痤疮患者皮损分离菌对痤疮常用抗生素耐药情况分析  

Analysis of the Resistance Status of Bacteria Isolated from Skin Lesions of Acne Patients to Commonly Used Antibiotics for Acne

作　　者：唐万娟 史春雨 李玲双 杨晓艳 王皓磊 任玉吉 杜艳[2] 孙东杰[1] TANG Wanjuan;SHI Chunyu;LI Lingshuang;YANG Xiaoyan;WANG Haolei;REN Yuji;DU Yan;SUN Dongjie(Department of Dermatology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院皮肤科,云南昆明650032 [2]昆明医科大学第一附属医院检验科,云南昆明650032

出　　处：《中国皮肤性病学杂志》2024年第7期740-747,共8页The Chinese Journal of Dermatovenereology

基　　金：国家自然科学基金地区项目(82260618);云南省“兴滇英才支持计划”:名医专项;云南省皮肤免疫性疾病临床医学中心(ZX2019-03-02)。

摘　　要：目的研究痤疮患者皮损分离的痤疮丙酸杆菌(Propionibacterium acnes,P.acnes)、表皮葡萄球菌(Staphylococcus epidermidis,S.epidermidis)及金黄色葡萄球菌(Staphylococcus aureus,S.aureus)对痤疮治疗常用抗生素的耐药情况及耐药与痤疮抗生素治疗的关系。方法从149例轻至重度痤疮患者面部皮损内容物中培养、分离得到P.acnes、S.epidermidis及S.aureus菌株,使用E-test法评价上述细菌对四环素类(四环素、多西环素、米诺环素)、大环内酯-林可酰胺类(红霉素、克林霉素)、甲硝唑及夫西地酸的体外药敏情况。采用χ^(2)检验及Fisher确切概率法分析痤疮抗生素治疗与耐药的相关性。结果检出139株P.acnes、143株S.epidermidis及7株S.aureus;上述菌对6种抗生素的耐药率分别为:四环素(0、9.79%、14.29%)、多西环素(0、9.79%、0)、米诺环素(0、0、0)、红霉素(42.45%、80.42%、57.14%)、克林霉素(39.57%、49.65%、28.57%)、甲硝唑(100.00%、100.00%、100.00%);夫西地酸对P.acnes、S.epidermidis及S.aureus的最小抑菌浓度分别波动在≤0.016~2μg/mL、0.25~64μg/mL、0.094~>256μg/mL。在检出的耐药菌中:患者曾口服大环内酯类抗生素治疗痤疮与P.acnes对大环内酯-林可酰胺类抗生素耐药具有相关性(P<0.05),但对S.epidermidis耐药无明显影响(P>0.05);四环素类抗生素治疗痤疮对P.acnes、S.epidermidis耐药均无明显影响(P>0.05)。结论P.acnes、S.epidermidis及S.aureus对四环素类抗生素的耐药率远低于大环内酯-林可酰胺类抗生素,且接受四环素类抗生素治疗对耐药影响不大,在痤疮治疗中可优先选择四环素类抗生素。Objective To analyze the resistance status of Propionibacterium acnes(P.acnes),Staphylococcus epidermidis(S.epidermidis)and Staphylococcus aureus(S.aureus)isolated from skin lesions of acne patients to commonly used antibiotics for acne treatment,and the relationship between resistance and acne antibiotic treatment.Methods P.acnes,S.epidermidis and S.aureus strains were isolated from the facial skin lesions of 149 patients with mild to severe acne.The E-test method was used to evaluate in vitro susceptibility to tetracyclines(tetracycline,doxycycline,minocycline),macrolide-lincosamides(erythromycin,clindamycin),metronidazole and fusidic acid.Theχ ^(2) test and Fisher′s exact probability method were used to analyze the correlation between acne antibiotic treatment and drug resistance.Results One hundred and thirty-nine strains of P.acnes,143 strains of S.epidermidis and 7 strains of S.aureus were detected.The resistance rates of above bacteria to 6 kinds of antibiotics were:tetracycline(0,9.79%,14.29%),doxycycline(0,9.79%,0),minocycline(0,0,0),erythromycin(42.45%,80.42%,57.14%),clindamycin(39.57%,49.65%,28.57%),metronidazole(100.00%,100.00%,100.00%).The minimum inhibitory concentration of fusidic acid to P.acnes,S.epidermidis and S.aureus fluctuated in≤0.016~2μg/mL,0.25~64μg/mL,and 0.094~>256μg/mL ranges,respectively.Among the detected drug-resistant bacteria,there was a correlation between taking oral macrolide antibiotics and P.acnes′resistance to macrolide-lincosamide antibiotics(P<0.05),but such correlation was not found for the resistance of S.epidermidis(P>0.05).The treatment of acne with tetracycline antibiotics had no significant effect on the resistance rates of P.acnes and S.epidermidis(P>0.05).Conclusion The resistance rates of P.acnes,S.epidermidis and S.aureus to tetracycline antibiotics were much lower than those to macrolide-lincosamide antibiotics,and treatment with tetracycline antibiotics had little effect on drug resistance.Tetracycline antibiotics are preferred in the treatment of acn

关 键 词：痤疮 痤疮丙酸杆菌 表皮葡萄球菌 金黄色葡萄球菌 抗生素耐药 

分 类 号：R758.733[医药卫生—皮肤病学与性病学]