1
|
Rafei R, Al Iaali R, Osman M, Dabboussi F, Hamze M. A global snapshot on the prevalent macrolide-resistant emm types of Group A Streptococcus worldwide, their phenotypes and their resistance marker genotypes during the last two decades: A systematic review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 99:105258. [PMID: 35219865 DOI: 10.1016/j.meegid.2022.105258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 12/29/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Watchful epidemiological surveillance of macrolide-resistant Group A Streptococcus (MRGAS) clones is important owing to the evolutionary and epidemiological dynamic of GAS. Meanwhile, data on the global distribution of MRGAS emm types according to macrolide resistance phenotypes and genotypes are scant and need to be updated. For this, the present systematic review analyses a global set of extensively characterized MRGAS isolates from patients of diverse ages and clinical presentations over approximately two decades (2000 to 2020) and recaps the peculiar epidemiological features of the dominant MRGAS clones. Based on the inclusion and exclusion criteria, 53 articles (3593 macrolide-resistant and 15,951 susceptible isolates) distributed over 23 countries were dissected with a predominance of high-income countries over low-income ones. Although macrolide resistance in GAS is highly variable in different countries, its within-GAS distribution seems not to be random. emm pattern E, 13 major emm types (emm12, 4, 28, 77, 75, 11, 22, 92, 58, 60, 94, 63, 114) and 4 emm clusters (A-C4, E1, E6, and E2) were significantly associated with macrolide resistance. emm patterns A-C and D, 14 major emm types (emm89, 3, 6, 2, 44, 82, 87, 118, 5, 49, 81, 59, 227, 78) and 3 well-defined emm clusters (A-C5, E3, and D4) were significantly associated with macrolide susceptibility. Scrutinizing the tendency of each MRGAS emm type to be significantly associated with specific macrolide resistance phenotype or genotype, interesting vignettes are also unveiled. The 30-valent vaccine covers ~95% of MRGAS isolates. The presented data urge the importance of comprehensive nationwide sustained surveillance of MRGAS circulating clones particularly in Low and Middle income countries where sampling bias is high and GAS epidemiology is obfuscated and needs to be demystified.
Collapse
Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| | - Rayane Al Iaali
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| |
Collapse
|
2
|
Hifumi T, Fujishima S, Ubukata K, Hagiwara A, Abe T, Ogura H, Shiraishi A, Kushimoto S, Saitoh D, Mayumi T, Ikeda H, Ueyama M, Otomo Y, Okamoto K, Umemura Y, Kotani J, Sakamoto Y, Sasaki J, Shiino Y, Shiraishi SI, Takuma K, Tarui T, Tsuruta R, Nakada TA, Yamakawa K, Masuno T, Takeyama N, Yamashita N, Fujimi S, Gando S. Clinical characteristics of patients with severe sepsis and septic shock in relation to bacterial virulence of beta-hemolytic Streptococcus and Streptococcus pneumoniae. Acute Med Surg 2020; 7:e513. [PMID: 32489668 PMCID: PMC7262430 DOI: 10.1002/ams2.513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/16/2020] [Accepted: 04/12/2020] [Indexed: 12/29/2022] Open
Abstract
Aim Combined detailed analysis of patient characteristics and treatment as well as bacterial virulence factors, which all play a central role in the cause of infections leading to severe illness, has not been reported. We aimed to describe the patient characteristics (Charlson comorbidity index [CCI]), treatment (3‐h bundle), and outcomes in relation to bacterial virulence of Streptococcus pneumoniae and beta‐hemolytic Streptococcus (BHS). Methods This sepsis primary study is part of the larger Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study, a multicenter, prospective cohort study. We included patients diagnosed with S. pneumoniae and BHS sepsis and examined virulence, defining the high‐virulence factor as follows: S. pneumoniae serotype 3, 31, 11A, 35F, and 17F; Streptococcus pyogenes, emm 1; Streptococcus agalactiae, III; and Streptococcus dysgalactiae ssp. equisimilis, emm typing pattern stG 6792. Included patients were divided into high and normal categories based on the virulence factor. Results Of 1,184 sepsis patients enrolled in the Japanese Association for Acute Medicine’s FORECAST study, 62 were included in the current study (29 cases with S. pneumoniae sepsis and 33 with BHS). The CCI and completion of a 3‐h bundle did not differ between normal and high virulence groups. Risk of 28‐day mortality was significantly higher for high‐virulence compared to normal‐virulence when adjusted for CCI and completion of a 3‐h bundle (Cox proportional hazards regression analysis, hazard ratio 3.848; 95% confidence interval, 1.108–13.370; P = 0.034). Conclusion The risk of 28‐day mortality was significantly higher for patients with high‐virulence compared to normal‐virulence bacteria.
