A survey of susceptibility to erythromycin amongst Streptococcus pyogenes isolates in Italy

Borzani, M; Luca, M. De; Varotto, F

doi:10.1093/jac/40.3.457

Cited by 26 publications

(10 citation statements)

References 4 publications

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“…The incidence of S. pyogenes erythromycin resistance remains low in most parts of the world but recently reached 17% in Finland (23), 27 to 34% in Spain (2,32,33), and 30 to 35% in Italy (5,11). In our study, the prevalence of erythromycin resistance in S. pyogenes isolates from French children was only 6.2%.…”

Section: Discussionmentioning

confidence: 99%

“…However, for patients sensitive to ␤-lactam antibiotics, and when these drugs fail, macrolides are often the recommended substitute. Penicillin resistance has not yet been described in S. pyogenes, but resistance to erythromycin and related antibiotics has been widely reported (2,3,5,8,10,11,17,20,29,33,43,46). The mechanism of acquired resistance to erythromycin involves a target site modification mediated by a methylase which modifies the 50S ribosomal subunit, leading to the MLS B resistance phenotype encoded by erm genes (25,36,47).…”

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confidence: 99%

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Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients

Bingen

Fitoussi

Doit

et al. 2000

Antimicrob Agents Chemother

105

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A total of 1,500 recent throat isolates of Streptococcus pyogenes collected between 1996 and 1999 from children throughout France were tested for their susceptibility to erythromycin, azithromycin, josamycin, clindamycin, and streptogramin B. The erythromycin-resistant isolates were further studied for their genetic mechanism of resistance, by means of PCR. The clonality of these strains was also investigated by means of serotyping and ribotyping. In all, 6.2% of the strains were erythromycin resistant, and 3.4 and 2.8% expressed the constitutive MLS B and M resistance phenotypes and harbored the ermB and mefA genes, respectively; ermTR was recovered from one isolate which also harbored the ermB gene. Ten serotypes and 8 ribotypes were identified, but we identified 17 strains by combining serotyping with ribotyping. Among the eight ribotypes, the mefA gene was recovered from six clusters, one being predominant, while the ermB gene was recovered from four clusters, of which two were predominant.Penicillin is the drug of choice for the treatment of Streptococcus pyogenes infection. However, for patients sensitive to ␤-lactam antibiotics, and when these drugs fail, macrolides are often the recommended substitute. Penicillin resistance has not yet been described in S. pyogenes, but resistance to erythromycin and related antibiotics has been widely reported (2,3,5,8,10,11,17,20,29,33,43,46). The mechanism of acquired resistance to erythromycin involves a target site modification mediated by a methylase which modifies the 50S ribosomal subunit, leading to the MLS B resistance phenotype encoded by erm genes (25,36,47). Erythromycin resistance due to an efflux mechanism (M phenotype), encoded by mef genes, has recently been described (6,45). While the prevalence of the S. pyogenes resistance to macrolides has been reported worldwide, very few recent data deal with the French situation (1,8). The aims of this study were to assess the macrolide sensitivity of recent throat isolates of S. pyogenes collected from French children, to determine the genetic mechanisms of resistance, and to explore clonality by means of serotyping and molecular methods. MATERIALS AND METHODSBacterial isolates. A total of 1,500 consecutive S. pyogenes isolates were collected between 1996 and 1999 throughout France. They were isolated by swabbing the throats of children, 4 to 17 years old (mean age, 11 years), with pharyngitis. The isolates were identified as S. pyogenes by colony morphology, beta-hemolysis on blood agar, and a commercial agglutination technique (Murex Diagnostics UK).Susceptibility testing. The procedures for susceptibility testing were those recommended by the National Committee for Clinical Laboratory Standards (NCCLS) (30).(i) Detection of erythromycin resistance and determination of resistance phenotypes. Erythromycin-resistant strains were initially identified by the disk diffusion method on Mueller-Hinton agar supplemented with 5% defibrinated horse blood (Diagnostic Pasteur, Marnes la Coquette, France) using 15-g erythrom...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients

