Relationship between quinolone use and resistance of Staphylococcus epidermidis in patients with acne vulgaris

Abstract

Staphylococcus epidermidis is a bacterium known to inhabit the skin. In treatment of acne vulgaris, the cutaneous milieu is exposed to oral or topical antimicrobials. We previously reported that the antimicrobial resistance of Cutibacterium acnes isolated from acne patients is affected by antimicrobial use. The aim of this study was to investigate the relationship between quinolone use and resistance in skin bacteria, particularly S. epidermidis, from acne patients. A total of 92 and 87 S. epidermidis strains isolated from clinic patients and hospital outpatients with acne vulgaris, respectively, were tested. No significant difference was found between the prevalence of methicillin‐resistant S. epidermidis (MRSE) strains from clinic patients (37.0%) and hospital outpatients (39.1%). The MRSE strains (20.6%, 14/68 strains) showed a significantly higher ratio of high‐level levofloxacin resistance (minimum inhibitory concentrations were 64 to ≥256 μg/mL) compared with methicillin‐susceptible S. epidermidis strains (2.7%, 3/111 strains) (P < 0.01). The rate of levofloxacin resistance in C. acnes strains, which were isolated from the same samples of acne patients, showed a strong positive correlation with that in S. epidermidis strains (r = 0.93, P < 0.01). The high‐level levofloxacin‐resistant strains were frequently found in patients with history of quinolone use compared with those without (P < 0.01). Our data showed for the first time that antimicrobial administration for acne treatment affects the antimicrobial resistance in not only C. acnes but also S. epidermidis. Thus, caution should be exercised in antimicrobial use for acne treatment to prevent increasing antimicrobial resistance in these species.

Alterations of human skin microbiome and expansion of antimicrobial resistance after systemic antibiotics

“…Given the intense interest in the biological relevance of the human microbiome, understanding how interventions may perturb the microbiome of the largest human organ over time is critically important. Although previous reports have suggested that systemic antibiotic usage can increase the prevalence of antibiotic-resistant microbes on skin (6)(7)(8), these studies focused on cultured isolates or targeted resistance genes. A limited number of skin microbiome studies have analyzed the effects of antibiotics (9,10).…”

Effect of 30% Supramolecular Salicylic Acid Peel on Skin Microbiota and Inflammation in Patients with Moderate-to-Severe Acne Vulgaris

“…The over-colonization of Propionibacterium acne triggers the immune response in sebocytes, keratinocytes, and monocytes [38]. In addition, the proportion of Staphylococcus increases with the severity of AV [38][39][40][41]. In this study, we found that patients with moderate-to-severe AV showed increased amounts of Staphylococcus and Propionibacterium compared with healthy controls (P = 0.013 and P = 0.0015, respectively), suggesting that the two genera could be possible biomarkers of moderate-to-severe AV and that their overgrowth may be related to the pathogenesis of acne.…”

Photodynamic therapy treats acne by altering the composition of the skin microbiota

“…Acne treatment is mainly based on severity, in which severe acne is treated mainly with oral isotretinoin and antibiotics, and could take months or even years for completion of treatment 34 . Long‐term antibiotic use may cause side effects, including dysbacteriosis and resistance to symbiotic bacteria, increasing the probability of opportunistic pathogen infection 35,36 . Long‐term use of isotretinoin may induce skin and mucous membrane dryness, elevated blood lipids, abnormal liver function, teratogenicity, depression, and suicidal tendencies.…”

“… 34 Long‐term antibiotic use may cause side effects, including dysbacteriosis and resistance to symbiotic bacteria, increasing the probability of opportunistic pathogen infection. 35 , 36 Long‐term use of isotretinoin may induce skin and mucous membrane dryness, elevated blood lipids, abnormal liver function, teratogenicity, depression, and suicidal tendencies. Therefore, a variety of safe and effective physical therapies gradually have become the new trend in acne treatment.…”