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Częstość występowania i lekowrażliwość szczepów Propionibacterium acnes izolowanych ze zmian trądzikowych

Authors:

Abstract

Introduction: Propionibacterium acnes is one of many pathogens causing the formation of lesions in acne vulgaris, the most common chronic disease of the skin. It affects most adolescents, but can also occur in newborns, and persists in adults. Acne lesions usually occur around the sebaceous glands on the skin of the face, back and chest. Increased resistance of P. acnes to topical antibiotics is a serious medical problem. The aim of the study was to determine the frequency of P. acnes in patients with acne depending on age and sex, and to evaluate drug susceptibility of the isolated strains. Materials and methods: We analyzed the results of tests performed in 470 outpatients with acne at the age of 9-59 years. The material was a discharge containing pus taken from inflamma-tory changes of the face (64.3%), back (7.6%) and chest (28.1%). Samples were cultured in anaerobic conditions on Schaedler Agar. The strains were tested for susceptibility to erythromycin, clindamycin, tetracycline and doxycycline, according to the EUCAST standards. Results: Positive cultures for P. acnes were found in 84.0% of patients. The highest proportion of positive culture was observed in the age group 21-30 years old (91.0%) and in >50 years (88.2%), the lowest in patients aged 31-40 (78.2%). P. acnes was isolated more often in men (86.1%) than in women (81.7%). All isolates showed sensitivity to doxycycline, and only 1.5% were resistant to tetracycline. A statistically significant (p ≤ 0.05) increase of resistance to erythromycin and clindamycin, from 29.6% in 2010 to 48.7% in 2014, was observed. Conclusions: Acne lesions are increasingly observed in adults >21 years old. The prevalence of acne in women and men is comparable. P. acnes strains show good sensitivity to tetracyclines, but the increased resistance to erythromycin and clindamycin is alarming.
Pomeranian J Life Sci 2018;64(3):33-37
33
Częstość występowania i lekowrażliwość szczepów Propionibacterium
acnes izolowanych ze zmian trądzikowych
The prevalence and drug sensitivity of Propionibacterium acnes isolated from acne lesions
Agata Pruss , Paweł Kwiatkowski , Helena Masiuk , Stefania Giedrys-Kalemba
Pomorski Uniwersy tet Medyczny w Szczecinie, Katedra Mikrobiolog ii, Immunologii i Medycyny Laboratoryjnej, al. Powstacw Wlkp. 72, 70-111 Szczecin
Pomeranian Medic al Universit y in Szczecin, Depar tment of Microbiolog y, Immunology and Laboratory Medicine
Alab Laboratoria, ul. Stępiska 22/30, 00-739 War szawa
agata.pruss@pum.edu.pl
ABSTRACT
Introduction: Propionibacterium acnes is one of many pat hogens
causing the formation of lesions in acne vulgaris, the most com-
mon chronic disease of the skin. It affects most adolescents, but
can also occur in newborns, and persists in adults. Acne lesions
usually occur around the sebaceous glands on the skin of the
face, back and chest. Increased resistance of P. acnes to topical
antibiotics is a serious medical problem.
The aim of the study was to determine the frequency of P. acnes
in patients with acne depending on age and sex, and to evaluate
drug susceptibilit y of the isolated strains.
Materials and methods: We analyzed the results of tests per-

material was a -

Samples were cultured in anaerobic conditions on Schaedler
Agar. The strains were tested for susceptibility to erythromycin,
clindamycin, tetracycline and doxycycline, according to the
EUCAST standards.
Results: Positive cultures for P. acnes
patient s. The highest proportion of positive cult ure was observed

P. acnes was isolated

showed sensitivity to -
ant to tet racycline. A 
of resistance to 
 
Conclusions: Acne lesions are increasingly observed in adults
-
parable. P. acnes strains show good sensitivity to tetracyclines,
but the increased resistance to erythromycin and clindamycin
is alarming.
Keywords: Propionibacterium acnes; drug susceptibility; acne.
ABSTRAKT
Wstęp: Propionibacterium acnes-
wiedzialnym za  

w  
  
 
 skórze twarzy i pleców, rzadziej k latki piersiowej.