Collapse
Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine St. Luke's International Hospital Emergency Medical Center Tokyo Japan
| | - Seitaro Fujishima
- Center for General Medicine Education School of Medicine Keio University Tokyo Japan
| | - Kimiko Ubukata
- Center for General Medicine Education School of Medicine Keio University Tokyo Japan
| | - Akiyoshi Hagiwara
- Emergency Medicine Center Hospital of the National Center for Global Health and Medicine Tokyo Japan
| | - Toshikazu Abe
- Department of General Medicine Juntendo University Tokyo Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | | | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Daizoh Saitoh
- Division of Traumatology Research Institute National Defense Medical College Saitama Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine School of Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Masashi Ueyama
- Department of Trauma Critical Care Medicine, and Burn Center Japan Community Healthcare Organization, Chukyo Hospital Nagoya Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center Medical Hospital Tokyo Medical and Dental University Tokyo Japan
| | - Kohji Okamoto
- Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Kitakyushu Japan
| | - Yutaka Umemura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan
| | - Yuichiro Sakamoto
- Emergency and Critical Care Medicine Saga University Hospital Saga Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Yasukazu Shiino
- Department of Acute Medicine Kawasaki Medical School Kurashiki Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine Aizu Chuo Hospital Fukushima Japan
| | - Kiyotsugu Takuma
- Emergency and Critical Care Center Kawasaki Municipal Kawasaki Hospital Kawasaki Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Mitaka Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center Yamaguchi University Hospital Ube Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Tomohiko Masuno
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Naoshi Takeyama
- Advanced Critical Care Center Aichi Medical University Hospital Nagakute Japan
| | - Norio Yamashita
- Advanced Emergency Medical Service Center Kurume University Hospital Kurume Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Satoshi Gando
- Division of Acute and Critical Care Medicine Hokkaido University Graduate School of Medicine Sapporo Japan
| | | |
Collapse
|
3
|
Ubukata K, Wajima T, Morozumi M, Sakuma M, Tajima T, Matsubara K, Itahashi K, Iwata S. Changes in epidemiologic characteristics and antimicrobial resistance of Streptococcus pyogenes isolated over 10 years from Japanese children with pharyngotonsillitis. J Med Microbiol 2020; 69:443-450. [PMID: 32011228 DOI: 10.1099/jmm.0.001158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Pharyngotonsillitis caused by Streptococcus pyogenes (group A streptococci, or GAS) is among the most common infections treated with antibiotics in pediatric patients.Aim. This study aimed to analyse changes in molecular epidemiology and antibiotic susceptibility among GAS isolates in three study periods spanning 10 years.Methodology. GAS isolated from paediatric patients with pharyngotonsillitis during Period I (mid-2007 to 2008, n=235), Period II (2012, n=210), and Period III (2018, n=189) were analysed for emm type, multilocus sequence type (MLST), antibiotic susceptibility, and macrolide (ML)- and quinolone (QL)-resistance genes.Results. Over 20 % of isolates represented emm1 and emm12 types, remaining common in all three periods. Among other emm types, emm4 was common in Period I, emm28 and emm89 in Period II, and emm3 and emm89 in Period III. All isolates remained highly susceptible to penicillins and cephalosporins. Isolates possessing mefA, ermA, or ermB genes mediating ML resistance increased from 34.9 % in Period I to 60.9 % in Period II, but fell to 27.5 % in Period III. QL-resistant isolates with amino acid substitutions affecting ParC and/or GyrA gradually increased from 11.5 to 14.3 %. Specific sequence types identified by MLST and emm typing were associated closely with ML or QL resistance.Conclusion. Our findings indicate that even in ambulatory care, antibiotic choice for these infections should be based on rapid identification and characterization of causative pathogens.
