High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan

Seki, Tomomi; Kimura, Kouji; Reid, Megan E.; Miyazaki, Akira; Banno, Hirotsugu; Jin, Wei; Wachino, Jun-ichi; Yamada, Keiko; Arakawa, Yoshichika

doi:10.1093/jac/dkv203

Cited by 85 publications

(72 citation statements)

References 15 publications

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“…The HLGR isolates display a high proportion of cross-resistance to macrolides and FQ, confirming the possible issue of multidrug resistance in GBS (12). This observation, together with other studies performed worldwide, might have significant clinical implications, mainly for the treatment of endocarditis and meningitis for which a combination of a beta-lactam and an aminoglycoside is frequently recommended.…”

Section: Discussionsupporting

confidence: 72%

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Changing Epidemiology of Group B Streptococcus Susceptibility to Fluoroquinolones and Aminoglycosides in France

Hays

Louis

Plainvert

et al. 2016

Antimicrob Agents Chemother

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Group B Streptococcus (GBS) is the leading cause of neonatal invasive infections and an emerging pathogen in the elderly. Our objectives were to describe the evolution of GBS resistance to antibiotics in France and to investigate the emergence of fluoroquinolone (FQ)-resistant isolates. A total of 8,757 unrelated GBS isolates were collected and tested for antibiotic susceptibility from 2007 to 2014 according to EUCAST recommendations. All isolates were susceptible to penicillin G, amoxicillin, and vancomycin. Resistance to macrolides decreased from 47.0% to 30.0%, whereas high-level resistance to aminoglycosides, especially amikacin, increased from 6.4% to 8.8% and 24 isolates (0.3%) were highly resistant to gentamicin. FQ resistance gradually increased from 0.2% in 2007 (n ‫؍‬ 1) to 1.5% in 2014 (n ‫؍‬ 18, P < 0.01). Capsular polysaccharide (CPS) genotyping, multilocus sequence typing, and sequencing of the quinolone resistance-determining region (QRDR) showed that GBS isolates of sequence type 19 (ST-19) CPS type V were largely overrepresented in FQ-resistant isolates (n ‫؍‬ 30, 45.5%). All 30 strains displayed the same QRDR mutations and were often associated with cross-resistance to macrolides (93.3%) and gentamicin (30%). In conclusion, we report the rise of FQ-and aminoglycoside-resistant GBS in France over an 8-year study period, an evolution likely linked to the clonal expansion of ST-19 CPS V-resistant isolates. This study emphasizes the need for a continuous surveillance of GBS epidemiology and antibiotic susceptibility. G roup B Streptococcus (Streptococcus agalactiae; GBS) is aGram-positive encapsulated bacterium colonizing the intestinal and vaginal tracts of 10 to 30% of healthy adults. This commensal bacterium is also the leading cause of neonatal invasive infections (bacteremia and meningitis) in industrialized countries and a pathogen of growing importance in the elderly, especially in people suffering from underlying diseases such as diabetes or cancer (1-5). The mortality rate of neonatal infections reaches approximately 10%, and up to 40% of infants who survive meningitis are left with permanent neurologic sequelae, making the global burden of GBS infections significant (2,5,6). Epidemiological studies based on capsular polysaccharide (CPS) typing revealed that GBS isolates are not similarly represented among colonizing and infectious strains. Among the 10 serotypes described to date (Ia, Ib, and II to IX), CPS types Ia, II, III, and V are almost equally prevalent among colonizing strains and are responsible for 70% of adult invasive infections worldwide (3-5, 7, 8). Conversely, CPS type III has been identified since the 1970s as strongly associated with neonatal infections and is currently responsible for more than 60% of these (1-3, 7).Penicillins or aminopenicillins are recommended as the firstline antibiotics against GBS infections (9). These antibiotics remain highly active, even though strains with reduced susceptibility were recently described in Asia and North America (10-12). Macroli...

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Section: Discussionsupporting

confidence: 72%

“…These antibiotics remain highly active, even though strains with reduced susceptibility were recently described in Asia and North America (10)(11)(12). Macrolides and clindamycin represent the second-line antibiotics and are usually administered in cases of allergy to beta-lactams.…”

Section: G Roup B Streptococcus (Streptococcus Agalactiae; Gbs) Is Amentioning

confidence: 99%

Changing Epidemiology of Group B Streptococcus Susceptibility to Fluoroquinolones and Aminoglycosides in France

Hays

Louis

Plainvert

et al. 2016

Antimicrob Agents Chemother

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“…Another important trend is the identification of PRGBS strains with resistance to multiple drugs, such as ML plus QL (multidrugresistant PRGBS [MDR-PRGBS]). In Japan, PRGBS and MDR-PRGBS are increasing among adults, not including pregnant women (39). Although these resistant strains have not yet been confirmed in neonatal infections, such an event would represent a serious threat.…”

