Whole genome sequencing as a tool for personalized selection of antibacterial agents in therapy of patients with microbial eczema

Introduction. This study performed a comparative analysis of the gut microbiome and affected skin areas in patients with microbial eczema (ME). In addition, the effectiveness of a personalized approach to selecting systemic and topical antibiotics, taking into account antibiotic resistance data obtained from whole-genome sequencing (WGS), was assessed.
Aim. To evaluate the effectiveness of complex treatment for patients with microbial eczema, including a personalized selection of systemic and topical antibacterial agents, taking into account whole-genome sequencing data from the skin and gut microbiome.
Materials and methods. The study included 60 patients with microbial eczema in the acute stage, divided into two equal groups (main group and comparison group) of 30 people each. All patients received treatment in accordance with Federal Clinical Guidelines. For patients in the main group, systemic and topical antibacterial medications were selected individually based on antibiotic resistance data obtained by WGS. The Eczema Area and Severity Index was used to assess the dynamics of skin manifestations, and the frequency of exacerbations after the main course of therapy was also recorded.
Results. After 6 months of observation, patients in the main group showed a decrease in microbial colonization in the gut (the proportion of P. aeruginosa decreased by 9.6 times, E. coli – by 14.3 times, C. difficile – by 43.5 times, K. pneumoniae – by 11.2 times) and on the skin (the proportion of S. aureus decreased by 3.9 times, P. aeruginosa – by 11.5 times, E. coli – by 13.6 times, C. difficile – by 39.8 times, K. pneumoniae – by 5.1 times). The EASI index in the main group was 0.44 (0.23–0.69) points, while in the comparison group it was 1.00 (0.77–3.31) (p < 0.001 from the start of therapy), while in the main group of patients, relapse occurred in 2 patients (6.67%), and in the comparison group – in 5 (16.67%).
Conclusions. Whole-genome sequencing allows for a highly accurate determination of the taxonomic composition of microbiomes. Patients receiving personalized antimicrobial therapy experienced faster restoration of their skin and gut microbiomes compared to the comparison group.

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