szczepów na antybiotyki stosowane miejscowo.
P. acnes
u pacjentów ze   wieku
i 
Materiał y i metody-
nanych u  
ze 
pobrana ze zmian zapalnych na 
 
Schaedler Agar z  inkubowano
w -
pów na  doksycy-
 wytycznymi EUCAST.
Wyniki kierunku P. acnes stwier-
dzono u -
nich uzyskano w  
 osób w P. acnes-
  -
kie wyizolowane szczepy P. acnes 
 -
 ery-
    r. d o   r.
Wnioski osób
  kobiet i 
jest porównywalna. Szczepy P. acnes-
 
na  
Słowa k luczowe: Propionibacterium acnes

WSTĘP
Propionibacterium acnes to -
-
 
  
i 
 -
nym za  -

34 ojs.pum.edu.pl/pomjlifesci
Agata Pruss, Pawe ł Kwiatkowski, Helena Masiuk , Stefania Giedr ys-Kalemba

  
 
 skórze twarzy i pleców, rzadziej klatki piersio
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wej  -
ków. W wyniku zmian hormonalnych dochodzi do -
 
a 
to P. acnes.
-
rydy do  w konsekwencji
prowadzi do 
nacieków zapalnych w  
 
od stopnia nasilenia zmian skórnych, a  czynników

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
 zaskórnikowy, grudkowo-

 przebiegiem choroby, a  -
 
ocena i 
jest bardzo przydatne w 
 stanu
 
i likwidacji objawów choroby, a -
 
 celu ograniczenie rogowa-

P. acnes tym rodzaju terapii naj-


 erytromycyna oraz klindamycyna, które
  zmniejszenie
kolonizacji P. acnes   
drobnoustrojów leki te  monote-
rapii, lecz w  innymi preparatami, np. nadtlenkiem
benzoilu. W 
 doustnym podaniu antybiotyku
i retinoidu, a u kobiet po  nasilonymi zmianami choro-
bowymi na leczeniu hormonalnym. Antybiotykiem z wyboru
jest tetracyklina lub doksycyklina. W przypadku nietolerancji
na te antybiotyki, u kobiet w  dzieci do 
  
 po 

P. acnes
u pacjentów ze   wieku
i 
MATERIAŁY I METODY

u  
w  Katedrze
i  Immunologii Pomorskiego Uniwer-
 Szczecinie w 
 zmian zapalnych skóry

  

dni w  atmosferze beztlenowej. Iden-
 podstawie oceny cech morfolo-
 testu

 
i -
pów P. acnes zgodnie z wytycznymi Europejskiego Komitetu
 wykorzystaniem
 
W 2 oraz test
 wykorzystaniem programu staty-
-
.
WYNIKI
Badania wydzieliny ropnej ze 
u P. acnes wyizolowano od  stanowi


(
do  tej grupie oraz u 
-
  przy-
 

stw ierdzono w  grupie
 

 
ze P. acnes  
  
P. acnes w grupach wiekowych w 
od  
stwierdzono jedynie w przypadku kobiet w grupie wiekowej

P. acnes ze zmian zapalnych w 
ze    skóry klatki
   
 to 
przedstawiono na 
 -
nych w P. acnes. Wszystkie szczepy
 -
liwych na  poszczególnych latach.
 tetra-
 
