Evolution of Erythromycin Resistance among <i>Streptococcus pneumoniae</i> Isolates in Malaysia from 2005 and 2010

Abstract

Objectives: This study focuses on the antibiotic susceptibility pattern and distribution of the ermB and mefA virulence genes among the Streptococcus pneumoniae due to an increase in erythromycin resistance in S. pneumoniae worldwide. Methodology: We investigated 255 clinical isolates collected from 2005-2010 to determine the serotype distribution and resistance to erythromycin in comparison to penicillin, clindamycin, clarithromycin, azithromycin, and trimethoprim sulfamethoxazole. Multiplex PCR was carried out to detect erythromycin resistance genes (ermB and mefA). Results: There were 146 (57.3%) isolates resistant to erythromycin. MIC90 for erythromycin is at >256 mg/L and MIC50 is at 16 mg/L. The ermB gene was detected in 25.3% of the erythromycin-resistant isolates and mefA gene was detected in 50.7% of the isolates. The four most common serotypes encountered are 19F, 19A, 23F and 14. The serotype distribution among the erythromycin resistant isolates was 19F (42.0%) followed by serotype 19A (11.3%), serotype 23F (9.2%) and serogroup 14 (7.0%). Conclusion: In conclusion, there is a significant rise in erythromycin resistance among the Malaysian pneumococcal isolates. The emergence of serotype 19A together with increasing prevalence of resistance to macrolide warrants for a more extensive surveillance study.

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

“…The majority of them have an MIC of > 256 μg/mL, with MIC 90 values of 32 μg/mL and 128 μg/mL for erythromycin and azithromycin, respectively. Compared with previous studies that investigated S. pneumoniae isolates in the years 2008–2010, the MIC 90 s of erythromycin are higher, with MIC values of ≥ 256 μg/mL ( 14 , 15 ). In this study, 96.7% of erythromycin-resistant isolates were also resistant to azithromycin, which is consistent with previous studies where 94.4%–97% of the erythromycin-resistant pneumococcal isolates had concomitant erythromycin and azithromycin resistance ( 6 , 15 ).…”

“…In Malaysia, the prevalence of macrolide-resistant S. pneumoniae appeared to have increased over the years from 36.8% in 2001 ( 14 ) to 46.2% in 2005, then drastically increased to 62.2% in the year 2010 ( 15 , 16 ). In our study, the rates of susceptibility towards macrolide antibiotics were not much different to those of a previous study ( 16 ), where the resistance rates to erythromycin and azithromycin were 26.5% and 30.1%, respectively.…”

“…However, we reported a decrease in erythromycin resistance compared to more recent studies. However, the resistance rate towards erythromycin in 2010, which was more than 60%, was higher ( 14 , 15 ).…”

Pneumococcal serotype distribution and antibiotic susceptibility in Malaysia: A four-year study (2014–2017) on invasive paediatric isolates

“…Pneumococcal antimicrobial resistance has increased rapidly over the past two decades, posing a threat to the management of the disease, especially due to increasing trends in penicillin resistance (Ghaffar et al, 2004;Gladstone et al, 2015;Feikin et al, 2013). However, penicillin resistance in Malaysia seems to be relatively low compared to other drugs (Rohani et al, 2011), whereas macrolide resistance seems to be a more alarming problem in Asian countries (Kim et al, 2016) and also in Malaysia (Arushothy et al, 2016).…”

Detection rate of Pneumococcal Pneumonia using the Urine Antigen Kit BinaxNow Streptococcus Pneumoniae Test: a Prospective Cohort Study in a Tertiary Hospital in Malaysia

“…In Malaysia there is a significant rise in macrolide resistance among Malaysian pneumococcal isolates based on a recent publication. 31 Whether the emergence of this resistance was associated with overzealous use of macrolides needs further studies. Narrowing the spectrum of given antibiotics once pneumococcal infection is detected may be of value.…”