Optimal management strategy for patients with infected eczema using whole-genome sequencing: from empiric treatment to personalized systemic antibacterial therapy

BACKGROUND: Every human has a unique combination of skin and gut microbiota, including a unique profile of resident and transient microorganisms. This work compares microbiomes of intestines and affected skin areas in patients with infected eczema. The effectiveness of selecting systemic antibiotics based on antibiotic resistance data is evaluated using a new molecular genetic technique—whole-genome sequencing. This technique facilitates thorough investigation of the microbiome and identification of microorganisms that are key to the pathogenesis of infected eczema.

AIM: This study aimed to evaluate the effectiveness of the combined treatment of patients with chronic infected eczema, including personalized systemic antibacterial therapy based on molecular genetic analysis of the skin and gut microbiome using whole-genome sequencing.

METHODS: In the prospetcive clinical controlled randomized study a total of 60 patients with acute infected eczema were divided into two groups of 30 for observation. The control group received treatment based on the national clinical guidelines. The study group received personalized systemic antibacterial therapy based on whole-genome sequencing data on antibiotic resistance. Biological samples were collected from the skin and intestines before treatment, on days 14 and 21, and 6 months after treatment. The Eczema Area and Severity Index (EASI) was used to assess the severity of skin symptoms. We aimed to characterize the composition of skin and gut microbiota by determining the percentage of each species present.

RESULTS: In the acute phase, a shift toward S. aureus, C. difficile, K. pneumoniae, P. aeruginosa, and E. coli was observed in both skin and gut microbiota. By month 6, both groups showed improvements in skin condition and a decrease in microbial colonization of infected eczema lesions. However, the gut microbiome of the study group showed more significant positive changes in microbial balance recovery.

CONCLUSION: Clinical metagenomic whole-genome sequencing provides highly accurate information about the taxonomic composition of the evaluated microbiomes. The group of personalized antibacterial therapy resulted in faster recovery of the skin and gut microbiota than the control group.