Macrolide-Resistant
            <i>Streptococcus pyogenes</i>
            in Norway: Population Structure and Resistance Determinants

Littauer, Pia; Caugant, Dominique A.; Sangvik, Maria; Høiby, E. Arne; Sundsfjord, Arnfinn; Simonsen, Gunnar Skov

doi:10.1128/aac.50.5.1896-1899.2006

Cited by 32 publications

(26 citation statements)

References 41 publications

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“…While macrolide resistance rates of over 20% were reported from Italy (6) and both macrolide and tetracycline resistance rates of over 90% have been found in China (10), antibiotic resistance in GAS is still rare in Norway. This finding is consistent with previous reports from both Norway and Denmark (13,14). Only one ofloxacin-resistant emm-6 isolate has been reported previously (15); however, the major part of fluoroquinolone nonsusceptibility is found in emm-6 strains (1, 15).…”

supporting

confidence: 83%

Sequence Type and emm Type Diversity in Streptococcus pyogenes Isolates Causing Invasive Disease in Norway between 1988 and 2003

et al. 2008

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The incidence of invasive group A streptococcal disease has increased in Norway since the 1980s. Analysis of 100 isolates recovered from 1988 to 2003 showed an increased genotypic diversity over time, while the prevalence of the strain that dominated in 1988, sequence type (ST)-28/ emm -1, decreased. Necrotizing fasciitis was often associated with ST-15/ emm -3.

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supporting

confidence: 83%

Sequence Type and emm Type Diversity in Streptococcus pyogenes Isolates Causing Invasive Disease in Norway between 1988 and 2003

et al. 2008

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“…Among them are emm-4 strains persistent in Finland, Sweden, and other European countries since the 1990s. Macrolide-resistant emm-4, emm-75, and emm-94 strains were also identified in a study of macrolide resistance in Norway between 1993 and 2002 by Littauer et al (28). However, our emm-75 strains were resistant or of intermediate susceptibility to fluoroquinolones, which may be explained by the loss of macrolide resistance and acquisition of fluoroquinolone resistance, as described by Billal et al (5,6), suggesting that emm-75 strains presently circulating in Norway have changed genetically since 2002.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

et al. 2010

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To investigate the epidemiological patterns and genetic characteristics of disease caused by group A Streptococcus (GAS), all available isolates from invasive cases in Norway during 2006 to 2007 (262 isolates) were subjected to antimicrobial susceptibility testing, T serotyping, emm typing, and multilocus sequence typing and screened for known streptococcal pyrogenic exotoxin (Spe) genes, smeZ, and ssa. The average incidence rate was 3.1 cases per 100,000 individuals. The most prevalent sequence types (STs) were STs 52, 28, and 334. In association with emm types 28, 77, and 87, the serotype T-28 comprised 24.8% of the strains. emm types 28, 1, and 82 were dominating. In 2007, a sharp increase in the number of emm-6 strains was noted. All strains were sensitive to penicillin and quinupristin-dalfopristin, while 3.4% and 6.1% of the strains were resistant to macrolides and tetracycline, respectively. Furthermore, the emm-6 strains had intermediate susceptibility to ofloxacin. Isolates displayed a wide variety of gene profiles, as shown by the presence or absence of the Spe genes, smeZ, and ssa, but 48% of the isolates fell into one of three profiles. In most cases, an emm type was restricted to one gene profile. Although the incidence decreased during this study, invasive GAS disease still has a high endemic rate, with involvement of both established and emerging emm types displaying variability in virulence gene profiles as well as differences in gender and age group preferences.

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“…The development of resistance is clearly related to local prescribing habits; nevertheless, resistant strains of S. aureus and S. pyogenes are emerging worldwide, leading to concerns about the potential for reduced clinical efficacy of commonly used treatments [22,28,29,30,31,32], particularly in countries where antibiotics can be purchased without prescription [33]. For example, two studies of isolates from a range of primary and secondary skin infections in European subjects revealed sodium fusidate resistance rates of 50 and 32.5% [22, 34].…”

Section: Discussionmentioning

confidence: 99%

Topical Retapamulin Ointment, 1%, versus Sodium Fusidate Ointment, 2%, for Impetigo: A Randomized, Observer-Blinded, Noninferiority Study

et al. 2007

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Background: Retapamulin is a novel pleuromutilin antibacterial developed for topical use. Objective: To compare the efficacy and safety of retapamulin ointment, 1% (twice daily for 5 days), with sodium fusidate ointment, 2% (3 times daily for 7 days), in impetigo. Methods: A randomized (2:1 retapamulin to sodium fusidate), observer-blinded, noninferiority, phase III study in 519 adult and pediatric (aged ≧9 months) subjects. Results: Retapamulin and sodium fusidate had comparable clinical efficacies (per-protocol population: 99.1 and 94.0%, respectively; difference: 5.1%, 95% confidence interval: 1.1–9.0%, p = 0.003; intent-to-treat population: 94.8 and 90.1%, respectively; difference: 4.7%, 95% confidence interval: –0.4 to 9.7%, p = 0.062). Bacteriological efficacies were similar. Success rates in the small numbers of sodium-fusidate-, methicillin- and mupirocin-resistant Staphylococcus aureus were good for retapamulin (9/9, 8/8 and 6/6, respectively). Both drugs were well tolerated. Conclusion: Retapamulin is a highly effective and convenient new treatment option for impetigo, with efficacy against isolates resistant to existing therapies.

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Macrolide-Resistant Streptococcus pyogenes in Norway: Population Structure and Resistance Determinants

Cited by 32 publications

References 41 publications

Sequence Type and emm Type Diversity in Streptococcus pyogenes Isolates Causing Invasive Disease in Norway between 1988 and 2003

Sequence Type and emm Type Diversity in Streptococcus pyogenes Isolates Causing Invasive Disease in Norway between 1988 and 2003

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

Topical Retapamulin Ointment, 1%, versus Sodium Fusidate Ointment, 2%, for Impetigo: A Randomized, Observer-Blinded, Noninferiority Study

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