Identification of an
            <i>erm</i>
            (A) Erythromycin Resistance Methylase Gene in
            <i>Streptococcus pneumoniae</i>
            Isolated in Greece

Syrogiannopoulos, George A.; Grivea, Ioanna N.; Tait-Kamradt, Amelia; Katopodis, George D.; Beratis, Nicholas G.; Sutcliffe, Joyce A.; Appelbaum, Peter C.; Davies, Todd A.

doi:10.1128/aac.45.1.342-344.2001

Cited by 60 publications

(54 citation statements)

References 24 publications

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“…As regards M-type isolates, recent Italian rates ranging between one-third (in the present study) and one-fifth (6,13,20,23) of erythromycin-resistant isolates contrast with the complete absence of M-type pneumococci in recent surveys carried out in a country as close as France (1,10). Rates of M-type isolates similar to those found in Italy have been reported in Greece (35), in a multinational European study (30), in Georgia (United States) (11), and in Taiwan (17); lower rates have been reported in Spain (32), Belgium (8), Central and Eastern European countries (24), and South Africa (22); higher rates have been reported in Germany (27), Japan (26), Canada (16), and in a nationwide study in the United States (9). mef(A) and mef(E) genes in M-type pneumococci.…”

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confidence: 45%

“…While efflux-mediated resistance is encoded by the above-mentioned mef genes, methylase-mediated resistance is usually encoded by the conventional erm(AM) gene, which belongs to gene class erm(B) (28). Another methylase, mediated by the erm(TR) gene, belonging to gene class erm(A) (28), was first described (31) and then found to be extensively present (14,19) in S. pyogenes, whereas its presence in S. pneumoniae has been reported only occasionally (4,35). The presence of erythromycin resistance genes was investigated by PCR.…”

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confidence: 99%

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Phenotypes and Genotypes of Erythromycin-Resistant Pneumococci in Italy

et al. 2003

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Of 120 erythromycin-resistant pneumococci isolated in Italian hospitals, 39 (32.5%) were M-type isolates, carrying the mef gene alone. The mef gene was also detected, together with erm(AM), in one constitutively resistant isolate and in five isolates of the partially inducible phenotype. Among the 45 mef-positive isolates, 25 (55.6%) carried mef(A) and 20 (44.4%) carried mef(E) as observed from PCR-restriction fragment length polymorphism analysis of a 1,743-bp amplicon. The same result was obtained by a similar method applied to a more common 348-bp amplicon.Macrolide resistance in Streptococcus pneumoniae is due to either target site modification-generally depending on a posttranscriptional modification of 23S rRNA mediated by ermclass methylases (39) or less often on mutations in 23S rRNA or ribosomal proteins (7, 37, 38)-or active efflux. In this study, 120 erythromycin-resistant pneumococci were investigated for macrolide resistance phenotypes and genotypes, with emphasis on the discrimination between mef(A) and mef(E).Efflux-mediated resistance. The efflux mechanism, which reduces the intracellular antibiotic concentration to subtoxic levels (40), is associated with a resistance pattern (M phenotype) characterized by resistance, among macrolides-lincosamidesstreptogramin B (MLS), only to 14-and 15-membered macrolides, usually at a low level (34). M-type resistance is mediated by the mef gene, two variants of which are conventionally described: one, mef(A), originally discovered in Streptococcus pyogenes (5), and the other, mef(E), originally discovered in S. pneumoniae (36). Considering that the mef genes are detected mostly by a PCR method unable to distinguish between the two variants (33) and that mef(A) and mef(E) have 90% identity (36), they are regarded as a single gene class, designated mef(A) (28). However, mef(A) and mef(E) have recently been shown to be carried by different genetic elements in S. pneumoniae, which are inserted at different sites in the chromosome. Both elements carry, adjacent to mef, an open reading frame showing homology to the msr(A) gene associated with macrolide efflux in Staphylococcus aureus (6,12,29). Due to a number of important differences in the properties of mef(A)-and mef(E)-carrying pneumococci, it has been recommended that the distinction between the two genes be maintained (6).Bacterial strains and typing. The 120 erythromycin-resistant pneumococci studied (for which the MIC of erythromycin was Ն1 g/ml) were independent isolates, collected from several laboratories throughout Italy between 1999 and 2002. All were clinical strains, isolated from a variety of clinical specimens (upper respiratory tract material, sputum, blood, cerebrospinal fluid). Multiple isolates from the same patient were excluded.Strain identification was confirmed in our laboratory by conventional tests such as susceptibility to optochin and solubility in bile and by employing the API system (BioMérieux, Marcyl'Etoile, France). Serotyping, done by the capsular swelling test using specific anti...