Collapse
Affiliation(s)
- Kimiko Ubukata
- Department of Infectious Diseases, Keio University, School of Medicine, Tokyo, Japan
| | - Takeaki Wajima
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University, School of Medicine, Tokyo, Japan
| | - Megumi Sakuma
- Department of Infectious Diseases, Keio University, School of Medicine, Tokyo, Japan
| | - Takeshi Tajima
- Department of Pediatrics, Hakujikai Memorial Hospital, Tokyo, Japan
| | - Keita Matsubara
- Department of Pediatrics, Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan
| | - Koju Itahashi
- Pharmaceutical R&D Division, Meiji Seika Pharma, Tokyo, Japan
| | - Satoshi Iwata
- Departments of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan.,Department of Infectious Diseases, Keio University, School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Hua CZ, Yu H, Xu HM, Yang LH, Lin AW, Lyu Q, Lu HP, Xu ZW, Gao W, Chen XJ, Wang CQ, Jing CM. A multi-center clinical investigation on invasive Streptococcus pyogenes infection in China, 2010-2017. BMC Pediatr 2019; 19:181. [PMID: 31167650 PMCID: PMC6549372 DOI: 10.1186/s12887-019-1536-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children. Patients and methods A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010–2017. Results A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with β-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS. Conclusions Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.
Collapse
Affiliation(s)
- Chun-Zhen Hua
- Division of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
| | - Hui Yu
- Division of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Hong-Mei Xu
- Division of Infectious Diseases, Chongqing Medical University Affiliated Children's Hospital, Chongqing, 400014, People's Republic of China
| | - Lin-Hai Yang
- Department of Cardiology, Shanxi Children's Hospital, Taiyuan, 030013, People's Republic of China
| | - Ai-Wei Lin
- Division of Infectious Diseases, Qilu Children's Hospital of Shandong University, Jinan, 250022, People's Republic of China
| | - Qin Lyu
- The Intensive Care Unit, Ningbo Women and Children's Hospital, Ningbo, 315012, People's Republic of China
| | - Hong-Ping Lu
- The intensive Care Unit, Taizhou Hospital of Zhejiang Province, Linhai, 317000, People's Republic of China
| | - Zhi-Wei Xu
- Division of Infectious Diseases, The Second Affiliated Hospital &Yuying Children's Hospital of Wenzhou Medicial University, Wenzhou, 325027, People's Republic of China
| | - Wei Gao
- Division of Infectious Diseases, Kaifeng Children's Hospital, Kaifeng, 475000, People's Republic of China
| | - Xue-Jun Chen
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China
| | - Chuan-Qing Wang
- Department of Clinical Laboratory, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Chun-Mei Jing
- Department of Clinical Laboratory, Chongqing Medical University Affiliated Children's Hospital, Chongqing, 400014, People's Republic of China
| |
Collapse
|
5
|
Shen Y, Cai J, Davies MR, Zhang C, Gao K, Qiao D, Jiang H, Yao W, Li Y, Zeng M, Chen M. Identification and Characterization of Fluoroquinolone Non-susceptible Streptococcus pyogenes Clones Harboring Tetracycline and Macrolide Resistance in Shanghai, China. Front Microbiol 2018; 9:542. [PMID: 29628918 PMCID: PMC5876283 DOI: 10.3389/fmicb.2018.00542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/09/2018] [Indexed: 12/18/2022] Open
Abstract
Streptococcus pyogenes, also known as group A Streptococcus (GAS), is one of the top 10 infectious causes of death worldwide. Macrolide and tetracycline resistant GAS has emerged as a major health concern in China coinciding with an ongoing scarlet fever epidemic. Furthermore, increasing rates of fluoroquinolone (FQ) non-susceptibility within GAS from geographical regions outside of China has also been reported. Fluoroquinolones are the third most commonly prescribed antibiotic in China and is an therapeutic alternative for multi-drug resistant GAS. The purpose of this study was to investigate the epidemiological and molecular features of GAS fluoroquinolone (FQ) non-susceptibility in Shanghai, China. GAS (n = 2,258) recovered between 2011 and 2016 from children and adults were tested for FQ-non-susceptibility. Efflux phenotype and mutations in parC, parE, gyrA, and gyrB were investigated and genetic relationships were determined by emm typing, pulsed-field gel electrophoresis and phylogenetic