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Antibiotic-resistant acne: lessons from Europe
J I Ross1, A M Snelling, E Carnegie
1Division of Microbiology, School of Biochemistry and Molecular Biology, University of Leeds, Leeds LS2 9JT, UK.
The British Journal of Dermatology
|March 26, 2003
Summary
Antibiotic-resistant propionibacteria are common in acne patients across Europe, with high rates of resistance to topical antibiotics like erythromycin and clindamycin. This highlights the need for stricter infection control measures in dermatology clinics.
Area of Science:
- Dermatology
- Microbiology
- Infectious Diseases
Background:
- Propionibacterium acnes and P. granulosum are implicated in inflammatory acne.
- Antibiotic resistance in these bacteria necessitates understanding prevalence.
- Current data on resistance prevalence is limited, particularly outside the UK.
Purpose of the Study:
- To determine the prevalence of antibiotic-resistant propionibacteria on the skin of acne patients.
- To investigate colonization in their close contacts and dermatologists.
- To assess resistance patterns across six European centers.
Main Methods:
- Skin swabs collected from 664 acne patients and contacts in the UK, Spain, Italy, Greece, Sweden, and Hungary.
- Phenotypic determination of antibiotic resistance using Minimum Inhibitory Concentrations (MIC).
- Genotypic characterization of resistance determinants via Polymerase Chain Reaction (PCR) and sequencing.
Main Results:
- Propionibacteria recovered from 622 patients; 515 isolates showed antibiotic resistance.
- Resistance prevalence varied by country, highest in Spain (94%).
- Combined resistance to clindamycin and erythromycin was more prevalent (up to 91% in Spain) than tetracycline resistance (up to 26.4% in UK).
- Resistant propionibacteria were found in 86% of contacts in Spain and 25/39 dermatologists.
Conclusions:
- Widespread use of topical erythromycin and clindamycin has led to cross-resistant propionibacteria strains.
- Resistance rates to oral tetracyclines were generally low, except in Sweden and UK.
- Resistant strains are distributed across Europe and transmissible between individuals.
- Dermatologists should implement stricter cross-infection control measures.