Research Article| Volume 35, ISSUE 2, P163-167, March 2017

Propionibacterium acnes and antimicrobial resistance in acne


      The human commensal bacterium Propionibacterium acnes (P. acnes) resides in the pilosebaceous duct of the skin. It has been long implicated in the pathogenesis of acne, although its exact role in the development of inflammatory acne lesions and in the formation of the microcomedo in the early stages of acne remains controversial. The worldwide prevalence of antibiotic-resistant P. acnes is increasing, with rates varying in different parts of the world. The reason for the difference in the antibiotic resistance patterns of P. acnes among different countries is not clear, although it may be attributed to different antibiotic prescribing habits, concomitant use of topical agents (retinoids, benzoyl peroxide, or other antibiotics), varying methods of bacterial sampling, or even different P. acnes populations. Although the relative abundances of P. acnes may be similar among patients with acne and individuals without acne, P. acnes populations and the presence of P. acnes biofilms differ, with different potential virulence properties and antimicrobial resistance patterns. Implications of the use of antibiotics and of antimicrobial resistance in patients with acne include the decreased efficacy of antibiotic treatments for acne, and the possible emergence of other resistant bacterial species via selective pressure by antibiotic use.
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        • Zouboulis C.C.
        • Eady A.
        • Philpott M.
        • et al.
        What is the pathogenesis of acne?.
        Exp Dermatol. 2005; 14: 143-152
        • Thiboutot D.M.
        • Layton A.M.
        • Eady E.A.
        IL-17: a key player in the P. acnes inflammatory cascade?.
        J Invest Dermatol. 2014; 134: 307-310
        • Isard O.
        • Knol A.C.
        • Castex-Rizzi N.
        • et al.
        Cutaneous induction of corticotropin releasing hormone by Propionibacterium acnes.
        Dermatoendocrinol. 2009; 1: 96-99
        • Isard O.
        • Knol A.C.
        • Aries M.F.
        • et al.
        Propionibacterium acnes activates the IGF-1/IGF-1 R system in the epidermis and induces keratinocyte proliferation.
        J Invest Dermatol. 2011; 131: 59-66
        • Dessinioti C.
        • Katsambas A.D.
        The role of Propionibacterium acnes in acne pathogenesis: facts and controversies.
        Clin Dermatol. 2010; 28: 2-7
        • Kim J.
        Review of the innate immune response in acne vulgaris: activation of Toll-like receptor 2 in acne triggers inflammatory cytokine responses.
        Dermatology. 2005; 211: 193-198
        • Kistowska M.
        • Gehrke S.
        • Jankovic D.
        • et al.
        IL-1 β drives inflammatory responses to Propionibacterium acnes in vitro and in vivo.
        J Invest Dermatol. 2014; 134: 677-685
        • Moon S.H.
        • Roh H.S.
        • Kim Y.H.
        • et al.
        Antibiotic resistance of microbial strains isolated from Korean acne patients.
        J Dermatol. 2012; 39: 833-837
        • Coates P.
        • Vyakrnam S.
        • Eady E.A.
        • et al.
        Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study.
        Br J Dermatol. 2002; 146: 840-848
        • Crawford W.W.
        • Crawford E.P.
        • Stoughton R.B.
        • et al.
        Laboratory induction and clinical occurrence of combined clindamycin and erythromycin resistance in Corynebacterium acnes.
        J Invest Dermatol. 1979; 72: 187-190
        • Leyden J.J.
        • McGinley K.J.
        • Cavalieri S.
        • et al.
        Propionibacterium acnes resistance to antibiotics in acne patients.
        J Am Acad Dermatol. 1983; 8: 41-45
        • Leclercq R.
        • Courvalin P.
        Intrinsic and unusual resistance to macrolide, lincosamide, and streptogramin antibiotics in bacteria.
        Antimicrob Agents Chemother. 1991; 35: 1273-1276
        • Weisblum B.
        Erythromycin resistance by ribosomal modification.
        Antimicrob Agents Chemother. 1995; 39: 577-585
        • Mendoza N.
        • Hernandez P.O.
        • Tyring S.K.
        • et al.
        Antimicrobial susceptibility of Propionibacterium acnes isolates from acne patients in Colombia.
        Int J Dermatol. 2013; 52: 688-692
        • Ross J.I.
        • Eady E.A.
        • Cove J.H.
        • et al.
        Clinical resistance to erythromycin and clindamycin in cutaneous propionibacteria isolated from acne patients is associated with mutations in 23 S rRNA.
        Antimicrob Agents Chemother. 1997; 41: 1162-1165
        • Gonzalez R.
        • Welsh O.
        • Ocampo J.
        • et al.
        In vitro antimicrobial susceptibility of Propionibacterium acnes isolated from acne patients in northern Mexico.
        Int J Dermatol. 2010; 49: 1003-1007
        • Ross J.I.
        • Eady E.A.
        • Cove J.H.
        • et al.
        16 S rRNA mutation associated with tetracycline resistance in a gram-positive bacterium.
        Antimicrob Agents Chemother. 1998; 42: 1702-1705
        • Ross J.I.
        • Eady E.A.
        • Carnegie E.
        • et al.
        Detection of transposon Tn5432-mediated macrolide-lincosamide-streptogramin B (MLSB) resistance in cutaneous propionibacteria from six European cities.
        J Antimicrob Chemother. 2002; 49: 165-168
        • Luk N.M.T.
        • Hui M.
        • Lee H.C.S.
        • et al.
        Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin center in Hong Kong.
        J Eur Acad Dermatol Venereol. 2013; 27: 31-36
        • Abdel Fattah N.S.
