Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne
The skin commensal Propionibacterium acnes, recently renamed Cutibacterium acnes, along with the other major pathophysiological factors of increased seborrhea, hyperkeratinization of the pilosebaceous unit, and inflammation, has long been implicated in the pathogenesis of acne.
The skin commensal Propionibacterium acnes, recently renamed Cutibacterium acnes, along with the other major pathophysiological factors of increased seborrhea, hyperkeratinization of the pilosebaceous unit, and inflammation, has long been implicated in the pathogenesis of acne.
Recent advances have contributed to our understanding of the role of P. acnes in acne. Although there are no quantitative differences in P. acnes of the skin of patients with acne compared with controls, the P. acnes phylogenic groups display distinct genetic and phenotypic characteristics.
P. acnes biofilms are more frequent in acne, and different phylotypes may induce distinct immune responses in acne.
P. acnes plays a further important role in the homeostasis of the skin’s microbiome, interacting with other cutaneous commensal or pathogenic microorganisms such as Staphylococcus epidermidis, Streptococcus pyogenes, and Pseudomonas species.
In the era of increasing antimicrobial resistance, the selection of acne treatment targeting P. acnes and the prevention of antibiotic resistance play a key role in improving outcomes in acne patients and public health.
The antibiotic resistance (to clindamycin, tetracycline, and erythromycin) of P. acnes is a worldwide problem, and rates of resistance increased from 20% in 1979 to 64% in 2000.
A study of 664 patients in the UK, Spain, Italy, Greece, Sweden, and Hungary reported that the prevalence of P. acnes resistance rates ranged from 50.8% to 93.6% to any antibiotic (tetracycline, macrolide, lincosamide, and streptogramin B).
All dermatologists who specialized in treating acne were colonized with resistant Propionibacteria.
The widespread use of antibiotics to treat acne may result in the development of P. acnes strains with cross-resistance to different antibiotics and have possible implications in acne and other diseases, such as periprosthetic infections.
Propionibacterium acnes and bacterial resistance
In this review article, the authors point out that Propionibacterium acnes is one of the main microorganisms found on the skin. It is predominantly found in hair follicles, prefers anaerobic conditions, preferably colonizes the areas with high sebum production, and is the main bacterium involved in the pathogenesis of acne. They suggest that the indiscriminate use of antibiotics for the treatment of acne vulgaris can result in the development of bacterial resistance.
There has been an increasing number of cases of antibiotic- resistance by P. acnes over the years: in the UK, the resistance rate increased from 34.5% in 1991 to 55.5% in 2000;156 94% of the isolates in Spain and 51% from the isolates in Hungary were resistant to at least one antibiotic. The highest resistance rates are related to erythromycin, with cross-resistance to clindamycin. The lowest resistance rates are to tetracyclines.
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The antibiotic resistance (to clindamycin, tetracycline, and erythromycin) of P. acnes is a worldwide problem, and rates of resistance increased from 20% in 1979 to 64% in 2000.
A study of 664 patients in the UK, Spain, Italy, Greece, Sweden, and Hungary reported that the prevalence of P. acnes resistance rates ranged from 50.8% to 93.6% to any antibiotic (tetracycline, macrolide, lincosamide, and streptogramin B).
All dermatologists who specialized in treating acne were colonized with resistant Propionibacteria.
The widespread use of antibiotics to treat acne may result in the development of P. acnes strains with cross-resistance to different antibiotics and have possible implications in acne and other diseases, such as periprosthetic infections.
Propionibacterium acnes and bacterial resistance
In this review article, the authors point out that Propionibacterium acnes is one of the main microorganisms found on the skin. It is predominantly found in hair follicles, prefers anaerobic conditions, preferably colonizes the areas with high sebum production, and is the main bacterium involved in the pathogenesis of acne. They suggest that the indiscriminate use of antibiotics for the treatment of acne vulgaris can result in the development of bacterial resistance.
Several observations in this article are of interest to us shoulder surgeons:
There are over one million Propionibacterium per square centimeter of skin.
Propionibacterium inhibits the invasion of the skin by common pathogens such as Staphylococcus aureus and Streptococcus pyogenes. Its hydrolyzation of triglycerides with the release of free fatty acids (including propionic acid) contributes to the acid pH of the skin’s surface, which is another factor for skin protection. Note: this suggests that elimination of Propionibacterium from the skin of the surgical site may open the door for worse bugs.
There are many different types of Propionibacterium; on average, each individual has 3 different Propi ribotypes on the skin each with different pathogen potential and different resistance patterns.
Propionibacterium inhibits the invasion of the skin by common pathogens such as Staphylococcus aureus and Streptococcus pyogenes. Its hydrolyzation of triglycerides with the release of free fatty acids (including propionic acid) contributes to the acid pH of the skin’s surface, which is another factor for skin protection. Note: this suggests that elimination of Propionibacterium from the skin of the surgical site may open the door for worse bugs.
There are many different types of Propionibacterium; on average, each individual has 3 different Propi ribotypes on the skin each with different pathogen potential and different resistance patterns.
Persons can transmit the different clones to other individuals, and thus resistant bacteria can be spread throughout the population by 'rubbing elbows'.
There has been an increasing number of cases of antibiotic- resistance by P. acnes over the years: in the UK, the resistance rate increased from 34.5% in 1991 to 55.5% in 2000;156 94% of the isolates in Spain and 51% from the isolates in Hungary were resistant to at least one antibiotic. The highest resistance rates are related to erythromycin, with cross-resistance to clindamycin. The lowest resistance rates are to tetracyclines.
Resistance comes from gene mutation:
In cases of severe infections caused by P. acnes, surgical procedures should be combined with crystalline penicillin, vancomycin, daptomycin, and rifampicin due to their effect on the biofilm.
The reasons for the emergence of Propionibacterium as a problem in shoulder surgery is becoming clearer - the use of antibiotics for acne and for other reasons is changing the genetics of the bacterium to favor antibiotic resistance and the resistant strains are being exchanged within the human population.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
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