Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa - 12/10/16

Doi : 10.1016/j.jaad.2016.08.001

Alexander H. Fischer, MPH ^a,^⁎ , Alessandra Haskin, BA ^b, Ginette A. Okoye, MD ^a
^a Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
^b Howard University College of Medicine, Washington, District of Columbia

^∗Reprint requests: Alexander H. Fischer, MPH, Johns Hopkins University School of Medicine, Edward D. Miller Research Bldg, 733 N Broadway, Suite 137, Baltimore, MD 21205-2196.Johns Hopkins University School of MedicineEdward D. Miller Research Bldg733 N BroadwaySuite 137BaltimoreMD21205-2196

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Abstract

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.

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Key words : acne inversa, antibiotics, antimicrobial resistance, hidradenitis suppurativa

Abbreviations used : HS, SMX, TMP