        • Darwish Y.W.
        In vitro antibiotic susceptibility patterns of Propionibacterium acnes isolated from acne patients: an Egyptian university hospital-based study.
        J Eur Acad Dermatol Venereol. 2013; 27: 1546-1551
        • Ross J.I.
        • Snelling A.M.
        • Carnegie E.
        • et al.
        Antibiotic-resistant acne: lessons from Europe.
        Br J Dermatol. 2003; 148: 467-478
        • Dumont-Wallon G.
        • Moyse D.
        • Blouin E.
        • et al.
        Bacterial resistance in French acne patients.
        Int J Dermatol. 2010; 49: 283-288
        • Alexeyev O.A.
        • Jahns A.C.
        Sampling and detection of skin Priopionibacterium acnes: current status.
        Anaerobe. 2012; 18: 479-483
        • Jahns A.C.
        • Lundskog B.
        • Ganceviciene R.
        • et al.
        An increased incidence of Propionibacterium acnes biofilms in acne vulgaris: a case-control study.
        Br J Dermatol. 2012; 167: 50-58
        • Yu Y.
        • Champer J.
        • Garban H.
        • et al.
        Typing of Propionibacterium acnes: a review of methods and comparative analysis.
        Br J Dermatol. 2015; 172: 1204-1209
        • Kwon H.H.
        • Yoon J.Y.
        • Park S.Y.
        • et al.
        Analysis of distribution patterns of Propionibacterium acnes phylotypes and Peptostreptococcus species from acne lesions.
        Br J Dermatol. 2013; 169: 1152-1155
        • Fitz-Gibbon S.
        • Tomida S.
        • Chiu B.H.
        • et al.
        Propionibacterium acnes strain populations in the human skin microbiome associated with acne.
        J Invest Dermatol. 2013; 133: 2152-2160
        • McDowell A.
        • Barnard E.
        • Nagy I.
        • et al.
        An expanded multilocus sequence typing scheme for Propionibacterium acnes: investigation of ‘pathogenic’, ‘commensal’ and antibiotic resistant strains.
        PLOS One. 2012; 7e41480
        • Honraet K.
        • Rossel B.
        • Coenye T.
        The acne biofilm.
        in: Zouboulis C.C. Katsambas A.D. Kligman A.M. Pathogenesis and Treatment of Acne and Rosacea. Springer, Berlin, Heidelberg, New York2014: 155-161
        • Leaper D.
        • Assadian O.
        • Edmiston C.E.
        Approach to chronic wound infections.
        Br J Dermatol. 2015; 173: 351-358
        • Burkhart C.
        • Burkhart C.G.
        Microbiology’s principle of biofilms as a major factor in the pathogenesis of acne vulgaris.
        Int J Dermatol. 2003; 42: 925-927
        • Eady E.A.
        • Ross J.I.
        • Cove J.H.
        • et al.
        Macrolide-lincosamide-streptogramin B (MLS) resistance in cutaneous propionibacteria: definition of phenotypes.
        J Antimicrob Chemother. 1989; 23: 493-502
        • Eady E.A.
        • Cove J.H.
        • Holland K.T.
        • et al.
        Erythromycin resistant propionibacteria in antibiotic treated acne patients: association with therapeutic failure.
        Br J Dermatol. 1989; 121: 51-57
        • Rollason J.
        • McDowell A.
        • Albert H.B.
        • et al.
        Genotypic and antimicrobial characterization of Propionibacterium acnes isolates from surgically excised lumbar disc herniations.
        Biomed Res Int. 2013; 2013: 530382
        • Levy P.Y.
        • Fenollar F.
        • Stein A.
        • et al.
        Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity.
        Clin Infect Dis. 2008; 46: 1884-1886
        • Daguze J.
        • Frenard C.
        • Saint-Jean M.
        • et al.
        Two cases of non-prosthetic bone and joint infection due to Propionibacterium acnes.
        J Eur Acad Dermatol Venereol. 2015; 30: e136-e137
        • Miller Y.W.
        • Eady E.A.
        • Lacey R.W.
        • et al.
        Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts.
        J Antimicrob Chemother. 1996; 38: 829-837
        • Eady E.A.
        • Cove J.H.
        • Holland K.T.
        • et al.
        Superior antibacterial action and reduced incidence of bacterial resistance in minocycline compared to tetracycline-treated acne patients.
        Br J Dermatol. 1990; 122: 233-244
        • Delost G.R.
        • Delost M.E.
        • Armile J.
        • et al.
        Staphylococcus aureus carriage rates and antibiotic resistance patterns in patients with acne vulgaris.
        J Am Acad Dermatol. 2016; 74: 673-678
        • Adams S.J.
        • Cunliffe W.J.
        • Cooke E.M.
        Long-term antibiotic therapy for acne vulgaris: effects on the bowel flora of patients and their relatives.
        J Invest Dermatol. 1985; 85: 35-37
        • Levy R.M.
        • Huang E.Y.
        • Roling D.
        • et al.
        Effect of antibiotics on the oropharyngeal flora in patients with acne.
        Arch Dermatol. 2003; 139: 467-471
        • Margolis D.J.
        • Bowe W.P.
        • Hoffstad O.
        • et al.
        Antibiotic treatment of acne may be associated with upper respiratory tract infections.
        Arch Dermatol. 2005; 141: 1132-1136
        • Nast A.
        • Dreno B.
        • Bettoli V.
        • et al.
        European Dermatology Forum. European evidence-based (S3) guidelines for the treatment of acne.
        J Eur Acad Dermatol. 2012; 26: 1-29