| Objectives Infection or colonization of skin with Staphylococcus aureus (S.aureus) as one of the aggravating factor have nearly correlated with atopic dermatitis (AD). To provid basis for clinically rational use of antimicrobial agents and effective control of those disease, the colonizing feature of bacteria on lesions in AD and the correlation of S.aureus with AD and the effect of an topical antimicrobial treatment of mupirocin were investigated.Methods Forty-eight patients with AD were diagnosed according to the criteria of Hanifm-Rajka's in departments of dermatology in the First affiliated Hospital of Nanjing Medical University from August 2002 to March 2003. Bacteriological sample were obtanined by the detergent scrub technique from the lesions and normal skin in AD. S.aureus were examined by culture and quantitative assessment of density and microbial sensitivity tests. Forty-eight patients of AD were entered a double-blind, compared study and were randomly allocated to compare the effect of hydrocortisone butyrate ointment (locoid) plus mupirocin to locoid plus vehicle placebo at the first 2 weeks, and all patients were treated by locoid plus mupirocin at the further 2 weeds. Bacteria on lesions in 48 cases of AD were cultured at first and post treatment, and the clinical severity of AD was determined by referring to Severity Scoring in AD (SCORAD) index. Study result was analyzed by SPSS software, and the quantified data was statisticed by t test and the qualitied data was statisticed by x2 test.Results The rates of bacterial colonization was 74.42% on lesionsskin of AD, and S.aureus was overwhelmingly the dominant species with a prevalence of 65.63%, S.epidermidis was the second species with a prevalence of 28.13%; The rates of bacterial colonization was 82.61% on acute, exudative lesion of AD, and prevalence of S.aureus was 68.42%, But there was no statistically significant compared to chronic lichenified plaques lesion of AD. The mean density of bacteria on lesions of forty-three was 54954/cm2, and the mean density of S.aureus was 207096/cm2; The mean density of bacteria or S.aureus on acute, exudative lesion of AD was too no statistically significant compared to chronic lichenified plaques lesion of AD. Bacteria were too isolated with a prevalence of 20.51% from culture of normal skin in these patients; The mean density of bacteria on normal skin of AD was 2138/cm2, and the mean density of S.aureus was 9333/cm2. Howerver, The rates and density of S.aureus colonization were very much greater in dermatitis skin compared to normal skin (p<0.001).Antimicrobial susceptibility test indicated that S.aureus was the most sensitive to vancomycin, tetracyclin, and more sensitive to amikacin, cefepime, piperacillin/tzobactam, levofloxacin, ete, and resistant to erythromycin, penicillin and many of them to cephalosporin.At 1 week and 2 week post-treatment, the efficacy rates were 74.07%, 88.88% for mupirocin and 25%, 60% for vehicle placebo, the efficacy rate of mupirocin was statistically better than that of vehicle placebo (p<0.01, p<0.05) ; At 4 week post-treatment, the efficacy rates were 92.59% for mupirocin and 95% for vehicle placebo, the difference of the efficacy rate in two groups was no statistically significant(p >0.05). The rates of bacteriological eradication after treatment in two groups was too no statistically significant (p >0.05) .Conclusions Staphylococcus aureus may play an important role as an aggravating factor in AD. S.aureus not only may aggravate and exacerbate inflammation of lesions in AD by secreting exotoxin withsuperantigenic properties, but they may also function as an allergen, as the level of toxic-specific IgE correlates with the severity of AD. Microbial sensitivity tests of S.aureus indicated that Vancomycin and tetracyclin may be the first of all selected medicine as treatment of S.aureus infections.S.aureus infection may decrease sensitivity of corticosteriod treatment. Topical antimicrobial medicine not only may efficiently remove bacter...
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