i opornych na  
identycznie w 
Pomeranian J Life Sci 2018;64(3) 35
Częs tość wys tępowania i lekowrażliwość s zczepów Propionibacterium acnes izolowanych ze zmian trądzikowych
TABELA 2 . Występowanie Propionibacterium acnes u pacjentw ze względu
na płe
Płe
Propionibacterium acnes
Razem
posiew dodatni
n () posiew ujemny
n ()
Męska  (,)  ( ,)  (,)
Żeska  (,)  (,)  (,)
Razem  (,)  (,)  (,)
TABELA 3. Występowanie Propionibacterium acnes w grupach wiekowych w zależnoci od płci
Grupa wiekowa
w latach
Mężczyni Kobiety
posiew dodatni
n () posiew ujemny
n () razem
n () posiew dodatni
n () posiew ujemny
n () razem
n ()
–  (,)  (,)  (,)  (,)  (,)  (,)
–  (,)  (,)  (,)  (,)*  (,)  (,)
– (,)  (,)  (,)  (,)*  (,)  (,)
– (,) (,)  (,)  (,) (,)  (,)
  (,)  (,)  (,)  (,)  (,)  (,)
Razem  (,)  (,)  (,)  (,)  (,)  (,)
* różnice istotne statystyc znie
TABELA 4. Lekowrażliwo szczepw Propionibacterium acnes w zależnoci od roku badania
Antybiotyk Interpretacja
wyniku
Liczba (odsetek) szczepw P. acnes wg roku badania

n () 
n () 
n () 
n () 
n () razem
n ()
Tetracyklina
S (, )  (,)  (,)  (,)  (, )  (,)
R (,)  (,)  (,)  (,)  (,)  (,)
I (,)  (.)  (,)  (,)  (,)  (,)
razem  (,)  (,)  (,)  (,)  (,)  (,)
Erytromycyna
S (,)  (,)  (, )  (,)  (,)  (, )
R (,)  (,)  (,)  (,)  (,)   ( ,)
razem  (,)  (,)  (,)  (,)  (,)  (,)
Klindamycyna
S (,)  (,)  (, )  (,)  (,)  (, )
R (,)  (,)  (,)  (,)  (,)   ( ,)
razem  (,)  (,)  (,)  (,)  (,)  (,)
S – szczepy wrażliwe; R – szczepy oporne; I – szczepy średnio wrażliwe
RYCINA 1. Miejsce izolacji Propionibacterium acnes
-

   r. do 
w  
DYSKUSJA
 P. acnes  
 drobnoustroje te  naj-

TABELA 1. Występowanie Propionibacterium acnes w zależnoci od grupy
wiekowej
Grupa
wiekowa
w latach
Propionibacterium acnes Razem
n ()
posiew dodatni
n () posiew ujemny
n ()
  (,)*  (,)  (,)
–  (,)  (,)  (,)
–  (,)*  (,)  (,)
– (,)  (,)  (,)
– (,) (, )  (,)
  (,)  (,)  (,)
Razem  (,)  (,)  (,)
* różnice istotne statystyc znie
36 ojs.pum.edu.pl/pomjlifesci
Agata Pruss, Pawe ł Kwiatkowski, Helena Masiuk , Stefania Giedr ys-Kalemba
 keratynizacji. Poprzez
 nabytej odpowiedzi immuno-
logicznej bakterie te  procesu zaburzenia
rogowacenia i proliferacji keratynocytów, co z kolei sprzyja
 

a  
 wieku
pacjentów i  

okresem pokwitania  
u P. acnes ze zmian

  
   
 
i   

dodatnie posiewy w kierunku P. acnes 
u  
   problem natury
 od kilkunastu lat coraz
  -
  
a     
 -
   -
ger i   
W  wsp. u osób
 ze zmianami skórnymi o etiologii P. acnes odsetek kobiet
  
  -
kowy mi w   gru-
 u   
  
a   kolei Collier i  
   
 
  
-
 kierunku, P. acnes
   kobiet. W 
grupach wiekowych, P. acnes wykazano w nieco mniejszych
 
jak i u 

u  
-
-
cych na  kobiet.
  jest to  zmia-
nami hormonalnymi i -
czego  
na  -
skich pacjentek, a  
  jego
   
u   posiewie P. acnes
  brak dodatkowych informacji klinicz-

 zlo-
kalizowane w  -
 skórze twarzy (w 
 -
nach  
posiewów wykonano ze  skóry
ramion i -

