Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.
Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy.
J Eur Acad Dermatol Venereol. 2019 May;33(5):930-936. doi: 10.1111/jdv.15332. Epub 2019 Feb 19.
Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection.
The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy.
Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria.
A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes.
Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.
抗生素（AB）治疗是治疗化脓性汗腺炎（HS）的第一步。在 HS 患者中，细菌可能具有双重作用，既是炎症反应的触发因素，也是感染的病原体。
本研究的目的如下：（i）评估 HS 患者细菌生长的患病率和 AB 耐药性；（ii）评估获得的数据在指导选择最有效的 AB 治疗方面的临床相关性。
用拭子从 137 例 HS 患者的皮肤病变中采集脓性材料。使用有氧和厌氧细菌的微生物培养来确定细菌菌群和 AB 敏感性。
共有 114 个样本中培养出细菌。样本采集自腋窝、腹股沟和肛周区域。共观察到 163 种单一细菌生长，其中 55%为革兰氏阳性菌，44%为革兰氏阴性菌。其中，18.4%为厌氧菌。最常见的细菌科包括肠杆菌科（30.7%）、葡萄球菌（25.2%）和链球菌（14.1%）。最常见的属或种是变形杆菌属（13.5%）和大肠杆菌（9.8%）。观察到的 AB 耐药率分别为克林霉素 65.7%、利福平 69.3%、青霉素 70.0%、环丙沙星 74%、四环素 84.7%和红霉素 89.0%。本研究的一个局限性是采用的短培养期可能会影响厌氧菌的分离。
HS 患者的细菌生长表现出对 AB 的高度耐药性，包括利福平、克林霉素和四环素，这些药物被作为 HS 治疗指南中的经验性选择。与经验性、通用、非特异性治疗方法相比，由延长培养期的微生物评估驱动的靶向和特异性 AB 治疗似乎更为合适。在更新 HS 治疗指南时，应考虑当前关于 HS 细菌 AB 耐药性的知识。
