Nakase Keisuke, Aoki Sae, Sei Sayaka, Fukumoto Sana, Horiuchi Yuki, Yasuda Takae, Tanioka Miki, Sugai Junichi, Huh Wook-Kang Winnie, Kakuta Mie, Nomoto Mayumi, Shimada Tokihiko, Watanabe Masako, Kobayashi Miwa, Murakami Saori, Takeo Chikage, Tsubouchi Rieko, Hayashi Nobukazu, Noguchi Norihisa
Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
Akihabara Skin Clinic, Tokyo, Japan.
J Dermatol. 2020 Aug;47(8):863-869. doi: 10.1111/1346-8138.15397. Epub 2020 May 18.
Use of antimicrobials for acne treatment is correlated with an increased occurrence of antimicrobial-resistant Cutibacterium acnes. To clarify the role of antimicrobial use on the resistance and to investigate the characteristics of resistant strains, we conducted a multicenter study in dermatological clinics frequently visited by new patients with acne vulgaris. We collected specimens in 264 acne patients and tested 164 C. acnes strains isolated from 164 patients visiting 13 dermatological clinics. Antimicrobial susceptibility testing showed that the rates of resistance for tetracyclines, macrolides and clindamycin were significantly higher in C. acnes strains isolated from patients using antimicrobials for acne treatment than patients not using them. In particular, clindamycin-resistant strains were frequently isolated from patients with older median age (≥24 years) and severe/moderate acne. After investigating the resistance mechanism of 15 high-level clindamycin-resistant strains, the transposable clindamycin resistance genes, erm(X) or erm(50), were detected in 14 strains. Using single-locus sequence typing for C. acnes, the strains with erm(X) or multidrug resistance plasmid pTZC1 coding erm(50) and tetracycline resistance gene tet(W) were classified into clade F, which were specifically isolated from Japanese patients with acne, except for one strain. Our data showed that patients' information, such as antimicrobial use, age and acne severity, are valuable in estimating whether a patient carries antimicrobial-resistant C. acnes. Additionally, our results suggest that the clade F strains have a high risk of acquiring multidrug resistance.
使用抗菌药物治疗痤疮与痤疮丙酸杆菌耐药性增加有关。为阐明抗菌药物使用对耐药性的作用并研究耐药菌株的特征，我们在寻常痤疮新患者常就诊的皮肤科诊所开展了一项多中心研究。我们收集了264例痤疮患者的标本，并对从13家皮肤科诊所就诊的164例患者中分离出的164株痤疮丙酸杆菌进行了检测。抗菌药物敏感性试验表明，与未使用抗菌药物治疗痤疮的患者相比，从使用抗菌药物治疗痤疮的患者中分离出的痤疮丙酸杆菌菌株对四环素、大环内酯类和克林霉素的耐药率显著更高。特别是，耐克林霉素菌株常从年龄中位数较大（≥24岁）且患有重度/中度痤疮的患者中分离出来。在研究了15株高水平耐克林霉素菌株的耐药机制后，在14株菌株中检测到了可移动的克林霉素耐药基因erm(X)或erm(50)。使用痤疮丙酸杆菌的单基因座序列分型，携带erm(X)或编码erm(50)和四环素耐药基因tet(W)的多药耐药质粒pTZC1的菌株被归类为进化枝F，除一株外，这些菌株均专门从日本痤疮患者中分离得到。我们的数据表明，患者的信息，如抗菌药物使用情况、年龄和痤疮严重程度，对于评估患者是否携带耐抗菌药物的痤疮丙酸杆菌很有价值。此外，我们的结果表明，进化枝F菌株具有获得多药耐药性的高风险。
