The widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from patients with atopic dermatitis

C P Harkins, M A McAleer, D Bennett, M McHugh, O M Fleury, K A Pettigrew, K Oravcová, J Parkhill, C M Proby, R S Dawe, J A Geoghegan, A D Irvine, M T G Holden

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13 Citations (Scopus)


BACKGROUND: Carriage rates of Staphylococcus aureus on affected skin in atopic dermatitis (AD) are approximately 70%. Increasing disease severity during flares and overall disease severity correlate with increased burden of S. aureus. Treatment in AD therefore often targets S. aureus with topical and systemic antimicrobials.

OBJECTIVES: To determine whether antimicrobial sensitivities and genetic determinants of resistance differed in S. aureus isolates from the skin of children with AD and healthy child nasal carriers.

METHODS: In this case-control study, we compared S. aureus isolates from children with AD (n = 50) attending a hospital dermatology department against nasal carriage isolates from children without skin disease (n = 49) attending a hospital emergency department for noninfective conditions. Using whole genome sequencing we generated a phylogenetic framework for the isolates based on variation in the core genome, then compared antimicrobial resistance phenotypes and genotypes between disease groups.

RESULTS: Staphylococcus aureus from cases and controls had on average similar numbers of phenotypic resistances per isolate. Case isolates differed in their resistance patterns, with fusidic acid resistance (FusR ) being significantly more frequent in AD (P = 0·009). The genetic basis of FusR also differentiated the populations, with chromosomal mutations in fusA predominating in AD (P = 0·049). Analysis revealed that FusR evolved multiple times and via multiple mechanism in the population. Carriage of plasmid-derived qac genes, which have been associated with reduced susceptibility to antiseptics, was eight times more frequent in AD (P = 0·016).

CONCLUSIONS: The results suggest that strong selective pressure drives the emergence and maintenance of specific resistances in AD.

Original languageEnglish
Pages (from-to)951-958
Number of pages8
JournalBritish Journal of Dermatology
Issue number4
Publication statusPublished - Oct 2018

Bibliographical note

© 2018 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.


  • Administration, Cutaneous
  • Anti-Infective Agents, Local/administration & dosage
  • Carrier State/diagnosis
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Dermatitis, Atopic/diagnosis
  • Drug Resistance, Bacterial/drug effects
  • Female
  • Healthy Volunteers
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Microbial Sensitivity Tests
  • Mutation
  • Nasal Mucosa/microbiology
  • Peptide Elongation Factor G/genetics
  • Severity of Illness Index
  • Skin/microbiology
  • Staphylococcal Skin Infections/diagnosis
  • Staphylococcus aureus/isolation & purification


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