Staphylococcus aureus Bloodstream Infections in Atopic Dermatitis

Scanning electron micrograph of Staphylococcus aureus
Scanning electron micrograph of Staphylococcus aureus
Preventative measures and meticulous care of intravascular catheters and their placement, should keep the mortality rate from S. aureus low in patients with atopic dermatitis.

For patients with atopic dermatitis, Staphylococcus aureus bloodstream infections are most frequently acquired in the hospital setting through intravascular catheters or skin and soft tissue infections. With prompt and adequate diagnostic and therapeutic management, these patients have fewer complications and a lower mortality rate when compared with patients without atopic dermatitis, according to study data published in The Journal of Investigative Dermatology.

The aim of this post hoc analysis was to assess the clinical indications and effects of S. aureus bloodstream infections in patients with atopic dermatitis. Data for this analysis came from the microbiology laboratory at the University Medical Center Freiburg from patients prospectively evaluated by infectious disease physicians from 2014 to 2016.

Of the 419 patients with S. aureus bloodstream infections included in the study, 3.3% were diagnosed with mild or moderate atopic dermatitis. These patients were more frequently younger (P =.09), had fewer comorbidities (P =.001), and more frequently acquired the infection after a hospital admission than patients without atopic dermatitis. Most patients with atopic dermatitis contracted the infection through an intravascular catheter (50%) or through the skin (36%), and 71% reported the most severe manifestation of the disease as the skin and soft tissue infection or the catheter-related infection. For patients with atopic dermatitis, rates for severe sepsis or septic shock were lower (14% vs 31% for severe sepsis), and rates for S. aureus bloodstream infection-related in-hospital mortality was lower (0% vs 13%) when compared with patients without atopic dermatitis.

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Future studies need to increase the population size and include data from several different centers to validate these results.

The researchers concluded that “atopic skin, either directly via superinfection of lesional [atopic dermatitis] skin, or indirectly via intravascular catheters, plays a major role in the development of [S. aureus bloodstream infection] in [patients with atopic dermatitis].”

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Joschua Gebhard MP, Insa J, Gabriele PH, Christian S, Winfried K, Siegbert R. Staphylococcus aureus bloodstream infection in patients with atopic dermatitis – or: think twice before placing a venous catheter into lesional atopic skin [published online February 17, 2020]. J Invest Dermatol. doi: 10.1016/j.jid.2020.02.004