title: Heterogeneity and antibiotic resistance in Propionibacterium acnes isolates and its therapeutic implications: blurring the lines between commensal and pathogenic phylotypes.
abstract: Acne vulgaris is a multifactorial skin disease associated with the colonization of Propionibacterium acnes. Antibiotics are a mainstay of treatment for acne, yet the emergence of resistance against the currently approved antibiotics is a serious concern. In this case report, a slow responder had multiple Propionibacterium acnes isolates with varied levels of sensitivity to the conventional antibiotics. The bacterial isolates obtained from acne samples collected from the patient were analyzed for phylogeny, and was found to be largely restricted to two different lineage patterns. Propionibacterium acnes phylotype IA1, which is considered to be pathogenic, displayed clindamycin sensitivity, but phylotype IB, which is associated with commensals, exhibited high clindamycin resistance. Sensitivity analysis revealed uniform resistance to macrolides, but susceptibility to tetracycline and nadifloxacin. These results implicate Propionibacterium acnes in the pathophysiology of acne vulgaris, although the lines between commensal and pathological phylotypes may be blurred. Switching the patient to a combination of minocycline and nadifloxacin resulted in a significant improvement in the clinical lesions. Such a science-driven judicious selection of antibiotics can minimize the probability of development of resistance, and might be the way forward in the treatment of acne.
authors.affiliation: Vyome Biosciences Pvt. Ltd, Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area, Delhi, 110092, India.|Research Scholar, Research and Development Centre, Bharathiar University, Coimbatore, 641046, India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Sadhasivam
authors.affiliation: Vyome Biosciences Pvt. Ltd, Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area, Delhi, 110092, India.
authors.forename: Mau
authors.initials: M
authors.lastname: Sinha
authors.affiliation: Vyome Biosciences Pvt. Ltd, Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area, Delhi, 110092, India.
authors.forename: Swamini
authors.initials: S
authors.lastname: Saini
authors.affiliation: Vyome Biosciences Pvt. Ltd, Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area, Delhi, 110092, India.
authors.forename: Simar Preet
authors.initials: SP
authors.lastname: Kaur
authors.affiliation: Maulana Azad Medical College & Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
authors.forename: Tanvi
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Shiladitya
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Vyome Biosciences Pvt. Ltd, Plot # 465, Ground Floor, F.I.E, Patparganj Industrial Area, Delhi, 110092, India.
authors.forename: Shamik
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Maulana Azad Medical College & Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
authors.forename: Kabir
authors.initials: K
authors.lastname: Sardana
mesh_terms: D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use*; D005838:Genotype; D006801:Humans; D008297:Male; D008911:Minocycline / Q000627:therapeutic use*; D010641:Phenotype; D010802:Phylogeny; D011425:Propionibacterium acnes / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D011807:Quinolizines / Q000627:therapeutic use*; D012074:Remission Induction; D021521:Ribotyping; D012867:Skin / Q000187:drug effects* / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D011807:Quinolizines; C062127:nadifloxacin; D008911:Minocycline
keywords: Propionibacterium acnes; antibiotic resistance; clindamycin; commensal; phylotype