Staphylococcal Skin Colonization in Children with Atopic Dermatitis: Prevalence, Persistence, and Transmission of Toxigenic and Nontoxigenic Strains

Abstract

Staphylococcal skin colonization is a common feature of atopic dermatitis (AD) in adults. Little is known about prevalence and persistence of staphylococci in children. Forty-one AD children (mean age, 70 months) and 41 age-matched controls were studied. S. aureus was isolated from 38 AD patients (93%;32% of controls, P < .001) and 37% ofAD patients (5% of controls, P < .001) harbored toxigenic (enterotoxins, toxic shock syndrome toxin) S. aureus strains. No individual biotype prevailed. On follow-up (mean interval, 9 months), 70% of S. aureus strains were reisolated. Nasal and cutaneous S. aureus strains were identical in 73% of AD patients (7% of controls, P < .001), reflecting increased self-contamination. Identical staphylococcal strains in AD children and their mothers were observed in 38% (S. aureus) and 16% (coagulase-negative strains; P < .001). The prevalence of staphylococcal colonization in AD children is comparable to that in adults. High rates of self-contamination, transmission to contacts, and prevalence of toxigenic strains in AD children may have clinical and epidemiologic implications.