Background . Each individual has a unique skin microbiota that includes a diverse resident and transient community displaying an individualized composition. This study focuses on the identification of skin microbial genomes in patients with chronic microbial eczema. Objective . To evaluate the clinical efficacy of complex therapy in patients with microbial eczema using personalized selection of topical antibacterial agents while taking into account the determination of antibiotic resistance by whole genome sequencing. Methods . The prospective сomparative randomized study involved 60 patients with microbial eczema in the exacerbation stage, who were randomly divided into two groups of 30 people each: main and control groups. In the control group (group 2, n = 30) patients were treated according to the Federal Clinical Guidelines. In the main group (group 1, n = 30) patients were also treated with conventional therapy, while topical antibacterial agents were selected in a personalized manner based on antibiotic resistance data. On the 21st day of therapy, an emollient with a probiotic component was added to the treatment regimen for patients of both groups. The patients underwent therapy, observation, and examination at the Department of Dermatovenerology of the Kuban State Medical University of the Ministry of Health of the Russian Federation. The clinical study was performed between December 2023 and December 2024. The observation periods in the study were divided into several stages: before the start of therapy, on days 14, 21, and six months after treatment. In this study, the microbiome of the affected skin areas of the patients was analyzed comparatively, and the effect of topical antibacterial preparation selected on the basis of whole genome sequencing data was evaluated. The laboratory stage of the present study was conducted at two sites: CL Lab Clinical Diagnostic Laboratory (“СL Medicalgroup” LLC) in Krasnodar and Serbalab Genetic Laboratory (“Serbalab” LLC) in St. Petersburg. The Eczema Area and Severity Index (EASI) was used to evaluate the skin pathologic process. Statistical processing of data was performed using the Statistica 12.0 software package (StatSoft, USA) and Microsoft Exel 2010 (Microsoft, USA). Quantitative parameters were statistically described using median and quartiles (Me (Q1;Q3)), along with mean with standard deviation (M ± SD). Differences were considered statistically significant at the error level of p < 0.05. Results . During exacerbation in patients with chronic microbial eczema, the microbial equilibrium shifted towards an increase in microorganisms Staphylococcus aureus, Clostridioides difficile, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli that were present on the affected skin areas, while the number of functional bacteria was limited. A more pronounced tendency to restoration of healthy microbiome in the patients of the main group was observed as soon as the 14th day. By the 6th month of treatment, the patients of the main group experienced a greater decrease in microbial colonization in the foci of microbial eczema lesions than in the control group, whereas the proportion of Bifidobacterium and Lactobacillus functionalis was increased compared to the pre-treatment values by 2.31 and 2.10 times, respectively. In addition, the disease relapse occurred in two patients in the main group (versus five in the control group), which may indicate the higher efficacy of the therapy method proposed in the study. Conclusion . Whole genome sequencing method identifies the taxonomic diversity of the microbiome. Personalized application of topical antibacterial agent in complex therapy in the main group of patients promotes faster restoration of healthy skin microbiome than in the control group.
Лазарев et al. (Fri,) studied this question.