Join-Lambert Olivier, Coignard-Biehler Hélène, Jais Jean-Philippe, Delage Maïa, Guet-Revillet Hélène, Poirée Sylvain, Duchatelet Sabine, Jullien Vincent, Hovnanian Alain, Lortholary Olivier, Nassif Xavier, Nassif Aude
Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France
Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Antimicrob Chemother. 2016 Feb;71(2):513-20. doi: 10.1093/jac/dkv361. Epub 2015 Nov 12.
Hidradenitis suppurativa (HS) is an inflammatory skin disease typically localized in the axillae and inguinal and perineal areas. In the absence of standardized medical treatment, severe HS patients present chronic suppurative lesions with polymicrobial anaerobic abscesses. Wide surgery is the cornerstone treatment of severe HS, but surgical indications are limited by the extent of lesions. Intravenous broad-spectrum antibiotics may help control HS, but their efficacy is not documented. This study was designed to assess the efficacy of a 6 week course of ertapenem (1 g daily) and of antibiotic consolidation treatments for 6 months (M6) in severe HS.
Thirty consecutive patients with severe HS were retrospectively included in this study. The clinical severity of HS was assessed using the Sartorius score, which takes into account the number and severity of lesions.
The median (IQR) Sartorius score dropped from 49.5 (28-62) at baseline to 19.0 (12-28) after ertapenem (P < 10(-4)). Five patients were lost to follow-up thereafter. At M6 the Sartorius score further decreased for the 16 patients who received continuous consolidation treatments, since 59% of HS areas reached clinical remission at M6 (i.e. absence of any inflammatory symptoms, P < 10(-4)). Nine patients interrupted or received intermittent consolidation treatments due to poor observance or irregular follow-up. Their Sartorius score stopped improving or returned to baseline. No major adverse event occurred.
Ertapenem can dramatically improve severe HS. Consolidation treatments are needed to further improve HS and are mandatory to prevent relapses. Combined with surgery, optimized antibiotic treatments may be promising in severe HS.
化脓性汗腺炎（HS）是一种炎症性皮肤病，通常局限于腋窝、腹股沟和会阴部位。在缺乏标准化药物治疗的情况下，重度HS患者会出现伴有多微生物厌氧脓肿的慢性化脓性病变。广泛手术是重度HS的基石治疗方法，但手术指征受病变范围限制。静脉使用广谱抗生素可能有助于控制HS，但尚未记录其疗效。本研究旨在评估厄他培南（每日1g）为期6周的疗程以及6个月（M6）抗生素巩固治疗对重度HS的疗效。
本研究回顾性纳入了30例连续的重度HS患者。使用考虑病变数量和严重程度的萨托里厄斯评分评估HS的临床严重程度。
厄他培南治疗后，萨托里厄斯评分中位数（IQR）从基线时的49.5（28 - 62）降至19.0（12 - 28）（P < 10⁻⁴）。此后有5例患者失访。在M6时，接受持续巩固治疗的16例患者的萨托里厄斯评分进一步下降，因为59%的HS区域在M6时达到临床缓解（即无任何炎症症状，P < 10⁻⁴）。9例患者因依从性差或随访不规律而中断或接受间歇性巩固治疗。他们的萨托里厄斯评分停止改善或恢复到基线水平。未发生重大不良事件。
厄他培南可显著改善重度HS。需要巩固治疗以进一步改善HS，且对于预防复发必不可少。与手术相结合，优化的抗生素治疗在重度HS中可能前景良好。
