Original article
Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa

https://doi.org/10.1016/j.jaad.2016.08.001Get rights and content

Background

Antibiotic therapy is commonly used to treat hidradenitis suppurativa (HS). Although concern for antibiotic resistance exists, data examining the association between antibiotics and antimicrobial resistance in HS lesions are limited.

Objective

We sought to determine the frequency of antimicrobial resistance in HS lesions from patients on antibiotic therapy.

Methodology

A cross-sectional analysis was conducted on 239 patients with HS seen at the Johns Hopkins Medical Institutions from 2010 through 2015.

Results

Patients using topical clindamycin were more likely to grow clindamycin-resistant Staphylococcus aureus compared with patients using no antibiotics (63% vs 17%; P = .03). Patients taking ciprofloxacin were more likely to grow ciprofloxacin-resistant methicillin-resistant S aureus compared with patients using no antibiotics (100% vs 10%; P = .045). Patients taking trimethoprim/sulfamethoxazole were more likely to grow trimethoprim/sulfamethoxazole-resistant Proteus species compared with patients using no antibiotics (88% vs 0%; P < .001). No significant antimicrobial resistance was observed with tetracyclines or oral clindamycin.

Limitations

Data on disease characteristics and antimicrobial susceptibilities for certain bacteria were limited.

Conclusions

Antibiotic therapy for HS treatment may be inducing antibiotic resistance. These findings highlight the importance of stewardship in antibiotic therapy for HS and raise questions regarding the balance of antibiotic use versus potential harms associated with antibiotic resistance.

Section snippets

Study population

After institutional review board approval, we conducted a cross-sectional analysis of 632 patients with a dermatologist diagnosis of HS who were seen at the Johns Hopkins Medical Institutions from 2010 to 2015. We included 239 patients who had bacterial culture data from HS lesions, all of which were sampled using swabs.

Definition of variables

Using information from electronic medical records, the first recorded bacterial culture for each patient was examined to collect data on the isolated bacterial species and the

Results

Of the patients with information on antibiotic use at the time of bacterial culture (N = 227), 122 (54%) had documented antibiotic use (Table I). Individuals receiving antibiotics showed similar characteristics according age, gender, ethnicity, and body mass index compared with individuals not receiving antibiotics at the time of bacterial culture (P > .05 for all). The most common antibiotics used were tetracyclines (26%), topical clindamycin (19%), oral clindamycin (9%), and

Discussion

Although HS is not primarily an infectious disease, antibiotics are often the first-line treatment for HS, used for their anti-inflammatory, antimicrobial, and immunomodulatory properties.5, 6 However, the efficacy of certain antibiotics in HS may be suboptimal,3 and the associations observed in this study suggest that these antibiotics may be inducing antibiotic resistance in patients with HS. More specifically, we observed antimicrobial resistance in isolates of Staphylococcus aureus, which

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Cited by (65)

  • Antibiotic resistance in dermatology: The scope of the problem and strategies to address it

    2022, Journal of the American Academy of Dermatology
    Citation Excerpt :

    Daily administration of parenteral ertapenem is a safe and effective alternative for refractory disease.44 A 2010-2015 cross-sectional analysis of HS patients demonstrated a significantly higher prevalence of clindamycin-resistant S aureus in patients using topical clindamycin compared to patients using no antibiotics.45 Moreover, a 2019 study by Bettoli et al46 found that 84.7% of bacterial cultures from HS patients harbored resistance against tetracyclines.

  • Microbiota Perturbations in Hidradenitis Suppurativa

    2022, A Comprehensive Guide to Hidradenitis Suppurativa
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Funding sources: None.

Conflicts of interest: None declared.

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