analysis. The frequency of GAS FQ-non-susceptibility was 1.3% (30/2,258), with the phenotype more prevalent in GAS isolated from adults (14.3%) than from children (1.2%). Eighty percent (24/30) of FQ-non-susceptible isolates were also resistant to both macrolides (ermB) and tetracycline (tetM) including the GAS sequence types emm12, emm6, emm11, and emm1. Genomic fingerprinting analysis of the 30 isolates revealed that non-susceptibility may arise in various genetic backgrounds even within a single emm type. No efflux phenotype was observed in FQ non-susceptible isolates, and molecular analysis of the quinolone resistance-determining regions (QRDRs) identified several sequence polymorphisms in ParC and ParE, and none in GyrA and GyrB. Expansion of this analysis to 152 publically available GAS whole genome sequences from Hong Kong predicted 7.9% (12/152) of Hong Kong isolates harbored a S79F ParC mutation, of which 66.7% (8/12) were macrolide and tetracycline resistant. Phylogenetic analysis of the parC QRDR sequences suggested the possibility that FQ resistance may be acquired through inter-species lateral gene transfer. This study reports the emergence of macrolide, tetracycline, and fluoroquinolone multidrug-resistant clones across several GAS emm types including emm1 and emm12, warranting continual surveillance given the extensive use of fluoroquinolones in clinical use.
Collapse
Affiliation(s)
- Yinfang Shen
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.,Department of Pediatrics, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jiehao Cai
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Mark R Davies
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Chi Zhang
- Department of Microbiology, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Kun Gao
- Department of Clinical Laboratory, Xuhui Dahua Hospital, Shanghai, China
| | - Dan Qiao
- Department of Clinical Laboratory, Ruijin Hospital (North), Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haoqin Jiang
- Department of Laboratory Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Weilei Yao
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Yuefang Li
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Mingliang Chen
- Department of Microbiology, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.,Department of Microbiology, Shanghai Institutes of Preventive Medicine, Shanghai, China
| |
Collapse
|
6
|
Lu B, Fang Y, Fan Y, Chen X, Wang J, Zeng J, Li Y, Zhang Z, Huang L, Li H, Li D, Zhu F, Cui Y, Wang D. High Prevalence of Macrolide-resistance and Molecular Characterization of Streptococcus pyogenes Isolates Circulating in China from 2009 to 2016. Front Microbiol 2017. [PMID: 28642756 PMCID: PMC5463034 DOI: 10.3389/fmicb.2017.01052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Streptococcus pyogenes, or group A Streptococcus, is a pathogen responsible for a wide range of clinical manifestations, from mild skin and soft tissue infections and pharyngitis to severe diseases. Its epidemiological characteristics should be comprehensively under surveillance for regulating the national prevention and treatment practice. Herein, a total of 140 S. pyogenes, including 38 invasive and 102 noninvasive isolates, were collected from infected patients in 10 tertiary general hospitals from 7 cities/provinces in China during the years 2009–2016. All strains were characterized by classical and molecular techniques for its emm types/subtypes, virulent factors and antibiotic resistance profiling. Of 140 isolates, 15 distinct emm types and 31 subtypes were detected, dominated by emm12 (60 isolates, 42.9%), emm1(43, 30.7%), and emm89 (10, 7.1%), and 8 new emm variant subtypes were identified. All strains, invasive or not, harbored the superantigenic genes, speB and slo. The other virulence genes, smeZ, speF, and speC accounted for 96.4, 91.4, and 87.1% of collected isolates, respectively. Further multilocus sequence typing (MLST) placed all strains into 22 individual sequence types (STs), including 4 newly-identified STs (11, 7.9%). All isolates were phenotypically susceptible to penicillin, ampicillin, cefotaxime, and vancomycin, whereas 131(93.5%), 132(94.2%), and 121(86.4%) were resistant to erythromycin, clindamycin, and tetracycline, respectively. Our study highlights high genotypic diversity and high prevalence of macrolide resistance of S. pyogenes among clinical isolates circulating in China.
