Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
Department of Dermatology, Toranomon Hospital, Tokyo, Japan.
J Dermatol. 2023 Jun;50(6):793-799. doi: 10.1111/1346-8138.16757. Epub 2023 Mar 7.
Cutibacterium acnes, a resident bacterium of the skin, is a target for antimicrobial treatment of acne vulgaris, because it exacerbates inflammation. Recently, antimicrobial-resistant C. acnes strains have been isolated worldwide, and their prevalence has led to failure of antimicrobial treatment. This study aimed to analyze the antimicrobial resistance of C. acnes strains isolated from Japanese patients with acne vulgaris who visited the hospital and dermatological clinics between 2019 and 2020. Resistance rates to roxithromycin and clindamycin increased during 2019 to 2020 compared with those during 2013 to 2018. Additionally, the proportion of doxycycline-resistant and low-susceptibility strains (minimum inhibitory concentration [MIC] ≥8 μg/mL) increased. No difference in clindamycin resistance rates between patients with and without a history of antimicrobial use was observed during 2019 to 2020, which were significantly higher for patients with a history than for patients without a history during 2016 to 2018. The proportion of high-level clindamycin-resistant strains (MIC ≥256 μg/mL) gradually increased; particularly, the resistance rate was 2.5 times higher in 2020 than that in 2013. The proportion of strains showing high-level clindamycin resistance that also have the exogenous resistance genes erm(X) or erm(50), which confer high resistance, showed a strong positive correlation (r = 0.82). Strains with the multidrug resistance plasmid pTZC1 encoding erm(50) and tet(W) genes were frequent in clinic patients. Notably, most strains with erm(X) or erm(50) were classified as single-locus sequence types A and F (traditional types IA1 and IA2). Our data show that the prevalence of antimicrobial-resistant C. acnes is increasing in patients with acne vulgaris attributable to acquisition of exogenous genes in specific strains. To control the increasing prevalence of antimicrobial-resistant strains, it is important to select the appropriate antimicrobials while taking into consideration the latest information on resistant strains.
痤疮丙酸杆菌是皮肤的常驻细菌，是治疗寻常痤疮的抗菌药物治疗的靶标，因为它会加重炎症。最近，已经在全球范围内分离出了具有抗药性的痤疮丙酸杆菌菌株，并且它们的流行率导致了抗菌药物治疗的失败。本研究旨在分析 2019 年至 2020 年间在医院和皮肤科诊所就诊的日本寻常痤疮患者分离的痤疮丙酸杆菌菌株的抗菌药物耐药性。与 2013 年至 2018 年相比，2019 年至 2020 年，罗红霉素和克林霉素的耐药率增加。此外，多西环素耐药和低敏感性（最小抑菌浓度 [MIC]≥8μg/mL）菌株的比例增加。2019 年至 2020 年间，无抗菌药物使用史与有抗菌药物使用史患者的克林霉素耐药率无差异，但在 2016 年至 2018 年间，有抗菌药物使用史的患者的克林霉素耐药率明显高于无抗菌药物使用史的患者。高水平克林霉素耐药（MIC≥256μg/mL）菌株的比例逐渐增加；特别是，2020 年的耐药率是 2013 年的 2.5 倍。同时具有高水平克林霉素耐药性和外源性耐药基因 erm(X)或 erm(50)的菌株比例呈强正相关（r=0.82）。编码 erm(50)和 tet(W)基因的多药耐药质粒 pTZC1 的菌株在临床患者中频繁出现。值得注意的是，大多数具有 erm(X)或 erm(50)的菌株被分类为单基因座序列类型 A 和 F（传统类型 IA1 和 IA2）。我们的数据表明，由于特定菌株中获得外源性基因，寻常痤疮患者中抗菌药物耐药性痤疮丙酸杆菌的流行率正在增加。为了控制抗菌药物耐药菌株的流行率增加，在选择合适的抗菌药物时，考虑到耐药菌株的最新信息非常重要。