Section: Discussionmentioning

confidence: 99%

Molecular Characteristics of Group B Streptococci Isolated from Adults with Invasive Infections in Japan

et al. 2016

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bStreptococcus agalactiae (group B streptococcus) isolates (n ‫؍‬ 443) obtained from Japanese adults with invasive infections between April 2010 and March 2013 were analyzed for capsular serotype, multilocus sequence type (ST), antibiotic susceptibility, and resistance genes. Among these cases, bacteremia without primary focus was the most common variety of infection (49.9%), followed by cellulitis (12.9%) and pneumonia (9.0%). Concerning patient age (18 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 years old or older), the incidence of pneumonia increased in patients in their 70s and 80s (P < 0.001), while younger patients (18 to 59 and 60 to 69 years old) were more likely to have abscesses (P < 0.05). The mortality rate was 10.2% for all ages. The most common capsular serotype was Ib (39.5%), followed by V (16.0%), III (13.8%), VI (9.5%), and Ia (8.6%). The main ST of serotype Ib strains was ST10, which belonged to clonal complex 10 (88.0%). The predominant clonal complexes of serotypes V and III, respectively, were 1 (78.9%) and 19 (75.4%). Among these isolates, 9 strains (2.0%) were identified as group B streptococci with reduced penicillin susceptibility, reflecting amino acid substitutions in penicillin-binding protein 2X (PBP2X). In addition, 19.2% of all strains possessed mef(A/E), erm(A), or erm(B) genes, which mediate macrolide resistance, while 40.2% of strains were resistant to quinolones resulting from amino acid substitutions in GyrA and ParC. Our data argue strongly for the continuous surveillance of microbial characteristics and judicious antibiotic use in clinical practice.

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“…Por otro lado, Dahesh y col. (2008) (14) detectaron cuatro cepas con elevadas CIM a penicilina (todas del serotipo III) de un total de 5631 cepas ensayadas. Un estudio más reciente en Japón (27) reportó 45 aislamientos de muestras clínicas con PRGBS de un total de 306 (14,7 %) entre enero de 2012 y julio de 2013. Estas cepas presentaron, además resistencia a otras drogas.…”

Section: Discussionunclassified

Vigilancia de la sensibilidad a penicilina en Streptococcus agalactiae recuperados de embarazadas entre las 35-37 semanas de gestación

Velázquez

Bobadilla

Novosak

et al. 2017

Rev Fac Cien Med Univ Nac Cordoba

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ResumenStreptococcus agalactiae (SGB) es causa de infecciones severas en menores de tres meses. Meningitis, neumonía y sepsis son los principales cuadros en estos niños. Estas infecciones se encuentran entre las más graves que puede sufrir un individuo en sus primeras doce horas de vida. El niño adquiere la infección por transmisión vertical de la madre colonizada. Para prevenir la enfermedad neonatal se recomienda penicilina como droga de elección en la profilaxis intraparto (PIP) en embarazadas colonizadas. Sin embargo, actualmente se han detectado cepas con sensibilidad disminuida a penicilina por lo que resulta importante realizar la vigilancia de la sensibilidad al mismo para asegurar su utilidad durante la profilaxis. El objetivo de este trabajo fue determinar la sensibilidad a penicilina en cepas de SGB recuperados de mujeres embarazadas de 35-37 semanas de gestación. Se estudiaron 96 aislamientos y se determinó la sensibilidad por método epsilométrico Etest® (LIOFILCHEM, Italia), siguiendo las recomendaciones del Clinical Laboratory Standards Institute (CLSI). Se obtuvo la Concentración Inhibitoria Mínima (CIM) para cada aislamiento bacteriano. El 100% (96) de las cepas estudiadas fue sensible a penicilina con valores de CIM comprendidos entre 0,012 y 0,094 µg mL-1. Estos resultados indican que penicilina sigue siendo el antimicrobiano de elección durante la profilaxis intraparto, para la prevención de la enfermedad neonatal causada por SGB en nuestra región. Se destaca la importancia de la vigilancia epidemiológica de la sensibilidad a penicilina y a otros antimicrobianos para alertar sobre nuevos mecanismos de resistencia y adecuar estrategias de tratamiento.Palabras clave: streptococcus agalactiae; SGB; antimicrobiano; penicilina; profilaxis intraparto. AbstractStreptococcus agalactiae (GBS) cause severe infections in newborns under three months. Meningitis, pneumonia and sepsis are the main infectious diseases in these children. These infections are among the most serious that an individual can suffer in his first twelve hours of life. The child acquires the infection by vertical transmission of the colonized mother. To prevent neonatal disease, penicillin is recommended as the drug of choice for intrapartum prophylaxis (PIP) in pregnant women colonized. However, strains with decreased susceptibility to penicillin have been detected so it is important to monitor the susceptibility to penicillin to ensure its usefulness during prophylaxis. The aim of this study was to determine the sensitivity to penicillin in GBS strains recovered from pregnant women with 35-37 weeks of gestation. Ninety-six isolates were studied and sensitivity was determined by the epsilometric method Etest® (LIOFILCHEM, Italy), following the recommendations of the Clinical Laboratory Standards Institute (CLSI). Minimum Inhibitory Concentration (MIC) was obtained for each bacterial isolation. 100% (96) of the strains studied -1. These results indicate that penicillin remains the antimicrobial of choice during intrapartum prophylaxi...

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High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan

Abstract: These results suggest that the number of clinical PRGBS isolates with a tendency to multidrug resistance increased rapidly between 2005-06 and 2012-13 in Japan.

Cited by 85 publications

References 15 publications

Changing Epidemiology of Group B Streptococcus Susceptibility to Fluoroquinolones and Aminoglycosides in France

Changing Epidemiology of Group B Streptococcus Susceptibility to Fluoroquinolones and Aminoglycosides in France

Molecular Characteristics of Group B Streptococci Isolated from Adults with Invasive Infections in Japan

Vigilancia de la sensibilidad a penicilina en Streptococcus agalactiae recuperados de embarazadas entre las 35-37 semanas de gestación

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