Antibiotic-resistant acne: Lessons from Europe

J. I. Ross, A. M. Snelling, E. Carnegie, P. Coates, W. J. Cunliffe, V. Bettoli, G. Tosti, A. Katsambas, J. I. Galvan Peréz Del Pulgar, O. Rollman, L. Török, E. A. Eady, J. H. Cove

Research output: Contribution to journalArticle

278 Citations (Scopus)

Abstract

Background: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. Objectives: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. Methods: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. Results: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. Conclusions: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.

Original languageEnglish
Pages (from-to)467-478
Number of pages12
JournalBritish Journal of Dermatology
Volume148
Issue number3
DOIs
Publication statusPublished - Mar 1 2003

Fingerprint

Acne Vulgaris
Propionibacterium
Anti-Bacterial Agents
Hungary
Propionibacterium acnes
Spain
Tetracycline
Skin
Clindamycin
Erythromycin
Sweden
Italy
Streptogramin B
Lincosamides
Tetracycline Resistance
Greece
Macrolides
Microbial Sensitivity Tests
Infection Control
Cross Infection

Keywords

  • Clindamycin
  • Erythromycin
  • Propionibacterium acnes
  • Resistance
  • Tetracyclines

ASJC Scopus subject areas

  • Dermatology

Cite this

Ross, J. I., Snelling, A. M., Carnegie, E., Coates, P., Cunliffe, W. J., Bettoli, V., ... Cove, J. H. (2003). Antibiotic-resistant acne: Lessons from Europe. British Journal of Dermatology, 148(3), 467-478. https://doi.org/10.1046/j.1365-2133.2003.05067.x

Antibiotic-resistant acne : Lessons from Europe. / Ross, J. I.; Snelling, A. M.; Carnegie, E.; Coates, P.; Cunliffe, W. J.; Bettoli, V.; Tosti, G.; Katsambas, A.; Galvan Peréz Del Pulgar, J. I.; Rollman, O.; Török, L.; Eady, E. A.; Cove, J. H.

In: British Journal of Dermatology, Vol. 148, No. 3, 01.03.2003, p. 467-478.

Research output: Contribution to journalArticle

Ross, JI, Snelling, AM, Carnegie, E, Coates, P, Cunliffe, WJ, Bettoli, V, Tosti, G, Katsambas, A, Galvan Peréz Del Pulgar, JI, Rollman, O, Török, L, Eady, EA & Cove, JH 2003, 'Antibiotic-resistant acne: Lessons from Europe', British Journal of Dermatology, vol. 148, no. 3, pp. 467-478. https://doi.org/10.1046/j.1365-2133.2003.05067.x
Ross JI, Snelling AM, Carnegie E, Coates P, Cunliffe WJ, Bettoli V et al. Antibiotic-resistant acne: Lessons from Europe. British Journal of Dermatology. 2003 Mar 1;148(3):467-478. https://doi.org/10.1046/j.1365-2133.2003.05067.x
Ross, J. I. ; Snelling, A. M. ; Carnegie, E. ; Coates, P. ; Cunliffe, W. J. ; Bettoli, V. ; Tosti, G. ; Katsambas, A. ; Galvan Peréz Del Pulgar, J. I. ; Rollman, O. ; Török, L. ; Eady, E. A. ; Cove, J. H. / Antibiotic-resistant acne : Lessons from Europe. In: British Journal of Dermatology. 2003 ; Vol. 148, No. 3. pp. 467-478.
@article{838066a5921e4c00abc19dc8572288d5,
title = "Antibiotic-resistant acne: Lessons from Europe",
abstract = "Background: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. Objectives: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. Methods: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. Results: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51{\%}) and highest in Spain (94{\%}). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91{\%} in Spain) than resistance to the tetracyclines (highest prevalence 26.4{\%} in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41{\%} in Hungary to 86{\%} in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. Conclusions: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.",
keywords = "Clindamycin, Erythromycin, Propionibacterium acnes, Resistance, Tetracyclines",
author = "Ross, {J. I.} and Snelling, {A. M.} and E. Carnegie and P. Coates and Cunliffe, {W. J.} and V. Bettoli and G. Tosti and A. Katsambas and {Galvan Per{\'e}z Del Pulgar}, {J. I.} and O. Rollman and L. T{\"o}r{\"o}k and Eady, {E. A.} and Cove, {J. H.}",
year = "2003",
month = "3",
day = "1",
doi = "10.1046/j.1365-2133.2003.05067.x",
language = "English",
volume = "148",
pages = "467--478",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "Blackwell Publishing Ltd",
number = "3",