P. acnes ze  klatki piersiowej,
 twarzy.
-
 -
 w -
szych postaciach na 
terapii miejscowej jest zahamowanie nadmiernej keratyniza-

-
nie antybiotykoterapii miejscowej (erytromycyna, klindamy-
 jednoczesnym stosowaniem innych preparatów, np.

efektu klinicznego w 
 wskazaniem do zmiany leku stoso-
-
nej. W Polsce rekomendowane leki doustne to przede wszyst-
kim tetracykliny i makrolidy, przy czym ze  wiele

 ,
kobiet w  
poparta miejscowym stosowaniem preparatów z grupy reti-
noidów lub kwasu azelainowego, zapobiega nawrotom choroby
i jest skuteczna u  
Od 
  USA i Wielkiej Bry-
 
opornych na standardowo stosowane leki -
 ant ybiotyki
 
rzadziej na doustne tetracykliny -
 -
  badaniach przeprowadzo-
nych w  
u    tetracy-
   
odsetek izolatów opornych na 
Song i wsp. 
odsetek szczepów opornych na  poziomie
   
na   
w Wielkiej Brytanii w -
 -
 
 
na  
Pomeranian J Life Sci 2018;64(3) 37
Częs tość wys tępowania i lekowrażliwość s zczepów Propionibacterium acnes izolowanych ze zmian trądzikowych
w -
wano w  tetracy-
   

cztery ant ybiotyki powszechnie stosowane w 
w  doksy-
 doksy-
 w  

     r.
do   r.

P. acnes trudne do 
 osób, u któ-
 transmisji szczepów opornych od innych pacjen-
tów  
 tego
 oparciu
o  
to 
-
 w 
 -
terapii zarówno w leczeniu miejscowym, jak i ogólnym 
WNIOSKI
  -
 -

szczepów P. acnes  przewidywaniu
skutków klinicznych leczenia. Zmusza to lekarzy do dalszego
poszukiwania racjonalnych metod terapii, indywidualnego
 pacjenta oraz do 
 -
P. acnes. Wykonanie badania mikrobiologicznego
wydzieliny ze  -

i   -

PIŚMIENNICTWO



 
3.
Adam ski Z, Kas zuba A.  
 
4. -
agement of ac ne: a report fr om a  Improve Outcomes

5.
   


 Treatment of acne w ith topical antibiot ics: les-


European Com mittee on Antim icrobial Suscept ibility Testing. Br eakpoints
  

8.
-


9.
  Eva luation of
knowle dge about acne vulgaris among a select ed population of adoles-



  leczenie. Konsensus Pol-
  

-
 

    Ant imicrobial
susce ptibilit y of Propioniba cterium ac nes isolate s from acne pat ients in


 An epidem iological study of acne i n female
adults: resu lts of a 


 Kum ar C. A clinico-epidem iologica l study of adult acne: is



 
 
  
 -



tretinoin treatment is for acne v ulgari s through the age of 44 years: an



 


 


