Detection of Multiple Macrolide- and Lincosamide-Resistant Strains of Streptococcus pyogenes from Patients in the Boston Area
Open Access
- 1 April 2004
- journal article
- Published by American Society for Microbiology in Journal of Clinical Microbiology
- Vol. 42 (4) , 1559-1563
- https://doi.org/10.1128/jcm.42.4.1559-1563.2004
Abstract
Macrolide (including erythromycin and azithromycin) and lincosamide (including clindamycin) antibiotics are recommended for treatment of penicillin-allergic patients with Streptococcus pyogenes pharyngitis. Resistance to erythromycin in S. pyogenes can be as high as 48% in specific populations in the United States. Macrolide and lincosamide resistance in S. pyogenes is mediated by several different genes. Expression of the erm(A) or erm(B) genes causes resistance to erythromycin and inducible or constitutive resistance to clindamycin, respectively, whereas expression of the mef(A) gene leads to resistance to erythromycin but not clindamycin. We studied the resistance of S. pyogenes to erythromycin and clindamycin at an urban tertiary-care hospital. Of 196 sequential isolates from throat cultures, 15 (7.7%) were resistant to erythromycin. Three of these were also constitutively resistant to clindamycin and had the erm(B) gene. Five of the erythromycin-resistant isolates were resistant to clindamycin upon induction with erythromycin and had the erm(A) gene. The remaining seven erythromycin-resistant isolates were susceptible to clindamycin even upon induction with erythromycin and had the mef(A) gene. Pulsed-field gel electrophoresis analysis and emm typing demonstrated that the erythromycin-resistant S. pyogenes comprised multiple strains. These results demonstrate that multiple mechanisms of resistance to macrolide and lincosamide antibiotics are present in S. pyogenes strains in the United States.Keywords
This publication has 36 references indexed in Scilit:
- Antimicrobial susceptibility profile among β-haemolytic Streptococcus spp. collected in the SENTRY antimicrobial surveillance program—North America, 2001Diagnostic Microbiology and Infectious Disease, 2003
- Macrolide-Resistant Streptococcus pneumoniae and Streptococcus pyogenes in the Pediatric Population in Germany during 2000-2001Antimicrobial Agents and Chemotherapy, 2003
- Pharmacoepidemiological Analysis of Provincial Differences between Consumption of Macrolides and Rates of Erythromycin Resistance among Streptococcus pyogenes Isolates in SpainJournal of Clinical Microbiology, 2002
- Practice Guidelines for the Diagnosis and Management of Group A Streptococcal PharyngitisClinical Infectious Diseases, 2002
- Increased Prevalence of Erythromycin Resistance in Streptococci: Substantial Upsurge in Erythromycin-Resistant M Phenotype inStreptococcus pyogenes(1979-1998) but Not inStreptococcus pneumoniae(1985-1999) in TaiwanMicrobial Drug Resistance, 2002
- Mechanisms of Resistance to Macrolides and Lincosamides: Nature of the Resistance Elements and Their Clinical ImplicationsClinical Infectious Diseases, 2002
- Susceptibility to Telithromycin in 1,011 Streptococcus pyogenes Isolates from 10 Central and Eastern European CountriesAntimicrobial Agents and Chemotherapy, 2002
- Prevalence and Mechanisms of Macrolide Resistance in Invasive and Noninvasive Group B Streptococcus Isolates from Ontario, CanadaAntimicrobial Agents and Chemotherapy, 2001
- Molecular cloning and functional analysis of a novel macrolide‐resistance determinant, mefA, from Streptococcus pyogenesMolecular Microbiology, 1996
- In vitro susceptibility of recent North American Group A streptococcal isolates to eleven oral antibioticsThe Pediatric Infectious Disease Journal, 1994