Collapse
Affiliation(s)
- Binghuai Lu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Yujie Fang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and PreventionBeijing, China.,Collaborative Innovation Centre for Diagnosis and Treatment of Infectious DiseasesHangzhou, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship HospitalBeijing, China
| | - Xingchun Chen
- Department of Laboratory Medicine, People's Hospital of Guangxi Zhuang Autonomous RegionNanning, China
| | - Junrui Wang
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical UniversityHohhot, China
| | - Ji Zeng
- Department of Laboratory Medicine, Wuhan Pu Ai Hospital of Huazhong, University of Science and TechnologyWuhan, China
| | - Yi Li
- Department of Laboratory Medicine, Henan Provincial People's HospitalZhengzhou, China
| | - Zhijun Zhang
- Department of Laboratory Medicine, Tai'an City Central Hospital (Tai'an)Shandong, China
| | - Lei Huang
- Department of Laboratory Medicine, First Hospital, Peking UniversityBeijing, China
| | - Hongxia Li
- Department of Laboratory Medicine, Chengdu First People's Hospital (Chengdu)Sichuan, China
| | - Dong Li
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Fengxia Zhu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Yanchao Cui
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Duochun Wang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and PreventionBeijing, China.,Collaborative Innovation Centre for Diagnosis and Treatment of Infectious DiseasesHangzhou, China
| |
Collapse
|
7
|
Takahashi T, Arai K, Lee DH, Koh EH, Yoshida H, Yano H, Kaku M, Kim S. Epidemiological study of erythromycin-resistant Streptococcus pyogenes from Korea and Japan by emm genotyping and multilocus sequence typing. Ann Lab Med 2017; 36:9-14. [PMID: 26522753 PMCID: PMC4697353 DOI: 10.3343/alm.2016.36.1.9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/12/2015] [Accepted: 10/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background We determined the epidemiological characteristics of erythromycin (EM)-resistant Streptococcus pyogenes (group A streptococci, GAS) strains isolated from Korea and Japan, using emm genotyping and multilocus sequence typing (MLST). Methods Clinical isolates of GAS had been collected from 1992 to 2012 in Korea and from 2004 to 2009 in Japan. EM resistance was determined by the microdilution method, and resistance genotypes were assessed by PCR. The emm genotyping and MLST were performed by DNA sequencing. Results The emm genotypes and sequence types (STs) were concordant in 143 (85.1%) of 168 EM-resistant GAS strains from Korea. ST36/emm12 (35.1%), ST52/emm28 (22.6%), and ST49/emm75 (16.1%) were the most common types. Most of the ST36 (93.9%) and ST52 (95.8%) strains harbored erm(B), whereas strains ST49, ST42, and ST15 contained mef(A). The concordance between emm genotypes and STs was 41 (93.2%) among 44 EM-resistant GAS strains from Japan. ST36/emm12 (34.1%), ST49/emm75 (18.2%), and ST28/emm1 (15.9%) were the major types. ST36 isolates harbored either erm(B) (56.3%) or mef(A) (37.5%), whereas isolates ST28, ST49, and ST38 carried only mef(A). The proportion of erm(B) and mef(A) was 66.1% and 33.3% in Korea and 22.7% and 68.2% in Japan, respectively. Conclusions The common STs in Korea and Japan were ST36 and ST49, whereas ST52 was present only in Korea and ST28 only in Japan. Genotype erm(B) was predominant in Korea, whereas mef(A) was frequent in Japan. There were differences between Korea and Japan regarding the frequencies of emm genotypes, STs, and EM resistance genes among the EM-resistant GAS.
