Macrolide Resistance Determinants of Invasive and Noninvasive Group B Streptococci in a Turkish Hospital

Açıkgöz, Ziya Cibali; Almayanlar, Ebru; Gamberzade, S; Gocer, Safiye

doi:10.1128/aac.48.4.1410-1412.2004

Cited by 20 publications

(24 citation statements)

References 14 publications

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“…Finally, we observed 5 isolates that were resistant to both erythromycin and clindamycin, and yet contained none of the common resistance genes for which we tested, which is consistent with previous reports [22, 23]. This may suggest an alternatemechanism of resistance.…”

Section: Discussionsupporting

confidence: 91%

Rapid Determination of Macrolide and Lincosamide Resistance in Group B Streptococcus Isolated from Vaginal-Rectal Swabs

Cruz

Richardson

Broestler

et al. 2007

Infectious Diseases in Obstetrics and Gynecology

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Objective. Our objective was to assess the ability of real-time PCR to predict in vitro resistance in isolates of group B streptococcus (GBS). Methods. The first real-time PCR assays for the genes known to confer resistance to erythromycin and clindamycin in GBS were developed. Three hundred and forty clinical GBS isolates were assessed with these assays and compared with conventional disk diffusion. Results. The presence of an erythromycin ribosome methylation gene (ermB or ermTR variant A) predicted in vitro constitutive or inducible resistance to clindamycin with a sensitivity of 93% (95% CI 86%–97%), specificity of 90% (95% CI 85%–93%), positive predictive value of 76% (95% CI 67%–84%), and negative predictive value of 97% (95% CI 94%–99%). Conclusion. This rapid and simple assay can predict in vitro susceptibility to clindamycin within two hours of isolation as opposed to 18–24 hours via disk diffusion. The assay might also be used to screen large numbers of batched isolates to establish the prevalence of resistance in a given area.

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Section: Discussionsupporting

confidence: 91%

Rapid Determination of Macrolide and Lincosamide Resistance in Group B Streptococcus Isolated from Vaginal-Rectal Swabs

Cruz

Richardson

Broestler

et al. 2007

Infectious Diseases in Obstetrics and Gynecology

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“…Of the erythromycin-resistant GBS isolates, three had none of the erythromycin resistance genes that we studied, which is consistent with previous reports (1,16). It is possible that 23S rRNA mutations, which have been recently reported to cause macrolide resistance in S. pneumoniae (11), could be responsible for some erythromycin resistance in GBS.…”

Section: Discussionsupporting

confidence: 80%

Simultaneous Detection of Nine Antibiotic Resistance-Related Genes in Streptococcus agalactiae Using Multiplex PCR and Reverse Line Blot Hybridization Assay

Zeng

Kong

Wang

et al. 2006

Antimicrob Agents Chemother

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Streptococcus agalactiae (group B streptococcus [GBS]) is the leading cause of neonatal and maternal sepsis.Penicillin is recommended for intrapartum prophylaxis, but erythromycin or clindamycin is used for penicillinallergic carriers. Antibiotic resistance (AR) has increased recently and needs to be monitored. We have developed a multiplex PCR-based reverse line blot (mPCR/RLB) hybridization assay to detect, simultaneously, seven genes encoding AR-erm(A/TR), erm(B), mef(A/E), tet(M), tet(O), aphA-3, and aad-6-and two ARrelated genes, int-Tn and mreA. We tested 512 GBS isolates from Asia and Australasia and compared mPCR/RLB with antibiotic susceptibility phenotype or single-gene PCR. Phenotypic resistance to tetracycline was identified in 450 (88%) isolates, of which 442 had tet(M) (93%) and/or tet(O) (6%). Of 67 (13%) erythromycin-resistant isolates, 18 were susceptible to clindamycin, i.e., had the M phenotype, encoded by mef(A/E); 39 had constitutive (cMLS B ) and 10 inducible clindamycin resistance, and of these, 34 contained erm(B) and 12 erm(A/TR). Of four additional isolates with mef(A/E), three contained erm(B) with cMLS B and one was erythromycin susceptible. Of 61 (12%) clindamycin-resistant isolates, 20 were susceptible to erythromycin and two had intermediate resistance. Based on sequencing, 21 of 22 isolates with mef had mef(E), and 8 of 353 with int-Tn had an atypical sequence. Several AR genes, erm(B), tet(O), aphA-3, aad-6, and mef(A/E), were significantly more common among Asian than Australasian isolates, and there were significant differences in distribution of AR genes between GBS serotypes. Our mPCR/RLB assay is simple, rapid, and suitable for surveillance of antibiotic resistance in GBS.Streptococcus agalactiae (group B streptococcus [GBS]) is the leading cause of neonatal and maternal infections and an opportunistic pathogen in immunocompromised patients and adults with underlying disease (26). It is usually susceptible to penicillin, which is the antibiotic of choice for treatment or intrapartum antibiotic prophylaxis of GBS infections. Erythromycin (a macrolide) or clindamycin (a lincosamine) are recommended alternatives for intrapartum antibiotic prophylaxis in penicillin-allergic GBS carriers (2). However, an increase in the incidence of resistance to these agents has been observed in the last decade (24, 31), and surveillance is needed.Tetracycline resistance is common in GBS and usually is due to ribosomal protection encoded by tet(M) or tet(O) or less commonly to an efflux pump encoded by tet(K) or tet(L) (9,27). tet(M) is often carried by the conjugative transposon Tn916, and its integrase (int-Tn) is commonly present in isolates carrying tet(M). Erythromycin resistance genes (25) are also carried on transposons. They include the erm (B, A/TR, or C) genes, which encode a ribosomal methylase and confer constitutive or inducible cross-resistance to macrolide, lincosamine, and streptogramin B antibiotics (cMLS B or iMLS B phenotypes, respectively), and the mef (A or E) genes, which e...

