Antimicrobial Susceptibility, Biotypes and Phylotypes of Clinical Cutibacterium (Formerly Propionibacterium) acnes Strains Isolated from Acne Patients: An Observational Study

Abstract

IntroductionThe aim of this study was to investigate the distribution of antimicrobial susceptibility, biotypes and phylotypes of clinical Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes) isolates as well as the relationship among demographic factors, C. acnes biotypes and phylotypes.MethodsCutibacterium acnes was collected from the skin lesions of acne patients who visited the dermatologic department of Huashan Hospital in Shanghai from October 2016 to March 2017. The agar dilution method was conducted to determine the minimum inhibitory concentrations (MICs) of C. acnes, the fermentation test to identify biotypes and then multiplex touchdown polymerase chain reaction (PCR) to identify phylotypes.ResultsOf the 63 C. acnes strains we isolated, 18 (28.6%), 31 (49.2%) and 4 (6.3%) strains were resistant to clindamycin, erythromycin and moxifloxacin, respectively; no strains were resistant to tetracycline, minocycline, fusidic acid or β-lactam, while metronidazole was completely resisted; 3 strains showed multidrug resistance (MDR). Biotype III (BIII) was the major biotype (50.8%) followed by BI and BV (both 15.9%), BII (12.7%) and lastly BIV (4.8%). IA1 was the predominant phylotype (71.4%) followed by IA2 (19.0%), II (4.8%), IB (3.2%) and IC (1.6%), while III was not detected. Significant differences were observed in the severity of disease: different degrees of acne severity reflected different biotype and phylotype distributions, and the biotype distribution of mild acne was different from that of moderate acne; the phylotype distribution of moderate acne varies from that of severe acne, too. Additionally, there was no significant difference in the distribution of biotypes or phylotypes between resistant and susceptible strains.ConclusionErythromycin and clindamycin resistances are the most common in clinical C. acnes strains; BIII is the predominant biotype and IA1 is the major phylotype of C. acnes, which are mainly related to disease severity.

Antibiotic resistant Cutibacterium acnes among acne patients in Jordan: a cross sectional study

“…3). Multi-drug resistant C. acnes was also reported recently by Zhang et al who isolated strains that were simultaneously resistant to clindamycin, erythromycin and moxifloxacin [6]. Similarly, this pattern was also found in the staphylococcal strains isolated from the skin of patients and not from the acne lesions themselves (Fig.…”

“…The presence of antibiotic resistance in the normal flora of outpatients highlights the possibility of community spread of antibiotic resistant strains through horizontal transfer. In accordance with previous studies, the relationship between resistance and history of antibiotic use remains debated and resistance to antibiotics could be mainly acquired due to contact-mediated spread of resistant C. acnes [6,35].…”

“…The pathogenesis of acne is complicated; it develops as a result of hormonal imbalance leading to overproduction of sebum accompanied by follicular duct hyper-keratinisation. The accumulation of dead skin and fatty acids pave the way for Cutibacterium acnes (C. acnes) follicular enhanced colonization and the subsequent release of inflammatory mediators [5,6]. C. acnes, commonly known as the cause of acne vulgaris, is typically an aerotolerant anaerobic, Gram-positive bacillus that colonizes the pilosebaceous follicle, derives energy from hydrolyzing triglycerides of the sebum, and secretes fatty acid byproducts, mainly propionic acid.…”

Antibiotic resistance in acne: changes, consequences and concerns

“…There is no correlation between antibiotic resistance in in vitro testing and in samples from patients with clinical treatment failure for the antibiotic minimal inhibitory concentration (MIC) 50 . The great heterogeneity in the available data render the interpretation and comparison difficult; however, recent studies show antibiotic resistance differs in different biotypes and phylotypes of P. acnes 51–53 …”

Comparison of dermatologists and family physicians in terms of prescribing antibiotics for the treatment of acne vulgaris

“…[17][18][19][20][21] The resistance to macrolides is more pronounced. [21][22][23] Topical antibiotics like erythromycin and clindamycin have caused an increase in antibiotic-resistant bacteria both in the applied and other areas. 21,24,25 On the other hand, systemic antibiotics were found to cause microflora to gain resistance throughout the body.…”