Collapse
Affiliation(s)
- Takashi Takahashi
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan
| | - Kazuaki Arai
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan
| | - Dong Hyun Lee
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun Ha Koh
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Haruno Yoshida
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Nara, Japan
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
| |
Collapse
|
8
|
Tagini F, Aubert B, Troillet N, Pillonel T, Praz G, Crisinel PA, Prod'hom G, Asner S, Greub G. Importance of whole genome sequencing for the assessment of outbreaks in diagnostic laboratories: analysis of a case series of invasive Streptococcus pyogenes infections. Eur J Clin Microbiol Infect Dis 2017; 36:1173-1180. [PMID: 28124734 PMCID: PMC5495845 DOI: 10.1007/s10096-017-2905-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022]
Abstract
Outbreaks of Streptococcus pyogenes hypervirulent clones are constant public health threats. In western Switzerland, an increase of severe cases of S. pyogenes invasive infections was observed between December 2015 and March 2016. Our aim was (i) to investigate these cases by the use of Whole Genome Sequencing (WGS) and (ii) to determine the specific virulome and resistome of each isolate in order to undertake adequate public health measures. Eleven Streptococcus pyogenes strains isolated from 11 patients with severe invasive infections between December 13, 2015 and March 12, 2016 were included in our study. Practically, emm-typing, MLST and WGS were used to investigate the relatedness between the isolates. The presence of virulence and antibiotic resistance genes as well as mutations in transcriptional regulators of virulence and in genes encoding for antibiotic targets were assessed. Three and two groups of isolates shared the same emm-type and ST type, respectively. Single Nucleotide Polymorphism (SNP) analysis revealed 14 to 32 SNPs between the strains of the same emm-type group, ruling out the possibility of a clonal outbreak. Mutations found in covS and rocA could partially explain an increased virulence. As these reassuring results were obtained in less than 10 days, no specific hospital hygiene and no dedicated public health measures had to be undertaken. WGS is a powerful technique to discriminate between closely related strains, excluding an outbreak in less than 10 days. Moreover, WGS provided extensive data on the virulome and resistome of all these strains.
Collapse
Affiliation(s)
- F Tagini
- Institute of Microbiology, Department of Laboratory, University of Lausanne & Lausanne University Hospital, Lausanne, Switzerland
| | - B Aubert
- Unit of Pediatric Infectious Diseases and Vaccinology, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - N Troillet
- Service of Infectious Diseases, Central Institute of the Valais Hospitals, Sion, Switzerland
| | - T Pillonel
- Institute of Microbiology, Department of Laboratory, University of Lausanne & Lausanne University Hospital, Lausanne, Switzerland
| | - G Praz
- Service of Infectious Diseases, Central Institute of the Valais Hospitals, Sion, Switzerland
| | - P A Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - G Prod'hom
- Institute of Microbiology, Department of Laboratory, University of Lausanne & Lausanne University Hospital, Lausanne, Switzerland
| | - S Asner
- Unit of Pediatric Infectious Diseases and Vaccinology, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland.,Service of Infectious Diseases, Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, Department of Laboratory, University of Lausanne & Lausanne University Hospital, Lausanne, Switzerland. .,Service of Infectious Diseases, Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
9
|
Wajima T, Morozumi M, Hanada S, Sunaoshi K, Chiba N, Iwata S, Ubukata K. Molecular Characterization of Invasive Streptococcus dysgalactiae subsp. equisimilis, Japan. Emerg Infect Dis 2016; 22:247-54. [PMID: 26760778 PMCID: PMC4734521 DOI: 10.3201/eid2202.141732] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We collected β-hemolytic streptococci (1,611 isolates) from patients with invasive streptococcal infections in Japan during April 2010-March 2013. Streptococcus dysgalactiae subsp. equisimilis (SDSE) was most common (n = 693); 99% of patients with SDSE infections were elderly (mean age 75 years, SD ±15 years). We aimed to clarify molecular and epidemiologic characteristics of SDSE isolates and features of patient infections. Bacteremia with no identified focus of origin and cellulitis were the most prevalent manifestations; otherwise, clinical manifestations resembled those of S. pyogenes infections. Clinical manifestations also differed by patient's age. SDSE isolates were classified into 34 emm types; stG6792 was most prevalent (27.1%), followed by stG485 and stG245. Mortality rates did not differ according to emm types. Multilocus sequence typing identified 46 sequence types and 12 novel types. Types possessing macrolide- and quinolone-resistance genes were 18.4% and 2.6%, respectively; none showed β-lactam resistance. Among aging populations, invasive SDSE infections are an increasing risk.