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confidence: 45%

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confidence: 99%

Phenotypes and Genotypes of Erythromycin-Resistant Pneumococci in Italy

et al. 2003

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“…In 2001, ermA was described in a macrolide-resistant strain isolated in Greece [32]. Both ermA and ermB confer resistance to the macrolide-lincosamide-streptogramin B families (MLS B ) [30,32]. This form of co-resistance can be expressed in two different ways, either constitutive (cMLS B ) or inducible (iMLS B ).…”

Section: Aminoglycoside Resistancementioning

confidence: 99%

“…ermB encodes for a methylase responsible for the dimethylation of a specific adenine in 23S rRNA, A2058 in domain V, leading to a decreased affinity to macrolides [31]. In 2001, ermA was described in a macrolide-resistant strain isolated in Greece [32]. Both ermA and ermB confer resistance to the macrolide-lincosamide-streptogramin B families (MLS B ) [30,32].…”

Section: Aminoglycoside Resistancementioning

confidence: 99%

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Moujaber

Osman

Rafei

et al. 2017

Journal of Medical Microbiology

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Purpose. Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold.Methodology. This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries.Key findings. Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq.Conclusion. In order to better survey, control and prevent the emergence of multidrug-and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.

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“…Expression of MLS B -type resistance can be either constitutive (cMLS) or inducible (iMLS). The erm(B) gene is the most common erm gene in S. pneumoniae, but erm(A) has been reported in rare cases (48). (ii) The active efflux mechanism encoded by macrolide efflux (mef) genes is more specific and causes so-called M-type resistance only to 14-and 15-member ring macrolides.…”

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Molecular Epidemiology of Macrolide-Resistant Isolates of Streptococcus pneumoniae Collected from Blood and Respiratory Specimens in Norway

et al. 2005

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Norway has a low prevalence of antimicrobial resistance, including macrolide-resistant Streptococcus pneumoniae (MRSP). In a nationwide surveillance program, a total of 2,200 S. pneumoniae isolates were collected from blood cultures and respiratory tract specimens. Macrolide resistance was detected in 2.7%. M-type macrolide resistance was found in 60% of resistant isolates, and these were mainly mef(A)-positive, serotype-14 invasive isolates. The erm(B)-encoded macrolide-lincosamide-streptogramin B (MLS B ) type dominated among the noninvasive isolates. One strain had an A2058G mutation in the 23S rRNA gene. Coresistance to other antibiotics was seen in 96% of the MLS B -type isolates, whereas 92% of the M-type isolates were susceptible to other commonly used antimicrobial agents. Serotypes 14, 6B, and 19F accounted for 84% of the macrolideresistant isolates, with serotype 14 alone accounting for 67% of the invasive isolates. A total of 29 different sequence types (STs) were detected by multilocus sequence typing. Twelve STs were previously reported international resistant clones, and 75% of the macrolide-resistant isolates had STs identical or closely related to these clones. Eleven isolates displayed 10 novel STs, and 7/11 of these "Norwegian strains" coexpressed MLS B and tetracycline resistance, indicating the presence of Tn1545. The invasive serotype-14 isolates were all classified as ST9 or single-locus variants of this clone. ST9 is a mef-positive M-type clone, commonly known as England 14 -9, reported from several European countries. These observations suggest that the import of major international MRSP clones and the local spread of Tn1545 are the major mechanisms involved in the evolution and dissemination of MRSP in Norway.Antimicrobial resistance is an increasing problem worldwide, and several countries have implemented surveillance systems in recent years. The Norwegian surveillance program for antimicrobial resistance (NORM) was established in 1999 and has reported yearly on the epidemiology of antimicrobial resistance and the usage of antimicrobial agents. Antimicrobial susceptibility data on common pathogens such as Escherichia coli, Klebsiella spp., Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes confirm that antimicrobial resistance is still a limited problem in Norway (28). The prevalence of macrolide-resistant S. pneumoniae (MRSP) has increased dramatically in several European countries (16) but is still relatively low in Northern Europe (31, 34). In Norway, macrolide resistance in S. pneumoniae blood culture isolates has increased from 2.4% in 2000 to 4.8% in 2002 and 6.0% in 2003 (28). Macrolides are used as second-line alternatives in the treatment of respiratory tract infections, because the prevalence of non-penicillin-susceptible S. pneumoniae is below 3% in Norway. They are recommended only for patients who are allergic to penicillin or are suspected of having atypical pneumonia. Thus, the increase in MRSP is of clinical concern as we...

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Identification of an erm (A) Erythromycin Resistance Methylase Gene in Streptococcus pneumoniae Isolated in Greece

Cited by 60 publications

References 24 publications

Phenotypes and Genotypes of Erythromycin-Resistant Pneumococci in Italy

Phenotypes and Genotypes of Erythromycin-Resistant Pneumococci in Italy

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Molecular Epidemiology of Macrolide-Resistant Isolates of Streptococcus pneumoniae Collected from Blood and Respiratory Specimens in Norway

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