Bingen

Fitoussi

Doit

et al. 2000

Antimicrob Agents Chemother

105

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“…The considerable increase in the rate of isolation of erythromycin-resistant S. pyogenes deserves particular attention and requires modification in the prescription of macrolides for the treatment of upper respiratory tract infections. Several reports associate the increase of resistant strains with the overuse of erythromycin and the novel macrolides for treatment of pharyngitjs 2,5,8,14,28,29 Furthermore, several authors verified that reduction of macrolide use was associated with a decrease in the frequency of macrolide resistance in S. pyogenes?-29…”

Section: Discussionmentioning

confidence: 99%

Streptococcus py o genesIsolated in Portugal: Macrolide Resistance Phenotypes and Correlation with T Types

Melo‐Cristino¹,

Fernandes²

1999

Microbial Drug Resistance

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clinical isolates of Streptococcus pyogenes were collected from 10 microbiology laboratories in Portugal. All strains were highly sensitive to penicillin (MIC90 = 0.012 mg/liter). The prevalence of erythromycin resistance was 35.8% and of tetracycline resistance 41.4%. The majority (79.6%) of erythromycin-resistant strains were of the MLSr constitutive resistance (CR) phenotype with highlevel resistance to erythromycin (MIC90 > 256 mg/liter) and to clindamycin (MIC90 > 256 mg/liter), 16.7% showed the M phenotype with low-level erythromycin-resistance (MIC90 = 24 mg/liter) and susceptibility to clindamycin, and four isolates showed a phenotype characterized by low-level erythromycin resistance (MIC90 = 8 mg/liter) and high-level clindamycin resistance (MIC9u > 256 mg/liter), not previously described. Erythromycin resistance was not associated with invasive strains. Only minor discrepancies between disk diffusion and E-test methods were observed. T serotyping was very useful for the epidemiological characterization of the strains. The most prevalent T types were Tl, T4, T9, T12, T13, and T28. A statistically significant association with resistance patterns was found: T12 with erythromycin resistance MLSB CR phenotype (p < 0.001), T4 with erythromycin resistance M phenotype (p < 0.001), and T13 with tetracycline resistance (p < 0.01). Because of the high prevalence of resistance, careful surveillance of S. pyogenes isolates in Portugal is essential, routine antimicrobial susceptibility testing in clinical microbiology laboratories should be strongly encouraged, antibiotic prescription should be reviewed, and macrolides should no longer be used in the empirical therapy of acute pharyngitis.

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“…2,5 In 1997, the overall incidence of erythromycin resistance among S. pyogenes isolates was found to be approximately 43%. 33 A still elevated but substantially decreased mean incidence (25%) was documented in 1998.…”

Section: Introduction I N the Late 1950s Erythromycin Resistance In Smentioning

confidence: 99%

Erythromycin Resistance in Italian Isolates ofStreptococcus pyogenesand Correlations with Pulsed-Field Gel Electrophoresis Analysis

Zampaloni

Vitali²,

Prenna³

et al. 2002

Microbial Drug Resistance

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Erythromycin resistance among Streptococcus pyogenes strains has been reported in Italy at high rates during the last few years. A total of 152 erythromycin-resistant isolates of this species from southern Italian regions were characterized for the macrolide-resistance phenotype and screened by PCR for the corresponding genetic determinant. A close correlation was found between these phenotypic/genotypic data concerning macrolide resistance and results of Sma I macrorestriction fragment patterns (PFGE) analysis. In fact, the vast majority of the isolates assigned to individual PFGE classes mostly belonged to a single phenotype of macrolide resistance. All untypeable isolates belonged to the M phenotype. Twenty-two distinct PFGE types were recognized, of which 11 were recorded in only one isolate (one-strain type); about 50% of typeable isolates fell into five type clusters and 70% in seven. The increased erythromycin resistance among Italian isolates of S. pyogenes does not appear to be due to the spread of a single clone, but results indicate that the majority of group A streptococci examined are probably spread from a limited number of clones.

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A survey of susceptibility to erythromycin amongst Streptococcus pyogenes isolates in Italy

Cited by 26 publications

References 4 publications

Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients

Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients

Streptococcus py o genesIsolated in Portugal: Macrolide Resistance Phenotypes and Correlation with T Types

Erythromycin Resistance in Italian Isolates ofStreptococcus pyogenesand Correlations with Pulsed-Field Gel Electrophoresis Analysis

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