The Underlying Mechanisms For S. Aureus Infection And Colonization Of Skin in People With Atopic Dermatitis With And Without Eczema Herpeticum (MRSA)
Condition: Methicillin-Resistant Staphylococcus Aureus; Atopic Dermatitis; Eczema Herpeticum; MRSA
MeSH terms: Staphylococcal Infections; Kaposi Varicelliform Eruption; Dermatitis, Atopic; Dermatitis; Eczema
Study type: Observational

Summary: 
      Staphylococcus aureus (S.aureus) is a bacterium that causes many painful skin and soft tissue
      conditions, such as scalded-skin syndrome, boils, or impetigo. Serious cases may result in
      deadly complications but S.aureus can usually be treated successfully with antibiotics. There
      are, however, certain strains which cannot be treated with standard antibiotics.
      Methicillin-resistant staphylococcus aureus (MRSA) is one such strain.

      MRSA is increasingly being seen in both hospital and community settings, making it a serious
      public health issue. People with Atopic Dermatitis (AD), particularly those with a history of
      Eczema Herpeticum (EH), may be at greater risk for infection by MRSA. The reason for this
      higher risk is unknown but may be linked to extended treatment with staphylococcus
      antibiotics in addition to the absence of certain proteins on their skin, which have immune
      function. The purpose of this study is to determine the reasons for MRSA infection in AD
      participants with and without a history of EH.
    

Detailed description: 
      The emergence of drug-resistant staphylococcal strains was first seen in the US almost a
      decade ago, when the Centers for Disease Control (CDC) reported four fatal community-based
      MRSA infections in children. In recent years, MRSA has grown into a serious public health
      concern with an increasing number of both hospital-acquired and community-acquired cases
      being seen.

      There will be approximately 130 participants recruited for this trial. The study population
      will consist of people with Atopic Dermatitis (AD) and people without Atopic Dermatitis
      (non-atopic). AD is a skin disorder with an itchy, red skin rash. People with AD are more
      likely to get bacterial and viral skin infections, possibly because they lack certain
      proteins in their skin, which help the body's immune system to fight infections. AD people
      with a history of Eczema Herpeticum (EH) may also be at greater risk for being infected with
      MRSA. This could be due to extended treatment courses with staphylococcal antibiotics,
      especially because overuse and misuse of antibiotics can lead to bacterial antibiotic
      resistance. The precise reasons are unknown. The purpose of this study is to determine the
      reasons for infection in AD participants with and without a history of EH.

      Investigators are seeking to recruit patients with either Methicillin-sensitive
      staphylococcus aureus (MSSA) or MRSA bacteria on their skin, so that they may adequately
      study potential factors related to MRSA infection.

      Investigators will determine if the MRSA collected from people with AD is primarily community
      or hospital associated. They will also determine if the proteins on the skin of ADEH+ people
      with MRSA differ from the proteins on the skin of AD people with MSSA or people without AD,
      or if there are any marked differences in serum total IgE levels between AD subjects with
      MRSA, MSSA, or without S. aureus. Approximately 60 ADEH+ and 60 ADEH- participants will need
      to be enrolled to find participants with MRSA or MSSA on their skin. Presence of these
      bacteria on the skin can only be determined once skin swabs are collected and tested.

      If participants are deemed eligible at screening, they will continue on to the study visit,
      which will last for approximately 2-3 hours. At the study visit, participants will be asked
      to provide information related to their medical history including infection, hospitalization,
      and medication record. Additionally, a skin exam will be performed to verify diagnosis
      (ADEH-, ADEH+, or non-atopic); nasal and skin swabs samples will be collected; tape
      strippings samples will be collected; and a blood sample will be collected.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        ADEH-, ADEH+ people who may or may not be colonized with MRSA or MSSA, and non-atopic
        people not colonized with MRSA or MSSA.
      
Biospecimen description: 
      Nasal swabs, skin swabs, tape strippings, and blood draws.
    
Keywords: Methicillin-resistant Staphylococcus aureus; MRSA; Methicillin-sensitive Staphylococcus aureus; MSSA; Atopic Dermatitis; Eczema Herpeticum