Sardana Kabir, Gupta Tanvi, Kumar Bipul, Gautam Hemant K, Garg Vijay K
Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi - 110 025, India.
CSIR-Institute of Genomics and Integrative Biology, Department of Microbial Biotechnology, Sukhdev Vihar, Mathura Road, New Delhi - 110 025, India.
Indian J Dermatol. 2016 Jan-Feb;61(1):45-52. doi: 10.4103/0019-5154.174025.
Antibiotic resistance is a worldwide problem in acne patients due to regional prescription practices, patient compliance, and genomic variability in Propionibacterium acnes, though the effect of treatment on the resistance has not been comprehensively analyzed.
Our primary objective was to assess the level of antibiotic resistance in the Indian patients and to assess whether there was a difference in the resistance across common treatment groups.
A cross-sectional, institutional based study was undertaken and three groups of patients were analyzed, treatment naïve, those on antibiotics and patients on benzoyl peroxide (BPO) and/isotretinoin. The follicular content was sampled and the culture was verified with 16S rRNA polymerase chain reaction, genomic sequencing, and pulsed-field gel electrophoresis. Minimum inhibitory concentration (MIC) assessment was done for erythromycin (ERY), azithromycin (AZI), clindamycin (CL), tetracycline (TET), doxycycline (DOX), minocycline (MINO), and levofloxacin (LEVO). The four groups of patients were compared for any difference in the resistant strains.
Of the 52 P. acnes strains isolated (80 patients), high resistance was observed to AZI (100%), ERY (98%), CL (90.4%), DOX (44.2%), and TETs (30.8%). Low resistance was observed to MINO (1.9%) and LEVO (9.6%). Statistical difference was seen in the resistance between CL and TETs; DOX/LEVO and DOX/MINO (P < 0.001). High MIC90 (≥256 μg/ml) was seen with CL, macrolides, and TETs; moreover, low MIC90 was observed to DOX (16 μg/ml), MINO (8 μg/ml), and LEVO (4 μg/ml). Though the treatment group with isotretinoin/BPO had the least number of resistant strains there was no statistical difference in the antibiotic resistance among the various groups of patients.
High resistance was seen among the P. acnes strains to macrolides-lincosamides (AZI and CL) while MINO and LEVO resistance was low.
由于地区处方习惯、患者依从性以及痤疮丙酸杆菌的基因组变异性，抗生素耐药性在痤疮患者中是一个全球性问题，不过治疗对耐药性的影响尚未得到全面分析。
我们的主要目标是评估印度患者的抗生素耐药水平，并评估常见治疗组之间的耐药性是否存在差异。
开展了一项基于机构的横断面研究，分析了三组患者，即未接受过治疗的患者、正在使用抗生素的患者以及正在使用过氧化苯甲酰（BPO）和/或异维A酸的患者。采集毛囊内容物样本，并通过16S rRNA聚合酶链反应、基因组测序和脉冲场凝胶电泳对培养物进行验证。对红霉素（ERY）、阿奇霉素（AZI）、克林霉素（CL）、四环素（TET）、多西环素（DOX）、米诺环素（MINO）和左氧氟沙星（LEVO）进行最低抑菌浓度（MIC）评估。比较四组患者耐药菌株的差异。
在分离出的52株痤疮丙酸杆菌菌株（80例患者）中，观察到对AZI（100%）、ERY（98%）、CL（90.4%）、DOX（44.2%）和TETs（30.8%）的高耐药性。观察到对MINO（1.9%）和LEVO（9.6%）的低耐药性。CL与TETs之间；DOX/LEVO与DOX/MINO之间的耐药性存在统计学差异（P < 0.001）。CL、大环内酯类和TETs的MIC90较高（≥256μg/ml）；此外，观察到DOX（16μg/ml）、MINO（8μg/ml）和LEVO（4μg/ml）的MIC90较低。尽管使用异维A酸/BPO的治疗组耐药菌株数量最少，但各患者组之间的抗生素耐药性无统计学差异。
痤疮丙酸杆菌菌株对大环内酯类-林可酰胺类（AZI和CL）耐药性高，而对MINO和LEVO耐药性低。
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