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      Susceptibility to β-lactams in β-hemolytic streptococci Translated title: Sensibilidad a los β-lactámicos en estreptococos β-hemolíticos

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          Abstract

          Group A (GAS), B (GBS), c (GCS) and G (GGS) β-hemolytic streptococci are important human pathogens. They cause infections of different severity and frequency. Nowadays, after 70 years of use, penicillin is still universally active against GAS, GCS and GGS. However, therapeutic failures have been recorded in 2-28% of pharyngitis cases (median: 12%) attributable to different causes. By contrast, some GBS with reduced susceptibility to penicillin have been described, especially in Japan. In this group of bacteria, it is important to highlight that confirmation by reference methods is mandatory when decreased susceptibility to penicillin is suspected as well as checked for the detection of the mechanisms involved.

          Translated abstract

          Los estreptococos β-hemolíticos de los grupos A (GAS), B (GBS), C (GCS) y G (GGS) son importantes patógenos humanos. Ellos producen infecciones de diversa gravedad y frecuencia. Aún después de más de 70 años de uso, la penicilina sigue siendo activa in vitro frente al 100% de los GAS, GCS y GGS. No obstante se han producido fallas terapéuticas entre el 2-28% de los casos de faringitis (media: 12%), atribuibles a diversas causas. En cambio se han descrito aislados de GBS con sensibilidad reducida a la penicilina, especialmente en Japón. Es importante que toda sospecha de sensibilidad disminuida a la penicilina en este grupo de bacterias sea confirmada por los métodos de referencia y comprobada mediante la detección de los mecanismos involucrados.

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          Most cited references27

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          Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007.

          Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990-2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts. Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was 18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients. A total of 19,512 GBS cases were identified in nonpregnant adults during 1990-2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 (P < .001). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had 1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998-1999 and 78.5% of infections during 2005-2006. Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.
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            Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America

            Abstract The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.
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              Multimodular penicillin-binding proteins: an enigmatic family of orthologs and paralogs.

              The monofunctional penicillin-binding DD-peptidases and penicillin-hydrolyzing serine beta-lactamases diverged from a common ancestor by the acquisition of structural changes in the polypeptide chain while retaining the same folding, three-motif amino acid sequence signature, serine-assisted catalytic mechanism, and active-site topology. Fusion events gave rise to multimodular penicillin-binding proteins (PBPs). The acyl serine transferase penicillin-binding (PB) module possesses the three active-site defining motifs of the superfamily; it is linked to the carboxy end of a non-penicillin-binding (n-PB) module through a conserved fusion site; the two modules form a single polypeptide chain which folds on the exterior of the plasma membrane and is anchored by a transmembrane spanner; and the full-size PBPs cluster into two classes, A and B. In the class A PBPs, the n-PB modules are a continuum of diverging sequences; they possess a five-motif amino acid sequence signature, and conserved dicarboxylic amino acid residues are probably elements of the glycosyl transferase catalytic center. The PB modules fall into five subclasses: A1 and A2 in gram-negative bacteria and A3, A4, and A5 in gram-positive bacteria. The full-size class A PBPs combine the required enzymatic activities for peptidoglycan assembly from lipid-transported disaccharide-peptide units and almost certainly prescribe different, PB-module specific traits in peptidoglycan cross-linking. In the class B PBPs, the PB and n-PB modules cluster in a concerted manner. A PB module of subclass B2 or B3 is linked to an n-PB module of subclass B2 or B3 in gram-negative bacteria, and a PB module of subclass B1, B4, or B5 is linked to an n-PB module of subclass B1, B4, or B5 in gram-positive bacteria. Class B PBPs are involved in cell morphogenesis. The three motifs borne by the n-PB modules are probably sites for module-module interaction and the polypeptide stretches which extend between motifs 1 and 2 are sites for protein-protein interaction. The full-size class B PBPs are an assortment of orthologs and paralogs, which prescribe traits as complex as wall expansion and septum formation. PBPs of subclass B1 are unique to gram-positive bacteria. They are not essential, but they represent an important mechanism of resistance to penicillin among the enterococci and staphylococci. Natural evolution and PBP- and beta-lactamase-mediated resistance show that the ability of the catalytic centers to adapt their properties to new situations is limitless. Studies of the reaction pathways by using the methods of quantum chemistry suggest that resistance to penicillin is a road of no return.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ram
                Revista argentina de microbiología
                Rev. argent. microbiol.
                Asociación Argentina de Microbiología (Ciudad Autónoma de Buenos Aires, , Argentina )
                0325-7541
                1851-7617
                December 2018
                : 50
                : 4
                : 431-435
                Affiliations
                [04] Montevideo orgnameUniversidad de la República orgdiv1Programa de Desarrollo de las Ciencias Básicas (PEDECIBA) Uruguay
                [01] orgnameGrupo STREP de la Sociedad Argentina de Bacteriología, Micologia y Parasitología Clínicas (SADEBAC) orgdiv1Asociación Argentina de Microbiologia Argentina
                [05] Ciudad Autónoma de Buenos Aires orgnameHospital Juan A. Fernández orgdiv1División Laboratorio orgdiv2Sección Microbiología Clínica Argentina
                [07] La Plata Buenos Aires orgnameUniversidad Nacional de La Plata orgdiv1Facultad de Ciencias Exactas orgdiv2Cátedra de Microbiología Clínica Argentina
                [03] Ciudad Autónoma de Buenos Aires orgnameANLIS Dr. Carlos G. Malbrán orgdiv1Instituto Nacional de Enfermedades Infecciosas (INEI orgdiv2Departamento de Bacteriología Argentina
                [08] Posadas Misiones orgnameHospital Provincial de Pediatría Dr. F. Barreyro orgdiv1Laboratorio de Bacteriología Argentina
                [02] Ciudad Autónoma de Buenos Aires orgnameUniversidad de Buenos Aires orgdiv1Facultad de Farmacia y Bioquímica orgdiv2Departamento de Microbiología, Inmunología y Biotecnologia Argentina
                [09] Posadas Misiones orgnameUniversidad Nacional de Misiones orgdiv1Facultad de Ciencias Exactas Químicas y Naturales orgdiv2Departamento de Microbiología Argentina
                [10] orgnameCONICET Argentina
                [06] Rosario Santa Fe orgnameUniversidad Nacional de Rosario orgdiv1Facultad de Ciencias Bioquímicas orgdiv2Cátedra de Bacteriología Argentina
                Article
                S0325-75412018000400015
                10.1016/j.ram.2017.11.002
                29548731
                2a4de76b-fd09-44aa-9f00-e770f9f3eee1

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 31 May 2017
                : 09 November 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 5
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                SciELO Argentina

                Categories
                Special Article

                Streptococcus dysgalactiae subsp. equisimilis,Streptococcus pyogenes,Streptococcus agalactiae,Sensibilidad,Penicilina,β-lactámicos,Susceptibility,β-Lactams,Penicillin

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