 -
 
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Propionibac terium acnes resi stance to 
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biotic stewardship in dermatolog y: limiting antibiotic use in acne. Eur
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 Bowe WP. Ant ibiotic res istance a nd acne: where we st and and what t he
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Propionibac terium acnes among acne patients in a regional skin centre
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ceptibilit y of Propionibacter ium acnes isolated from acne v ulgari s in
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lence of antibiot ic-resis tant propionibacter ia on the sk in of acne pat ients:
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to 
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pionibacteria clinically relevant?: implications of resista nce for acne
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Article
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Introduction: It is estimated that approximately 80% of adolescents have different forms of acne vulgaris. Due to the high prevalence of the disease and its psycho-emotional impact on the quality of life, it is important to prevent the spread of misconceptions. Aim: To analyze the basic knowledge and misconceptions concerning acne vulgaris among adolescents. Material and methods: The study included 900 adolescents aged 15-19 years (mean age: 17.47 years), 401 females, 493 males attending high schools (n = 481) or technical colleges (n = 419). The study was based on a direct anonymous questionnaire that consisted of fourteen multiple choice questions. Results: On average, 50.3% of questions were answered correctly. 57.8% of participants stated that they had suffered from acne. As regards the causes, more than half (59.5%) of participants stated that acne is connected to eating and hygiene habits. 40.5% of students considered acne infectious. The study revealed that many "false beliefs" exist. 26.4% of adolescents believe that starting sexual activity can influence healing. Considering the effectiveness of curing acne in adolescence, 24.2% of participants do not see a point in early treatment. Regarding the sources of knowledge about acne, most adolescents use the internet, teenage newspapers and friends' opinions. Only 41.2% want to learn more, and almost 90% consider their knowledge sufficient. Conclusions: The results from a large population-based study indicate that the knowledge about acne is insufficient, which reveals the need for introducing educational programs in schools.
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Although acne is usually recognized as an adolescent skin disorder, the prevalence of adults with acne is increasing. There is surprisingly a paucity of data on the prevalence and clinical features of postadolescent acne in the adult Indian population. The clinical and epidemiological data of adult acne were evaluated with a view to establishing possible contributing etiological factors and observing whether clinical features differ from adolescent acne. Patients over the age of 25 years presenting with acne in a tertiary care hospital were included in the study. A detailed history and examination was carried out, with a stress on aggravating factors. Hormonal imbalances were investigated in females with alopecia, obesity, hirsutism and menstrual irregularity. Severity of acne and complications like scarring and psychological stress were included. Out of 280 patients included in the study 82.1% were women and 17.9% were men. The mean age of the patients was 30.5 years. Persistent acne was observed in 73.2%, while it was late onset in 26.8%. Majority of the patients had inflammatory papular acne (55%), whereas comedonal acne was the least common (6%). Most common predominant site of involvement was cheek (81%), followed by chin (67%), and mandibular area (58.3%). Family history of acne was present in 38.6%. Premenstrual flare was seen in 11.7% of female patients, obesity in 6.4%, hirsutism in 5.7% and alopecia in 1.8%, but raised laboratory markers of hyperandrogenism were observed in only 3.08%. Scarring was observed in a majority of patients (76.4%) and psychological stress in 52.8% patients. Adult acne is predominant in women, and as compared to adolescent acne is more inflammatory, with involvement of the cheeks and lower half of the face, while comedones are rare. Facial scarring occurs in a majority and stress is common, which emphasizes that adult acne should not be neglected.
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Antibiotic resistance is described as "a global public health challenge" and a "major health security challenge of the 21st century" by global health authorities,1 and there is a growing need for dermatologists to counteract it in their treatments of acne.3,4 Antibiotic limiting regimens, such as a combination of topical retinoids and benzoyl peroxide, have shown effectiveness in the treatment of acne; and topical probiotics could also play a needed role. J Drugs Dermatol. 2014;13(suppl 6):s66-s70.
