Prevalence and Antibiotics Susceptibility Profiles of Streptococcus Pyogenes Among Pediatric Patients With Acute Pharyngitis at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background: Streptococcus pyogenes (S. pyogenes) is a Gram positive bacterium which is a leading cause of pharyngitis, skin and soft tissue infection and post streptococcal syndromes. Due to lack of β-lactamase enzyme production, it was considered universally susceptible to penicillin group and later generation of β-lactam antibiotics. As such, empirical treatment was common which might leads to development of antibiotics resistance. Therefore, the aims of this study were to determine the prevalence and antibiotics susceptibility profile; associated factors of S. pyogenes among pediatrics patients with acute pharyngitis in Felege Hiwot Comprehensive Specialized Hospital, Northwest EthiopiaMethods: A total of 154 pediatric patients, whose age ranged from 0-18 years recruited to the study by convenient sampling technique on which hospital based cross-sectional study was carried out from 1st February to 19th June 2020 at FHCSH. S. pyogenes were identified by throat swab culture on 5% sheep blood agar with an overnight incubation at 37oC in candle jar with 5% CO2. Gram stain, catalase test and bacitracin test were used to identify S. pyogenes. The data were entered into EpiData version 3.1 and analyzed by SPSS version 20 software. Bivariables and multivariable logistic regressions were carried out for analysis by considering P < 0.05 as statistically significant. Results: From the total throat swabs, 14 (9.1%) with (95% CI; 4.5-14.3) were culture positive for S. pyogenes. All isolates were sensitive to penicillin and ampicillin whereas 4 (35.7%), 4 (35.5%), 3 (21.4%), 2 (14.3%), 1 (7.1%), 7 (50.0%) and 1 (7.1%) were resistant for ceftriaxone, vancomycin, erythromycin, tetracycline, chloramphenicol, clindamycin and levofloxacin, respectively. Presence of any smoker in home was significantly associated with S. pyogenes acute pharyngitis, while tender lymphadenopathy and recurrence were clinical predictors for S. pyogenes acute pharyngitis (P < 0.05). Conclusion: The prevalence of S. pyogenes 9.1% which is considered as low prevalence. All S. pyogenes remain sensitive to penicillin and resistance was also obtained to clindamycin 7 (50.0%), ceftriaxone 5 (35.7%), erythromycin 3 (21.4%). The current practice of giving erythromycin, clindamycin instead of penicillin and ampicillin is in contrary with microbiology result. There should be routine throat culture and a continuous surveillance of antibiotics resistance pattern for S. pyogenes to improve the use of antibiotics in hospitals.

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“…Result of culturing gave 21 (42%) positive sample for S.pyogen.As for the other antibiotics, it was resistant (100%) included all of Ceftriaxone, Tetracycline, Amoxicillin\Clavulanic acid, Oxacillin, Erythromycin, Ceprofloxacin. These results are in agreement with the findings (Kebede et al, 2021), where the results showed that high resist of S. pyogen for beta-lactam antibiotics. This is due to a lack of production beta-lactam by S. pyogen.…”

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“…The S. pyogenes isolates tested in this study were resistant to ampiclox (30 µg) and amoxicillin (30 µg). This corroborates with Rasheed, [36]; Kebede et al [37] that S. pyogenes isolates from ponds were found to be resistant to ampiclox and amoxicillin. This could be as a result of indiscriminate use of these antibiotics by patients attending the hospital.…”

Streptococcal Pyrogenic Exotoxin Genes SpeA and SpeB in Isolates of <i>Streptococcus pyogenes</i> from Children with Pharyngitis, Gezira State, Sudan

“…Streptococcus pyogenes is sensitive to penicillin; different studies worldwide showed that like [10] study from Iran, [11] study from Senegal, [12] study from Ethiopia, [13] study from China and our study also showed that which confirms the penicillin is still the drug of choice for the treatment of GAS pharyngitis.…”