我国痤疮患者皮损中痤疮丙酸杆菌对抗生素耐药性的Meta分析

目的:系统评价我国痤疮患者的皮损分离的痤疮丙酸杆菌(P.acnes )对抗生素的耐药情况,为痤疮抗生素合理治疗提供临床依据。方法:计算机网络检索中国知网(CNKI)、中文科技期刊文数据库(VIP)、万方数据库和PubMed中的相关研究,收集痤疮皮损分离痤疮丙酸杆菌对四环素类、大环内酯类等抗菌药物耐药率的相关研究,对符合纳入标准研究资料进行提取,采用R语言3.3.2 Meta程序包进行Meta分析。结果:共纳入文章13篇,合计1770例痤疮患者,共分离痤疮丙酸杆菌合计1259株。对我国 P.acnes 的抗生素耐药率进行单组率Meta分析,结果显示 P.acnes 对红霉素、克拉霉素、阿奇霉素耐药率分别为:45%(95% CI 0.35~ 0.58 ),74%(95% CI 0.51~0.89),59%(95% CI 0.33~ 0.84 );对米诺环素、多西环素、四环素耐药率分别为:2%(95% CI 0.00~0.07),6%(95% CI 0.00~ 0.26 ),8%(95% CI 0.00~0.24);对甲硝唑耐药率为96%(95% CI 0.80~1.00)。不同抗生素之间存在交叉耐药。结论:我国痤疮患者皮损分离的 P.acnes 对大环内酯类及甲硝唑耐药率高,对四环素类、喹诺酮类抗生素较为敏感,其中以米诺环素敏感性最高。

Systematic evaluation of positivity rates to antibiotic resistance of Propionibacterium acnes isolated from lesions of patients with acne in China

Objective: To systematically evaluate the positivity rates to antimicrobial agents of Propionibacterium acnes (P.acnes) isolated from patients with acne in China and to provide a clinical reference for the antibiotic therapy of acne. Methods: The relevant studies were searched from CNKI, Quotation Databases of Chinese Science and Technology Periodical (VIP), Wanfang Data and PubMed and analyzed with Meta analysis through R3.3.2 Meta software package. Results: A total of 13 articles were enrolled, including 1770 patients with acne, 1259 bacterial strains of P.acnes. The drug resistance rates of P.acnes to Erythromycin, Clarithromycin, Azithromycin were 45%（95% CI 0.35～0.58)，74%（95% CI 0.51～0.89)，59%（95% CI 0.33～0.84) respectively；the drug resistance rates of P.acnes to minocycline, doxycycline, tetracycline were 2%（95% CI 0.00～0.07)，6%（95% CI 0.00～0.26)，8%（95% CI 0.00～0.24) respectively；the drug resistance rate of P.acnes to Metronidazole was 96% (95% CI 0.80～1.00) and there was cross resistance between different antibiotic classes. Conclusion: There was a high drug resistance rates of P.acnes isolated from patients with acne to macrolides and Metronidazoles and P.acnes was sensitive to etracyclines, minocycline was at maximum sensitivity.