Article
Increasing antibiotic resistance in the population of Propionibacterium acnes is a major concern. Our aims were to examine the clonal relationships and anatomical distribution of resistant and sensitive P. acnes. A collection of 350 P. acnes isolates was therefore used to determine the minimum inhibitory concentration of tetracycline, erythro-mycin and clindamycin, multilocus sequence type, and the identity of genetic resistance markers. Two hitherto unknown resistance mutations were detected. Resistant P. acnes mainly belonged to clonal clusters in division I-1a frequently isolated from skin and associated with moderate to severe acne. All high-level tetracyc-line resistant strains were members of a single clone. Multiple isolates from distinct anatomic areas of surface skin and follicles of 2 acne patients revealed substantial clonal diversity between areas and co-existence of resistant and sensitive clones. Fifty-two percent of Danish acne patients and 43% of controls carried at least one resistant P. acnes strain, resistance to clindamycin being most frequent followed by tetracycline and erythromycin. Resistance to tetracycline was detected exclusively among isolates from acne patients. In conclusion, antibiotic resistance is associated with particular evolutionary clades of P. acnes and a substantial part is due to a single geographically widespread clone (ST3). Individuals carry a strikingly complex population of P. acnes with distinct virulence potential and antibiotic resistance.
Article
Background The increasing prevalence of antimicrobial resistance in Propionibacterium acnes poses a significant challenge to successful treatment outcomes in acne patients. Although P. acnes resistance has been demonstrated throughout the world, no previous data regarding the antimicrobial susceptibility of P. acnes in Colombia are available. Objectives The aim of this study was to determine the antimicrobial susceptibility of P. acnes to common antibiotics used in the treatment of acne in a Colombian population. Methods Samples were collected from facial acne lesions of 100 dermatology patients. All’samples were cultured in anaerobic conditions, and final identification of isolates was performed. Isolates of P. acnes were then subjected to antimicrobial susceptibility tests using erythromycin, clindamycin, tetracycline, doxycycline, and minocycline. Results Propionibacterium acnes isolates resistant to erythromycin (35%), clindamycin (15%), doxycycline (9%), tetracycline (8%), and minocycline (1%) were observed. Isolates with cross-resistance were also observed (to erythromycin and clindamycin [12%] and to doxycycline and tetracycline [6%]). Overall, 46% of isolates taken from patients with a history of antibiotic use demonstrated resistance, whereas 29% of isolates taken from patients who had never used antibiotics demonstrated resistance. Conclusions Antimicrobial resistance in P. acnes in this Colombian population has a lower prevalence than those reported in Europe and follows a similar pattern to findings elsewhere in Latin America. Resistance is demonstrated even in isolates from patients with no previous history of antibiotic use. Resistance to erythromycin is most commonly observed. Minocycline emerges as the most effective antibiotic.
Article
Background There has been no study on antibiotic-resistant Propionibacterium acnes in Hong Kong. Objective We investigated the prevalence and pattern of antibiotic-resistant P. acnes and to identify any associated factors for harbouring the resistant strains. Methods Culture and sensitivity testing of P. acnes to commonly used antibiotics were performed. Resistance to tetracycline was defined at a minimal inhibitory concentration (MIC) of 2 μg/mL or more; erythromycin at an MIC of 0.5 μg/mL or more; clindamycin at an MIC of 0.25 μg/mL or more according to EUCAST. For breakpoints of doxycycline and minocycline, those with an MIC of 1 μg/mL or more were defined as resistant strains. Results Among the 111 specimens collected from 111 patients, 86 strains of P. acnes were recovered, one from each specimen. Twenty-five specimens had no growth. Forty-seven (54.8%) strains were found to be resistant to one or more antibiotics. Forty-six (53.5%), 18 (20.9%), 14 (16.3%), 14(16.3%) and 14 (16.3%) strains were resistant to clindamycin (CL), erythromycin (EM), tetracycline (TET), doxycycline (DOX) and minocycline (MR) respectively. Ten strains (11.6%) had cross resistance between the MLS antibiotics (erythromycin or clindamycin), one strain (1.2%) had cross resistance among the cyclines and 14 strains (16.4%) had cross resistance between the MLS and cycline antibiotics. Binary logistic regression showed an association between MLS antibiotic resistance with an increased age whereas cycline resistance was associated with the duration of treatment. Conclusions Antibiotic-resistant P. acnes is prevalent in Hong Kong. Dermatologists should be more vigilant in prescribing antibiotics for acne patients.
Article
Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.