Association between atopic dermatitis and extra-cutaneous bacterial and mycobacterial infections: A systematic review and meta-analysis

Publication date: Available online 22 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): Linda Serrano, Kevin R. Patel, Jonathan I. Silverberg

Abstract

Background

Atopic dermatitis (AD) is associated with increased bacterial colonization and infection of skin, and multiple risk factors for extra-cutaneous infections. However, previous studies found conflicting results about whether AD is associated with increased extra-cutaneous infections.

Objectives

To determine whether extra-cutaneous bacterial and mycobacterial infections are increased in AD.

Methods

A systematic review was performed of all published observational studies with controls in MEDLINE, EMBASE, GREAT, Cochrane, and Web of Science that assessed extra-cutaneous infections in AD. Pooled meta-analysis was performed using random-effects weighting.

Results

Overall, 7 studies met inclusion criteria. All 7 studies found increased odds of at least one extra-cutaneous infection in AD, including endocarditis, meningitis, encephalitis, bone and joint infections, and sepsis. In pooled meta-analysis, AD in children and adults was associated with higher odds of ear infection (odds ratio [95% confidence interval]: 1.29 [1.16–1.43]), strep throat (2.31 [1.66–3.22]) and urinary tract infection (2.31 [1.66–3.22]), but not pneumonia (1.72 [0.75–3.98]). No publication bias was detected.

Limitations

Individual level data were not available.

Conclusions

AD patients have higher odds of extra-cutaneous infections. Future studies are needed to confirm these associations and determine their mechanisms.

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