趋势需引起注意.选择正确的治疗方法是防止AD病情加重的措施之一.     

湿疹皮炎中葡萄球菌及对常用抗生素耐药性状况与硝酸益康唑/曲安奈德霜治疗的观察

为了探讨湿疹皮炎中金黄色葡萄球菌（金葡菌）及其它葡萄球菌定殖或感染，以及对某些常用外用抗生素敏感性，对149例湿疹皮炎类皮肤病患者的皮损进行细菌分离，并对分离出的125株葡萄球菌进行6种抗生素的药敏试验。临床上同时使用硝酸益康唑/曲安奈德治疗，观察疗效。结果149例患者有121例查出细菌，共有135株菌，其中金葡萄菌58侏（42.96%)等。细菌对抗生素的敏感率以利福平最高（82.4%)。硝酸益康唑/曲安奈德霜治疗，3周内痊愈率88.6%。比较带金葡菌者与未带金葡菌者的疗效，两组结果无显著性差异。本研究显示湿疹皮炎类皮肤病皮损中带菌率高，疾病与细菌可能有重要关系。治疗这类疾病时，合用敏感性高的抗菌药物很有帮助。     

特应性皮炎患者皮损和非皮损处细菌定植分析

采集127例特应性皮炎(AD)患者皮损与非皮损处和健康人正常皮肤处的标本进行细菌培养,观察病原菌分布以及金黄色葡萄球菌(以下简称金葡菌)的检出率,采用湿疹面积与严重度指数(EASI)评价病情严重程度.AD皮损处、非皮损处和健康人对照组细菌阳性率分别为77.2％、20.5％和3.4％,差异具有统计学意义(P ＜0.05);AD皮损处和非皮损处金葡菌构成比分别为61.4％和11.0％,差异有统计学意义(P＜0.05),健康人对照组只分离到1株金葡菌.EASI评分和菌落密度在红斑、渗出、糜烂、皲裂和水肿等部位比较差异具有统计学意义(P＜0.05),经Spearman相关分析显示EASI评分和菌落密度呈正相关(r=0.529,P＜0.05).细菌定植尤其是金葡菌定植与AD的发生发展密切相关,菌落密度与AD的病情进展具有显著相关性.     

Skin colonization by Staphylococcus aureus in patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial

BACKGROUND: Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation between the severity of the eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. OBJECTIVES: To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. METHODS: A multicentre, double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. RESULTS: Of 327 patients enrolled in the study, 208 had eczema and 119 had AD. Bacteria were isolated from 70.2% of lesional and 32.7% of nonlesional skin samples from patients with eczema, of which S. aureus accounted for 47.3% and 27.9%, respectively. Bacteria were isolated from 74.8% of lesional and 34.5% of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79.8% and 80.5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with eczema and with AD (P < 0.01, P < 0.05), and was positively correlated with lesion severity. Considering the EASI scores before and after treatment and the final effective rate, good therapeutic effects were obtained in both the combination experimental groups and the control groups (P < 0.01), and there were no differences in the global therapeutic effect between the two groups in patients with eczema and with AD (P > 0.05). However, in patients with eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P < 0.05) on the 7th day of treatment. There were no differences between the two groups on the 14th and 28th days of treatment (P > 0.05). Following the improvement of symptoms and signs of eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment. CONCLUSIONS: This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.     

Are there predominant strains and toxins of Staphylococcus aureus in atopic dermatitis patients? Genotypic characterization and toxin determination of S. aureus isolated in adolescent and adult patients with atopic dermatitis

The colonization of Staphylococcus aureus is one of the most important aggravating factors of atopic dermatitis (AD). Until now, the importance of S. aureus in AD and a positive correlation between colonization with S. aureus and clinical severity/skin barrier function has been demonstrated. The aim of this study was to determine whether there are certain clones of S. aureus which colonize the skin of AD patients. For this purpose, the genotype of S. aureus isolated from AD patients was examined by newly-developed typing methods. With 36 strains of S. aureus isolated from 35 patients with AD, spa typing, multi-locus sequence typing (MLST), and staphylococcal toxin gene assay by multiplex polymerase chain reaction, were performed. Clinical severity and skin barrier function were evaluated with eczema area and severity index (EASI) and with transepidermal water loss (TEWL). Among 36 strains of S. aureus , 14 sequence types (ST) and 20 spa types were identified, suggesting a very heterogeneous genetic composition of S. aureus and the absence of a prevailing genotype in S. aureus colonized with AD patients. Furthermore, there was no specific genotype of S. aureus which was associated with the clinical severity of AD or skin barrier dysfunction. A toxin gene assay, however, showed the predominance of S. aureus strains carrying sea and/or tsst-1 . To the best of our knowledge, this is the first report to show the genetic composition of S. aureus strains isolated from AD patients determined by sequence-based typing methods.     

Staphylococcus aureus in Atopic Dermatitis and in Nonatopic Dermatitis

Skin colonization with Staphylococcus aureus (S. aureus) was examined in 30 patients with atopic dermatitis (AD), in 25 patients with nonatopic eczema (NAE) and in 30 individuals as healthy controls (HC). Bacteria growth was examined in aerobic cultures and the population densities per dish were estimated; S. aureus colonization was found in the eczematous skin of 24 of 30 (80%) AD patients and in 13 of 25 (52%) NAE patients (NS, p greater than 0.1). In nonaffected skin S. aureus colonization was found in 19 of 30 (63%) of all AD patients compared with 6 of 25 (24%) in NAE patients and 1 of 30 (3%) in HC, respectively (p less than 0.05). In nonaffected skin, coagulase negative strains of staphylococcus were found in 25 of 30 (84%) controls and in 18 of 25 (72%) NAE patients compared with 12 of 30 (40%) patients with AD. It seems that colonization with S. aureus is not a characteristic feature for atopic dermatitis but is a frequent event in damaged skin; significantly elevated values were also observed in nonatopic eczema. The degree of colonization may depend on the severity and duration of the eczematous lesions.     