}

TY - JOUR

T1 - Antibiotic-resistant acne

T2 - Lessons from Europe

AU - Ross, J. I.

AU - Snelling, A. M.

AU - Carnegie, E.

AU - Coates, P.

AU - Cunliffe, W. J.

AU - Bettoli, V.

AU - Tosti, G.

AU - Katsambas, A.

AU - Galvan Peréz Del Pulgar, J. I.

AU - Rollman, O.

AU - Török, L.

AU - Eady, E. A.

AU - Cove, J. H.

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Background: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. Objectives: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. Methods: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. Results: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. Conclusions: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.

AB - Background: Propionibacterium acnes and P. granulosum are widely regarded as the aetiological agents of inflammatory acne. Their proliferation and metabolism are controlled using lengthy courses of oral and/or topical antibiotics. Despite numerous reports of skin colonization by antibiotic-resistant propionibacteria among acne patients, accurate prevalence data are available only for the U.K. Objectives: To determine the prevalence of skin colonization by antibiotic-resistant propionibacteria among acne patients and their contacts from six European centres. Methods: Skin swabs were collected from 664 acne patients attending centres in the U.K., Spain, Italy, Greece, Sweden and Hungary. Phenotypes of antibiotic-resistant propionibacteria were determined by measuring the minimum inhibitory concentrations (MIC) of a panel of tetracycline and macrolide, lincosamide and streptogramin B (MLS) antibiotics. Resistance determinants were characterized by polymerase chain reaction (PCR) using primers specific for rRNA genes and erm(X), followed by nucleotide sequencing of the amplified DNA. Results: Viable propionibacteria were recovered from 622 patients. A total of 515 representative antibiotic-resistant isolates and 71 susceptible isolates to act as control strains were characterized phenotypically. The prevalence of carriage of isolates resistant to at least one antibiotic was lowest in Hungary (51%) and highest in Spain (94%). Combined resistance to clindamycin and erythromycin was much more common (highest prevalence 91% in Spain) than resistance to the tetracyclines (highest prevalence 26.4% in the U.K.). No isolates resistant to tetracycline were detected in Italy, or in Hungary. Overall, there were strong correlations with prescribing patterns. Prevalence of resistant propionibacteria on the skin of untreated contacts of the patients varied from 41% in Hungary to 86% in Spain. Of the dermatologists, 25 of 39 were colonized with resistant propionibacteria, including all those who specialized in treating acne. None of 27 physicians working in other outpatient departments harboured resistant propionibacteria. Conclusions: The widespread use of topical formulations of erythromycin and clindamycin to treat acne has resulted in significant dissemination of cross-resistant strains of propionibacteria. Resistance rates to the orally administered tetracycline group of antibiotics were low, except in Sweden and the U.K. Resistant genotypes originally identified in the U.K. are distributed widely throughout Europe. Antibiotic-resistant propionibacteria should be considered transmissible between acne-prone individuals, and dermatologists should use stricter cross-infection control measures when assessing acne in the clinic.

KW - Clindamycin

KW - Erythromycin

KW - Propionibacterium acnes

KW - Resistance

KW - Tetracyclines

UR - http://www.scopus.com/inward/record.url?scp=0345578675&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0345578675&partnerID=8YFLogxK

U2 - 10.1046/j.1365-2133.2003.05067.x

DO - 10.1046/j.1365-2133.2003.05067.x

M3 - Article

C2 - 12653738

AN - SCOPUS:0345578675

VL - 148

SP - 467

EP - 478

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

IS - 3

ER -