Antimicrobial Use and Colonization with Erythromycin‐Resistant<i>Streptococcus pneumoniae</i>in Greece during the First 2 Years of Life

Syrogiannopoulos, George A.; Grivea, Ioanna N.; Davies, Todd A.; Katopodis, George D.; Appelbaum, Peter C.; Beratis, Nicholas G.

doi:10.1086/318118

Cited by 41 publications

(53 citation statements)

References 43 publications

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“…We studied a collection of 128 S. pneumoniae isolates susceptible to penicillin but resistant to erythromycin and/or other non-␤-lactam agents; the isolates were recovered from nasopharyngeal cultures obtained from children during two independent studies in Greece (3,30,31). The first study was performed in 338 children attending seven day care centers in the city of Patras in southwestern Greece during the 2-month period from December 1995 to February 1996.…”

Section: Bacterial Isolatesmentioning

confidence: 99%

“…Isolation, identification, and susceptibility testing of the Greek S. pneumoniae isolates were performed by applying standard methods as described previously (30,31). Penicillin and erythromycin MICs for the Greek isolates were determined by the E-test method (AB Biodisk, Solna, Sweden).…”

Section: Bacterial Isolatesmentioning

confidence: 99%

“…During the period from December 1995 to February 1996, 24% of the pneumococci isolated from healthy carriers attending day care centers were demonstrated to be penicillin-susceptible, non-␤-lactamresistant isolates (29). In a recent study in which 2,448 children younger than 2 years old living in various areas in Greece were screened during a 2-year period (1997 to 1999) for pneumococcal carriage, 15% of the pneumococci appeared to have reduced susceptibility to non-␤-lactam agents (31).…”

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confidence: 99%

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Molecular Epidemiology of Penicillin-Susceptible Non-β-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

et al. 2003

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A total of 128 Streptococcus pneumoniae isolates that were susceptible to penicillin but resistant to non-␤-lactam agents were isolated from young carriers in Greece and analyzed by antibiotic susceptibility testing, serotyping, restriction fragment end labeling (RFEL), and antibiotic resistance genotyping. The serotypes 6A/B (49%), 14 (14%), 19A/F (11%), 11A (9%), 23A/F (4%), 15B/C (2%), and 21 (2%) were most prevalent in this collection. Of the isolates, 65% were erythromycin resistant, while the remaining isolates were tetracycline and/or trimethoprim-sulfamethoxazole resistant. Fifty-nine distinct RFEL types were identified. Twenty different RFEL clusters, harboring 2 to 19 strains each, accounted for 76% of all strains. Confirmatory multilocus sequence typing analysis of the genetic clusters showed the presence of three international clones (Tennessee 23F -4, England 14 -9, and Greece 6B -22) representing 30% of the isolates. The erm(B) gene was present in 70% of the erythromycin-resistant isolates, whereas 18 and 8% contained the mef(A) and mef(E) genes, respectively. The pneumococci representing erm(B), erm(A), and mef genes belonged to distinct genetic clusters. In total, 45% of all isolates were tetracycline resistant. Ninety-six percent of these isolates contained the tet(M) gene. In conclusion, penicillin-susceptible pneumococci resistant to non-␤-lactams are a genetically heterogeneous group displaying a variety of genotypes, resistance markers, and serotypes. This suggests that multiple genetic events lead to non-␤-lactam-resistant pneumococci in Greece. Importantly, most of these genotypes are capable of disseminating within the community.

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Section: Bacterial Isolatesmentioning

confidence: 99%

Section: Bacterial Isolatesmentioning

confidence: 99%

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confidence: 99%

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Molecular Epidemiology of Penicillin-Susceptible Non-β-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

et al. 2003

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“…Worldwide, risk factors for the carriage of resistant S. pneumoniae have been well investigated in the last couple of decades [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] and those studies reported that the most influencing factor was the previous use of antibiotics. Unnecessary use of antibiotics had been thought to cause this emergence of antibiotic resistant S. pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

Non-Antibiotic Treatment for Pediatric Outpatients With Common Cold Inhibits the Emergence of Drug Resistant Pneumococci

Matsumoto

Takeyama

Hashimoto

et al. 2010

FJMS

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: The occurrence of drug resistant Streptococcus pneumoniae (S. pneumoniae) is very high in Japan. Unnecessary use of antibiotics had been thought to cause this problem but previous studies had not clearly showed that the decreasing rate of antibiotic use had been related to the reduction of the prevalence of resistant strains. In this study, we tried to prove that non -antibiotic treatment for common cold would reduce the antibiotic resistant S. pneumoniae in nasopharynx in children. Forty -five children with the common cold were randomly selected from pediatric patients who had taken antibiotics within the past three months. We collected nasopharyngeal swabs from all of the participants and once again after a period of 2 to 3 months without using any antibiotics. Twenty -four of these patients had the S. pneumoniae strains isolated. Then these strains were undergone a susceptibility test and drug -resistant gene detection. The susceptibility test reveled that patients with penicillin -resistant strains decreased from 17 to 7 (p<0.01). The test also reveled that the decreased number of patients had strains that were resistant to cefditren. The gene detection revealed that none of the patients acquired a higher resistance to penicillin. Our study suggests that the treatment without antibiotics reduces the drug -resistant S. pneumoniae. Controlled antibiotic use in children might prevent children from carrying the antibiotic resistant S. pneumoniae.