Staphylococcus aureus re-colonization in atopic dermatitis: beyond the skin

Patients with atopic dermatitis (AD) are often heavily colonized by Staphylococcus aureus, which adversely affects eczema severity. Strategies to control S. aureus in AD include antibiotic and or antiseptics. However long-term efficacy is unclear. In this study we consider extra-cutaneous factors that may cause S. aureus re-colonization in adult AD. Twenty-one patients with AD were recruited and were assessed for: duration of AD, use of topical or oral antibiotic within the preceding 3 months, the number of hospital admissions during the preceding year and current treatment. The types of topical treatments used, vehicle, container and the expiry dates were also recorded. The severity of AD was assessed by SCORAD index. Microbiological assessment for S. aureus carriage from affected skin, anterior nares, emollient and topical steroid was undertaken using culture, Staphaurex test and antibiotic resistance. Of the patients 86% had S. aureus colonization. The median SCORAD score were greater in those colonized with S. aureus (P = 0.02) and those with contaminated treatments (P = 0.05). Prior antibiotic treatment, prior hospital admission and nasal carriage did not influence the median SCORAD. Three extra-cutaneous mechanisms by which S. aureus can re-colonize the skin were identified: antibiotic resistance, nasal carriage and treatment contamination.     

Adherence characteristics and susceptibility to antimicrobial agents of Staphylococcus aureus strains isolated from skin infections and atopic dermatitis

We examined the adherence characteristics and susceptibility to various antimicrobial agents of 130 strains of Staphylococcus aureus isolated from infective skin lesions and 135 strains of S. aureus isolated from non-infective eczematous lesions of atopic dermatitis (AD) patients. The isolation rate of methicillin-resistant S. aureus (MRSA) was 27.7% in strains from clinical sources excluding AD and 31.1% in those from AD. Coagulase type II strains were most frequently observed in MRSA strains isolated from all sources excluding AD, and coagulase type III strains were most frequently observed in those isolated from AD. We proposed that antimicrobial treatment for AD patients should be carefully designed to prevent MRSA infection. Plasma coagulation ability was lowest in S. aureus strains isolated from abscesses, suggesting that the lower production of fibrin observed in abscesses may assist the infiltration of neutrophils into skin tissues and that a decrease in plasma coagulation ability may enable abscess formation. Adherence to polypropylene tubes with slime production was most evident in S. aureus strains isolated from felon and least evident in those isolated from cellulitis and lymphangitis. Tube adherence was characteristic of the S. aureus strains attached to superficial skin tissues, but not necessarily for strains that had infiltrated the deep skin tissues. Fusidic acid demonstrated significant antimicrobial activity against the MRSA strains, but rifampicin was the strongest antimicrobial agent.     

早婴儿特应性皮炎发病因素探讨

目的观察纯母乳喂养特应性皮炎(atop ic derm atitis,AD)患儿皮损金黄色葡萄球菌(金葡菌)带菌率,与黄疸的相关性及乳母饮食对AD的影响,探讨以上因素在AD发病中的作用。方法AD皮损局部、非皮损局部分离金葡菌、经皮测定黄疸指数、乳母饮食随机分组,并与对照组进行统计学比较。结果与对照组相比,AD患儿皮损局部金葡菌与对照组金葡菌相比明显升高,黄疸与AD的发病无统计学意义,乳母饮食与AD有关。结论AD患儿皮损区带菌率45.00%,黄疸与AD的发病无相关性,乳母饮食情况参与AD发病。     

Isolation of α-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis

Background  Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion.
Objectives  To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD.
Patients and methods  We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens.
Results  Forty-eight of 127 patients were colonized with S. aureus , suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen.
Conclusions  Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus .     

Short-term effects of topical fusidic acid or mupirocin on the prevalence of fusidic acid resistant (FusR) Staphylococcus aureus in atopic eczema

BACKGROUND: Staphylococcus aureus has a role in the pathophysiology of atopic eczema. Topical fusidic acid is widely used in its treatment. There is concern that topical use of fusidic acid may be driving the selection and dissemination of fusidic acid-resistant (FusR) S. aureus. OBJECTIVES: To test the hypothesis that treatment of atopic eczema for 2 weeks with topical fusidic acid/steroid combination can increase carriage of FusRS. aureus. METHODS: Forty-six patients with atopic eczema were allocated randomly to one of two treatment groups. Group 1 (28 patients) were treated with topical 2% fusidic acid plus 0.1% betamethasone cream, and group 2 (18 patients) with topical 2% mupirocin and 0.1% betamethasone cream. The clinical response and nasal and skin colonization with S. aureus were recorded before treatment and after 1 and 2 weeks of therapy. RESULTS: Baseline samples from the site of worst eczema showed S. aureus (sensitive and resistant) in 76% of patients, and FusRS. aureus in 26%, with no significant difference between treatment groups. After 1 and 2 weeks, both groups showed similar significant clinical improvement. The overall median clinical improvement was paralleled by a reduction in prevalence and population density of S. aureus (sensitive and resistant) at the worst eczema site (P < 0.0001). However, for FusRS. aureus there was no significant change in the prevalence of carriage, or population density in either group compared to baseline. Over 50% of patients carried S. aureus in the nerves and over 20% carried FusRS. aureus. Neither regimen affected either the prevalence or population density of S. aureus or FusRS. aureus in the nerves. CONCLUSIONS: In this small study there is no evidence to support the hypothesis that short-term treatment of atopic eczema with fusidic acid/steroid combination increases fusidic acid resistant S. aureus during a 2-week period.