Macrolide Resistance Trends in β-Hemolytic Streptococci in a Tertiary Korean Hospital

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Abstract

Purpose

Erythromycin-resistant β-hemolytic streptococci (BHS) has recently emerged and quickly spread between and within countries throughout the world. In this study, we evaluate the antimicrobial susceptibility patterns and erythromycin resistance mechanisms of BHS during 2003-2004.

Materials and Methods

The MICs of seven antimicrobials were determined for 204 clinical isolates of BHS from 2003 to 2004. Resistance mechanisms of erythromycin-resistant BHS were studied by the double disk test as well as by polymerase chain reaction (PCR).

Results

Compared with our previous study, resistance among Streptococcus pyogenes isolates to a variety of drugs decreased strikingly: from 25.7% to 4.8% in erythromycin; 15.8% to 0% in clindamycin; and 47.1% to 19.0% in tetracycline. The prevalent phenotypes and genotypes of macrolide-lincosamide-streptogramin _B (MLS _B) resistance in Streptococcus pyogenes isolates have been changed from the constitutive MLS _B phenotype carrying erm(B) to the M phenotype with mef(A) gene. In contrast with Streptococcus pyogenes, resistance rates to erythromycin (36.7%), clindamycin (43.1%), and tetracycline (95.4%) in Streptococcus agalactiae isolates did not show decreasing trends. Among the Streptococcus dysgalactiae subsp. equisimilis isolates (Lancefield group C, G), resistance rates to erythromycin, clindamycin, tetracycline and chloramphenicol were observed to be 9.4%, 3.1%, 68.8%, and 9.4%, respectively.

Conclusion

Continual monitoring of antimicrobial resistance among large-colony-forming BHS is needed to provide the medical community with current data regarding the resistance mechanisms that are most common to their local or regional environments.

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Most cited references 24

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Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.

Alan Bisno, Michael Gerber, Jack Gwaltney … (2002)

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Characterization of group C and G streptococcal strains that cause streptococcal toxic shock syndrome.

Yoshitsugu Iinuma, Michio Ohta, K Torii … (2003)

Twelve strains (the largest number ever reported) of group C and G(1) streptococci (GCS and GGS, respectively) that caused streptococcal toxic shock syndrome (STSS) were collected and characterized. Eleven strains were identified as Streptococcus dysgalactiae subsp. equisimilis, and one strain was identified as Streptococcus equi subsp. zooepidemicus. We found that it was the first reported case of STSS caused by S. equi subsp. zooepidemicus. Cluster analysis according to the 16S rRNA gene (rDNA) sequences revealed that the S. dysgalactiae strains belonged to clusters I and II, both of which were closely related. The emm types and the restriction patterns of chromosomal DNA measured by pulsed-field gel electrophoresis were highly variable in these strains except BL2719 and N1434. The 16S rDNA sequences and other characteristics of these two strains were indistinguishable, suggesting the clonal dissemination of this particular S. dysgalactiae strain in Japan. As the involvement of superantigens in the pathogenesis of group A streptococcus-related STSS has been suggested, we tried to detect known streptococcal superantigens in GCS and GGS strains. However, only the spegg gene was detected in seven S. dysgalactiae strains, with none of the other superantigen genes being detected in any of the strains. However, the sagA gene was detected in all of the strains except Tokyo1291. In the present study no apparent factor(s) responsible for the pathogenesis of STSS was identified, although close genetic relationships of GCS and GGS strains involved in this disease were suggested.

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Group G beta-hemolytic streptococcal bacteremia characterized by 16S ribosomal RNA gene sequencing.

Natalie Yuen, Patrick C. Y. Woo, Kar-Ming A. Fung … (2001)

Little is known about the relative importance of the four species of Lancefield group G beta-hemolytic streptococci in causing bacteremia and the factors that determine the outcome for patients with group G beta-hemolytic streptococcal bacteremia. From 1997 to 2000, 75 group G beta-hemolytic streptococcal strains were isolated from the blood cultures of 66 patients. Sequencing of the 16S rRNA genes of the group G beta-hemolytic streptococci showed that all 75 isolates were Streptococcus dysgalactiae subspecies equisimilis. The API system (20 STREP) and Vitek system (GPI) successfully identified 65 (98.5%) and 62 (93.9%) isolates, respectively, as S. dysgalactiae subspecies equisimilis with >95% confidence, whereas the ATB Expression system (ID32 STREP) only successfully identified 49 isolates (74.2%) as S. dysgalactiae subspecies equisimilis with >95% confidence. The median age of the patients was 76 years (range, 33 to 99 years). Fifty-six patients (85%) were over 60 years old. All patients had underlying diseases. No source of the bacteremia was identified (primary bacteremia) in 34 patients (52%), whereas 17 (26%) had cellulitis and 8 (12%) had bed sore or wound infections. Fifty-eight patients (88%) had community-acquired group G streptococcal bacteremia. Sixty-two patients (94%) had group G Streptococcus recovered in one blood culture, whereas 4 patients (6%) had it recovered in multiple blood cultures. Fifty-nine patients (89%) had group G Streptococcus as the only bacterium recovered in their blood cultures, whereas in 7 patients other bacteria were recovered concomitantly with the group G Streptococcus in the blood cultures (Staphylococcus aureus in 3, Clostridium perfringens in 2, Citrobacter freundii in 1, and Bacteroides fragilis in 1). Overall, 10 patients (15%) died. Male sex, diagnosis other than cellulitis, hospital-acquired bacteremia, and multiple positive blood cultures were associated with mortality [P < 0.005 (relative risk [RR] = 7.6), P < 0.05 (RR = 3.7), P < 0.005 (RR = 5.6), and P < 0.05 (RR = 5.6), respectively]. Unlike group C beta-hemolytic streptococcal bacteremia, group G beta-hemolytic streptococcal bacteremia is not a zoonotic infection in Hong Kong.

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Author and article information

Journal

Journal ID (nlm-ta): Yonsei Med J

Journal ID (publisher-id): YMJ

Title: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

ISSN (Print): 0513-5796

ISSN (Electronic): 1976-2437

Publication date (Print): 31 October 2007

Publication date (Electronic): 31 October 2007

Volume: 48

Issue: 5

Pages: 773-778

Affiliations

[1 ]Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

[2 ]Department of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Korea.

[3 ]Institute of Lifelong Health, Yonsei University Wonju College of Medicine, Wonju, Korea.

Author notes

Reprint address: requests to Dr. Young Uh, Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Ilsan-dong 162, Wonju, Gangwon-do, Korea. Tel: 82-33-741-1592, Fax: 82-33-731-0506, u931018@ 123456yonsei.ac.kr

Article

DOI: 10.3349/ymj.2007.48.5.773

PMC ID: 2628142

PubMed ID: 17963333

SO-VID: f0b49aed-eccc-4ef3-8b41-c39e6f5c4d92

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Macrolide Resistance Trends in β-Hemolytic Streptococci in a Tertiary Korean Hospital

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Abstract

Purpose

Materials and Methods

Results

Conclusion

Related collections

Microbiology Independent Research Journal (MIR Journal)

Most cited references 24

Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America.

Characterization of group C and G streptococcal strains that cause streptococcal toxic shock syndrome.

Group G beta-hemolytic streptococcal bacteremia characterized by 16S ribosomal RNA gene sequencing.

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