Characterization of acne patients carrying clindamycin‐resistant Cutibacterium acnes: A Japanese multicenter study

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.

A Janus-Faced Bacterium: Host-Beneficial and -Detrimental Roles of Cutibacterium acnes

“…A recent study has reported the association of the SLST type A (a subset of IA 1 strains, Figure 2) with acne-affected skin; however, this study only processed a rather small cohort (n = 36) (Dagnelie et al, 2018). In contrast, studies with Japanese patients have detected the SLST type F (IA 2 ) as strongly acne-associated (Nakase et al, 2017(Nakase et al, , 2020, suggesting geographic differences between Europe and Asia. In addition, the SLST type C (IA 1 ) is enriched among acne patients; this SLST type corresponds to the (MLST-based) phylogenetic lineage CC3 (Lomholt and Kilian, 2010;McLaughlin et al, 2019).…”

Interference and co-existence of staphylococci and Cutibacterium acnes within the healthy human skin microbiome

“…Recent work has shown that some phylotypes/SLST classes are enriched in individuals with the skin disorder acne vulgaris, whereas others have been identified as markers of healthy skin. Acne-associated phylotypes include SLST classes A and C (both phylotype IA 1 ) and F (IA 2 ), whereas healthy skin is colonised with more diverse populations with a higher prevalence of strains belonging to the SLST classes H (IB) and K (II) 21 – 26 .…”

Multidrug Resistance Plasmid pTZC1 Could Be Pooled among Cutibacterium Strains on the Skin Surface

“…In 2008, the multidrug resistance plasmid pTZC1, which harbors erm (50) and tet (W), was found in the C. acnes strains isolated from acne patients in Osaka, Japan ( 16 ). Subsequently, C. acnes strains having pTZC1 were isolated in Tokyo and Hiroshima, and spread in Japan ( 12 ). In this study, the C. acnes and C. granulosum strains harboring pTZC1 were isolated together from two patients.…”

“…C. acnes can develop antimicrobial resistance through various mechanisms. Mutations in 23S rRNA and acquisition of ribosomal methylase coding genes erm (X) and erm (50) are well-known mechanisms of resistance against the macrolides-clindamycin ( 12 , 13 ). erm (X) is found on chromosomes or linear plasmids and is transmitted between C. acnes strains ( 14 , 15 ).…”