Erythromycin-Resistant Group A Streptococci in Schoolchildren in Pittsburgh

Martin, Judith M.; Green, Michael; Barbadora, Karen A.; Wald, Ellen R.

doi:10.1056/nejmoa013169

Cited by 215 publications

(144 citation statements)

References 32 publications

Supporting

Mentioning

135

Contrasting

Order By: Relevance

“…Health education regarding the GAS infections, their sequelatex agglutination method (HiStrep Latex Test Kit, Hi-Media, Mumbai).The latex kit identifies the groups A, B, C, D, F and G of the Lancefield group of Streptococci. Two more throat swabs were studied from the GAS positive students at intervals of 3 months, to classify them as transient (first culture-positive and the subsequent two cultures-negative), recurrent (first two cultures-positive and the third culture-negative) and chronic carriers (all the three cultures positive) [2].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The Prevalence of Group A Streptococci Carriers Among Asymptomatic School Children

Vijaya¹

2013

JCDR

View full text Add to dashboard Cite

Aim: The Group A Streptococci (GAS) cause several suppurative and nonsuppurative infections. GAS frequently gets colonized in the throat of asymptomatic school children. A preliminary study was conducted to identify the GAS carrier state in apparently healthy children who belonged to various schools which were located in and around the rural village, B.G.Nagara, Mandya Dist, Karnataka state, India. Material and Methods:Throat swabs were collected from 2000 asymptomatic school children who were aged 5-15 years. The beta haemolytic streptococci isolates were sero-grouped by agglutination tests by using specific antisera (HiStrep Latex Test, Hi-Media, Mumbai, India). Results:Out of the 44 (2.2%) beta haemolytic which were isolated, 38 (86.36%) were GAS, 5 (11.36%) were Group C Streptococci and one (2.27%) was Group G Streptococcus. Among the 38 GAS positive children, 24 (63.16%) were transient carriers, 10(26.32%) were recurrent carriers and 4 (10.52%) were chronic carriers. The GAS chronic carriers were of the age group of 9-12 years.

show abstract

Section: Methodsmentioning

confidence: 99%

“…GAS frequently gets colonized in the throats of asymptomatic persons. There are few studies which have described the natural history of the pharyngeal carriage with GAS [2]. A streptococcal carriage has been defined as the recovery of GAS from the nasopharynx or the oropharynx in the absence of any evidence of an acute infection [3].…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Group A Streptococci Carriers Among Asymptomatic School Children

Vijaya¹

2013

JCDR

View full text Add to dashboard Cite

show abstract

“…Given the emergence of group A |S-hemolytic streptococci resistance to macrolides (which has never been documented for penicillins), use of off-guideline therapy for GAS pharyngitis risks both exposure to unnecessary broad-spectrum antibiotics and the potential for treatment failure. 2 ' 28 Our analysis has limitations. First, data were extracted from an EHR using ICD-9 codes to identify GAS pharyngitis.…”

Section: Discussionmentioning

confidence: 97%

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

Fierro

Prasad

Localio

et al. 2014

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

OBJECTIVE. To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.DESIGN. Retrospective cohort study.SETTING. All encounters to 25 pediatric primary care practices sharing an electronic health record.METHODS. Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.RESULTS. Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P< .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P< .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.CONCLUSIONS. Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition. Infect Control Hosp Epidemiol 2014;35(S3):S79-S85

show abstract

“…In contrast to ␤-lactams, resistance of GAS to macrolide antibiotics was described as early as the late 1950s and has increased markedly worldwide in the last decade. 33 Martin and colleagues 34 reported an outbreak of pharyngitis caused by erythromycin-resistant serotype M6 GAS strains among schoolchildren in Pittsburgh, PA. This event was of particular concern because within a few months the frequency of macrolide-resistant GAS increased rapidly, and drug-resistant strains spread widely to surrounding communities.…”

Section: Insight Into the Emergence Of Drug-resistant Gas Strains: Anmentioning

confidence: 99%

“…Molecular studies implicated serotype M6 strains of a single clone, and drug resistance was due to the presence of the mefA gene encoding a macrolide efflux pump. 34 Inasmuch as serotype M6 strains are one of the more common causes of pharyngitis and invasive infections 4,19 -21,26,35 and there was considerable conflicting information in the literature about the molecular mechanism of acquisition and transfer of the mefA gene in GAS, we chose to sequence the genome of a genetically representative strain. 26,36 Interestingly, we found that the mefA gene in the Pittsburgh clone was encoded by an unusual 58.8-kb foreign genetic element with characteristics of both a transposon and a prophage.…”

Section: Insight Into the Emergence Of Drug-resistant Gas Strains: Anmentioning

confidence: 99%

Toward a Genome-Wide Systems Biology Analysis of Host-Pathogen Interactions in Group A Streptococcus

Musser

DeLeo

2005

The American Journal of Pathology

View full text Add to dashboard Cite

Genome-wide analysis of microbial pathogens and molecular pathogenesis processes has become an area of considerable activity in the last 5 years. These studies have been made possible by several advances, including completion of the human genome sequence, publication of genome sequences for many human pathogens, development of microarray technology and high-throughput proteomics, and maturation of bioinformatics. Despite these advances, relatively little effort has been expended in the bacterial pathogenesis arena to develop and use integrated research platforms in a systems biology approach to enhance our understanding of disease processes. This review discusses progress made in exploiting an integrated genome-wide research platform to gain new knowledge about how the human bacterial pathogen group A Streptococcus causes disease. Results of these studies have provided many new avenues for basic pathogenesis research and translational research focused on development of an efficacious human vaccine and novel therapeutics. One goal in summarizing this line of study is to bring exciting new findings to the attention of the investigative pathology community. In addition, we hope the review will stimulate investigators to consider using analogous approaches for analysis of the molecular pathogenesis of other microbes.

show abstract

Erythromycin-Resistant Group A Streptococci in Schoolchildren in Pittsburgh

Abstract: In January 2001, during a longitudinal study of schoolchildren, we detected the emergence of erythromycin resistance in pharyngeal isolates of group A streptococci. This clonal outbreak also affected the wider community.

Cited by 215 publications

References 32 publications

The Prevalence of Group A Streptococci Carriers Among Asymptomatic School Children

The Prevalence of Group A Streptococci Carriers Among Asymptomatic School Children

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

Toward a Genome-Wide Systems Biology Analysis of Host-Pathogen Interactions in Group A Streptococcus

Contact Info

Product

Resources

About