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“…The presence of genes coding for macrolide resistance was studied by PCR as described previously (8,12,13 (14,15), were evaluated for their susceptibility to 10 antibiotics representing different classes of antimicrobial agents. These agents were 14-member (erythromycin and clarithromycin), 15-member (azithromycin), and 16-member ring macrolides (miocamycin), lincosamides (clindamycin), streptogramins (quinupristin/dalfopristin), ketolides (telithromycin), penicillin G, tetracycline, and chloramphenicol.…”

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confidence: 99%

Antimicrobial Susceptibility and Macrolide Resistance Inducibility of Streptococcus pneumoniae Carrying erm (A), erm (B), or mef (A)

Syrogiannopoulos

Grivea

Ednie

et al. 2003

Antimicrob Agents Chemother

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Erythromycin-resistant Streptococcus pneumoniae isolates from young carriers were tested for their antimicrobial susceptibility; additionally, inducibility of macrolide and clindamycin resistance was investigated in pneumococci carrying erm(A), erm(B), or mef(A). Of 125 strains tested, 101 (81%) were multidrug resistant. Different levels of induction were observed with erythromycin, miocamycin, and clindamycin in erm(B) strains; however, in erm(A) strains only erythromycin was an inducer. Induction did not affect macrolide MICs in mef(A) strains.The predominant mechanisms of resistance to erythromycin and the other macrolides in Streptococcus pneumoniae are through target site modification by methylation that prevents the binding of the antibiotic to its ribosomal target, encoded by the erm(B) gene (16), or through efflux of the antibiotic, mediated by the mef(A) gene (13). Methylation of the ribosomal target of the antibiotics leads to cross-resistance to macrolides (M), lincosamides (L), and streptogramin B (S B ), the so-called MLS B phenotype. Erm methylase synthesis can be inducible or constitutive (10, 11). Alterations in ribosomal proteins L4 and L22 or 23S rRNA have been reported to cause resistance in S. pneumoniae (1). Antibiotic efflux confers resistance only to the 14-and 15-member macrolides (1, 4, 5, 7).Recently, S. pneumoniae isolates resistant to erythromycin due to carriage of the erm(A) gene have been reported (15). The macrolide resistance determinant erm(A) gene was previously described as erm(TR) in S. pyogenes (12) and now is reclassified as erm(A) (9).The present study was undertaken to compare differences in antimicrobial susceptibility between S. pneumoniae isolates harboring erm(A) and those carrying either the erm(B) or mef(A) gene and to investigate the effect of induction on the expression of macrolide resistance in erm(A)-, erm(B)-, or mef(A)-positive pneumococci. The presence of genes coding for macrolide resistance was studied by PCR as described previously (8,12,13).(This work was presented in part at the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, Calif., 27 to 30 September 2002 [abstract no. C2-1977).One hundred twenty-five erythromycin-resistant S. pneumoniae isolates carrying the erm(A), erm(B), or mef(A) gene, recovered from 2,448 carriers younger than 2 years between February 1997 and February 1999 (14, 15), were evaluated for their susceptibility to 10 antibiotics representing different classes of antimicrobial agents. These agents were 14-member (erythromycin and clarithromycin), 15-member (azithromycin), and 16-member ring macrolides (miocamycin), lincosamides (clindamycin), streptogramins (quinupristin/dalfopristin), ketolides (telithromycin), penicillin G, tetracycline, and chloramphenicol. Antimicrobial susceptibility tests were performed by the agar dilution method as previously described (3). Plates were incubated in ambient air at 37°C. Antibiotics were obtained from their respective manufacturers. Miocamycin was from Meiji Sei...

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Antimicrobial Use and Colonization with Erythromycin‐ResistantStreptococcus pneumoniaein Greece during the First 2 Years of Life

Cited by 41 publications

References 43 publications

Molecular Epidemiology of Penicillin-Susceptible Non-β-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

Molecular Epidemiology of Penicillin-Susceptible Non-β-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

Non-Antibiotic Treatment for Pediatric Outpatients With Common Cold Inhibits the Emergence of Drug Resistant Pneumococci

Antimicrobial Susceptibility and Macrolide Resistance Inducibility of Streptococcus pneumoniae Carrying erm (A), erm (B), or mef (A)

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