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“…of strains (and % of total) for which the MIC value (mg ml "1 ) was: rarely used in Kuwait. However, high prevalence of chloramphenicol resistance in GBS (44.2 %) was also observed in Turkey (Acikgoz et al, 2004).…”

Section: B-lactammentioning

confidence: 99%

Serotypes and antibiotic resistance in Group B streptococcus isolated from patients at the Maternity Hospital, Kuwait

Boswihi

Udo

Al‐Sweih

2012

Journal of Medical Microbiology

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A total of 143 group B streptococcus (GBS) isolates collected from mothers at the Maternity Hospital in Kuwait were investigated for their serotypes and antibiotic resistance, and screened by PCR for the carriage of genes for resistance to tetracycline (tetk, tetM, tetL, tetO), erythromycin (ermA, ermB, ermC, ermTR, ermM, mefA, mefE, msrA) and aminoglycosides (aph3, ant4, ant6). All isolates were serotyped using a latex agglutination test. Most of the isolates belonged to serotypes V (38.5 %), III (20.9 %), Ia (7.7 %) and II (11.2 %). Sixteen isolates (11.2 %) were nontypable. All isolates were susceptible to penicillin, ampicillin and cefotaxime (MICs 0.016-0.094 mg ml "1 ) but were resistant to trimethoprim (92.3 %), tetracycline (89.5 %), minocycline (89.5 %), high-level kanamycin (76.9 %), chloramphenicol (30.0 %), erythromycin (12.6 %), clindamycin (7.0 %), high-level streptomycin (3.5 %) and ciprofloxacin (0.7 %). The tetracycline-resistant isolates contained tetM (94.5 %), tetO (3.9 %), tetL (1.6 %) and tetK (0.8 %). The erythromycin-resistant isolates contained ermB (61.1 %), ermTR (38.9 %), ermA (5.5 %), mefA (5.5 %) and mefE (11 %). All high-level kanamycin-resistant isolates contained aph3. One of the high-level streptomycin-resistant isolates contained ant6. Partial DNA sequencing of aph3 revealed sequences with 99 % similarity to aph3 found in Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis, suggesting that the GBS isolates could have acquired aph3 from other Gram-positive cocci. The high proportion of isolates with resistance to tetracycline, high-level kanamycin and trimethoprim, and the increase in the prevalence of erythromycin resistance, represents an emerging public health concern that needs further surveillance. INTRODUCTIONGroup B streptococcus (GBS), also known as Streptococcus agalactiae, is a leading cause of serious infections in neonates and immunocompromised adults (Truog et al., 1976;Baker, 1979;High et al., 2005).GBS are encapsulated and have been classified into ten serotypes (Ia, Ib, II, III, IV, V, VI, VII, VIII and IX) on the basis of the capsular polysaccharide components of their cell wall (Victor & Rubens, 2000;Slotved et al., 2007). The capsular polysaccharide, as a virulence factor, assists GBS survival in vivo by avoiding recognition by the host defence system (Rubens et al., 1987). There are major differences between countries in the distribution of GBS serotypes. In the USA, Germany and Sweden, the most common serotypes isolated from infants and colonized mothers have been types Ia, III, and V (Persson et al., 2004;Brimil et al., 2006;Harrison et al., 1998). Serotype V strains emerged in the 1990s as a frequent cause of neonatal sepsis and adult diseases in the USA. On the other hand, serotypes VI and VIII represented 35.6 % and 24.7 %, respectively, of GBS isolated from pregnant women in Japan (Lachenauer et al., 1999).Penicillin G is the drug of choice for the intrapartum prophylaxis of GBS infections (Figueira-Coelho e...

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Macrolide Resistance Determinants of Invasive and Noninvasive Group B Streptococci in a Turkish Hospital

Cited by 20 publications

References 14 publications

Rapid Determination of Macrolide and Lincosamide Resistance in Group B Streptococcus Isolated from Vaginal-Rectal Swabs

Rapid Determination of Macrolide and Lincosamide Resistance in Group B Streptococcus Isolated from Vaginal-Rectal Swabs

Simultaneous Detection of Nine Antibiotic Resistance-Related Genes in Streptococcus agalactiae Using Multiplex PCR and Reverse Line Blot Hybridization Assay

Serotypes and antibiotic resistance in Group B streptococcus isolated from patients at the Maternity Hospital, Kuwait

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