Prevalence of antibiotic-resistant Cutibacterium acnes (formerly Propionibacterium acnes) isolates, a systematic review and meta-analysis
Masoumeh Beig, Omid Shirazi, Elaheh Ebrahimi, Abbas Zare Banadkouki, Narges Golab, Mohammad Sholeh
Abstract
• Spanning 27 countries over four decades, our study meticulously reviewed 23,198 records and incorporated 39 studies, offering a comprehensive global perspective on Cutibacterium acnes antibiotic resistance. • Revealing a worrisome increase from 25.5% (1983–2014) to 35.4% (2015–2023), clindamycin resistance now stands at 31%. This surge underscores a critical need for immediate and effective antibiotic stewardship in acne treatment. • Through temporal analysis, our study identified notable rises in resistance to erythromycin and azithromycin, illustrating the dynamic nature of antibiotic resistance patterns. These findings stress the importance of continuous surveillance for effective acne management. • Notably, levofloxacin demonstrated a lower resistance rate compared to clindamycin, reflecting positive antibiotic stewardship. Furthermore, tetracycline resistance, specifically to doxycycline, showed relatively low rates, emphasizing the necessity for tailored prescription practices amid changing resistance patterns. This study aimed to assess the overall antibiotic susceptibility of Cutibacterium acnes ( C. acnes ), a bacterium implicated in acne vulgaris, with a particular focus on clindamycin and fluoroquinolones, which are commonly used in inflammatory acne treatment. A systematic search of Scopus, PubMed, Web of Science and EMBASE databases was conducted to identify relevant studies. Pooled prevalence estimates were calculated using a random-effects model, and additional analyses included quality assessment, evaluation of publication bias, meta-regression and subgroup analyses based on antimicrobial susceptibility methods and year of publication. The analysis incorporated a total of 39 studies. The random-effects model revealed that the proportion of clindamycin-resistant isolates was 0.031 (95% CI: 0.014–0.071). Additionally, macrolides, including erythromycin (0.366; 95% CI: 0.302–0.434) and azithromycin (0.149; 95% CI: 0.061–0.322), exhibited distinct prevalence rates. Tetracyclines, including doxycycline (0.079; 95% CI: 0.014–0.071), tetracycline (0.062; 95% CI: 0.036–0.107) and minocycline (0.025; 95% CI: 0.012–0.051), displayed varying prevalence estimates. Fluoroquinolones, including ciprofloxacin (0.050; 95% CI: 0.017–0.140) and levofloxacin (0.061; 95% CI: 0.015–0.217), demonstrated unique prevalence rates. Additionally, the prevalence of the combination antibiotic trimethoprim/sulfamethoxazole (SXT) was estimated to be 0.087 (95% CI: 0.033–0.208). The study findings highlight a concerning increase in antimicrobial-resistant C. acnes with the use of antibiotics in acne treatment. The strategic utilization of appropriate antimicrobials has emerged as a crucial measure to mitigate the emergence of antimicrobial-resistant skin bacteria in acne management.