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Characterization of acne patients carrying clindamycin-resistant Cutibacterium acnes: A Japanese multicenter study
Keisuke Nakase1, Sae Aoki1, Sayaka Sei1
1Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
Abstract:
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.
Insights
Antimicrobial use in acne treatment increases resistant Cutibacterium acnes. Clindamycin-resistant strains are linked to older patients and severe acne, often carrying specific resistance genes.
Area of Science:
- Dermatology
- Microbiology
- Antimicrobial Resistance
Background:
- Antimicrobial use for acne vulgaris is common.
- Increased antimicrobial resistance in Cutibacterium acnes (C. acnes) is a growing concern.
- Understanding resistance patterns is crucial for effective acne treatment.
Purpose of the Study:
- To investigate the correlation between antimicrobial use and C. acnes resistance.
- To characterize antimicrobial-resistant C. acnes strains.
- To identify factors associated with resistance, including patient demographics and acne severity.
Main Methods:
- Multicenter study involving 264 acne patients and 164 C. acnes isolates.
- Antimicrobial susceptibility testing for common acne medications.
- Investigation of resistance mechanisms, including gene detection (erm(X), erm(50), tet(W)).
- Single-locus sequence typing to classify C. acnes strains.
Main Results:
- Higher resistance rates to tetracyclines, macrolides, and clindamycin were observed in patients with prior antimicrobial acne treatment.
- Clindamycin resistance was more frequent in older patients (≥24 years) with moderate to severe acne.
- Specific resistance genes (erm(X), erm(50)) were detected in most clindamycin-resistant strains.
- Clade F strains, carrying erm(X) or erm(50) and tet(W), were predominantly found in Japanese acne patients and showed a high risk for multidrug resistance.
Conclusions:
- Antimicrobial use significantly contributes to the emergence of resistant C. acnes.
- Patient factors like age, acne severity, and prior antimicrobial exposure are key indicators for resistant strains.
- Clade F C. acnes strains represent a significant public health concern due to their propensity for multidrug resistance.
