Coates P, Vyakrnam S, Ravenscroft J C, Stables G I, Cunliffe W J, Leyden J J, Johnson J, Eady E A, Cove J H
School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, U.K.
Br J Dermatol. 2005 Dec;153(6):1126-36. doi: 10.1111/j.1365-2133.2005.06897.x.
Skin colonization by antibiotic-resistant propionibacteria is commonplace among acne patients globally. Increasing attention is now being paid to how resistance rates might be reduced to preserve the future efficacy of antibiotics, especially erythromycin and clindamycin in acne therapy.
To assess the efficacy of oral isotretinoin in the control of antibiotic-resistant propionibacteria.
Acne patients (72 in the U.K., 62 in the U.S.A.) colonized with high numbers of antibiotic-resistant propionibacteria were sampled before, during and 12 weeks after oral isotretinoin therapy. Propionibacterial samples were collected from five acne-prone skin surface sites using a detergent scrub method and from the anterior nares using moistened swabs. Total and antibiotic-resistant propionibacteria were enumerated by viable counting on media with and without selective antibiotics.
After 16 weeks of oral isotretinoin therapy, mean population densities of viable propionibacteria and variants resistant to erythromycin, clindamycin or tetracycline had fallen by more than 90% at all skin sites and in the nares. The sole exception was a smaller reduction in tetracycline-resistant strains on the lower back. In general, greater reductions were observed on skin than in the nares. By the end of the treatment period only three patients (all in Philadelphia) yielded no antibiotic-resistant strains from any site. Post-treatment, propionibacterial counts remained well below pretreatment levels but had begun to recover on the face and in the nares. The recovering propionibacterial population included both susceptible and resistant strains. Changes during and post-treatment at the two centres were similar but not identical.
Oral isotretinoin effectively reduced skin and nasal colonization by antibiotic-resistant propionibacteria. However, viable populations of resistant isolates persisted post-treatment at multiple sites. Novel methods are required to eradicate antibiotic-resistant propionibacteria completely, especially from the nasal reservoir.
在全球范围内，痤疮患者皮肤被耐抗生素丙酸杆菌定植的情况很常见。目前，人们越来越关注如何降低耐药率，以维持抗生素尤其是红霉素和克林霉素在痤疮治疗中的未来疗效。
评估口服异维A酸控制耐抗生素丙酸杆菌的疗效。
对大量耐抗生素丙酸杆菌定植的痤疮患者（英国72例，美国62例）在口服异维A酸治疗前、治疗期间及治疗后12周进行采样。采用去污剂擦洗法从五个易患痤疮的皮肤表面部位采集丙酸杆菌样本，并用湿棉签从前鼻孔采集样本。通过在含和不含选择性抗生素的培养基上进行活菌计数来确定总丙酸杆菌和耐抗生素丙酸杆菌的数量。
口服异维A酸治疗16周后，所有皮肤部位和鼻孔处的活菌丙酸杆菌以及对红霉素、克林霉素或四环素耐药的变体的平均种群密度下降了90%以上。唯一的例外是下背部耐四环素菌株的减少幅度较小。一般来说，皮肤部位的减少幅度大于鼻孔处。到治疗期结束时，只有三名患者（均在费城）在任何部位都未检出耐抗生素菌株。治疗后，丙酸杆菌计数仍远低于治疗前水平，但面部和鼻孔处已开始恢复。恢复的丙酸杆菌种群包括敏感菌株和耐药菌株。两个中心在治疗期间及治疗后的变化相似但不完全相同。
口服异维A酸可有效减少皮肤和鼻孔被耐抗生素丙酸杆菌的定植。然而，治疗后多个部位仍存在耐药分离株的活菌种群。需要新的方法来彻底根除耐抗生素丙酸杆菌，尤其是从鼻腔定植源中根除。