Collapse
|
10
|
Macrolones Are a Novel Class of Macrolide Antibiotics Active against Key Resistant Respiratory Pathogens In Vitro and In Vivo. Antimicrob Agents Chemother 2016; 60:5337-48. [PMID: 27353268 DOI: 10.1128/aac.00524-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/14/2016] [Indexed: 11/20/2022] Open
Abstract
As we face an alarming increase in bacterial resistance to current antibacterial chemotherapeutics, expanding the available therapeutic arsenal in the fight against resistant bacterial pathogens causing respiratory tract infections is of high importance. The antibacterial potency of macrolones, a novel class of macrolide antibiotics, against key respiratory pathogens was evaluated in vitro and in vivo MIC values against Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Haemophilus influenzae strains sensitive to macrolide antibiotics and with defined macrolide resistance mechanisms were determined. The propensity of macrolones to induce the expression of inducible erm genes was tested by the triple-disk method and incubation in the presence of subinhibitory concentrations of compounds. In vivo efficacy was assessed in a murine model of S. pneumoniae-induced pneumonia, and pharmacokinetic (PK) profiles in mice were determined. The in vitro antibacterial profiles of macrolones were superior to those of marketed macrolide antibiotics, including the ketolide telithromycin, and the compounds did not induce the expression of inducible erm genes. They acted as typical protein synthesis inhibitors in an Escherichia coli transcription/translation assay. Macrolones were characterized by low to moderate systemic clearance, a large volume of distribution, a long half-life, and low oral bioavailability. They were highly efficacious in a murine model of pneumonia after intraperitoneal application even against an S. pneumoniae strain with constitutive resistance to macrolide-lincosamide-streptogramin B antibiotics. Macrolones are the class of macrolide antibiotics with an outstanding antibacterial profile and reasonable PK parameters resulting in good in vivo efficacy.
Collapse
|
11
|
Sakata H. The change of macrolide resistance rates in group A Streptococcus isolates from children between 2002 and 2013 in Asahikawa city. J Infect Chemother 2015; 21:398-401. [DOI: 10.1016/j.jiac.2014.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/15/2014] [Accepted: 12/30/2014] [Indexed: 11/24/2022]
|
12
|
Chiba N, Morozumi M, Shouji M, Wajima T, Iwata S, Ubukata K. Changes in capsule and drug resistance of Pneumococci after introduction of PCV7, Japan, 2010-2013. Emerg Infect Dis 2015; 20:1132-9. [PMID: 24960150 PMCID: PMC4073837 DOI: 10.3201/eid2007.131485] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We aimed to clarify changes in serotypes and genotypes mediating β-lactam and macrolide resistance in Streptococcus pneumoniae isolates from Japanese children who had invasive pneumococcal disease (IPD) after the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into Japan; 341 participating general hospitals conducted IPD surveillance during April 2010-March 2013. A total of 300 pneumococcal isolates were collected in 2010, 146 in 2011, and 156 in 2012. The proportion of vaccine serotypes in infectious isolates decreased from 73.3% to 54.8% to 14.7% during the 3 years. Among vaccine serotype strains, genotypic penicillin-resistant S. pneumoniae strains also declined each year. Among nonvaccine serotype strains, 19A, 15A, 15B, 15C, and 24 increased in 2012. Increases were noted especially in genotypic penicillin-resistant S. pneumoniae isolates of serotypes 15A and 35B, as well as macrolide resistance mediated by the erm(B) gene in 15A, 15B, 15C, and 24.
Collapse
|
13
|
Silva-Costa C, Friães A, Ramirez M, Melo-Cristino J. Macrolide-resistant Streptococcus pyogenes: prevalence and treatment strategies. Expert Rev Anti Infect Ther 2015; 13:615-28. [PMID: 25746210 DOI: 10.1586/14787210.2015.1023292] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although penicillin remains the first-choice treatment for Streptococcus pyogenes infection, macrolides are important alternatives for allergic patients and lincosamides are recommended together with β-lactams in invasive infections. S. pyogenes may exhibit macrolide resistance because of active efflux (mef genes) or target modification (erm genes), the latter conferring cross resistance to lincosamides and streptogramin B. Worldwide, resistance is restricted to a limited number of genetic lineages, despite resistance genes being encoded on mobile genetic elements. For reasons that are not completely clear, resistance and the associated phenotypes are highly variable across countries. Although resistance remains high in several countries, particularly in Asia, an overall decreasing trend of resistance has been noted in recent years, mostly in Europe. This decrease is not always accompanied by declines in macrolide consumption, suggesting significant roles of other factors in determining the dynamics of macrolide-resistant clones. Continued surveillance is needed to obtain further insights into the forces governing macrolide resistance in S. pyogenes.
Collapse
Affiliation(s)
- Catarina Silva-Costa
- Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, PT 1649-028 Lisboa, Portugal
| | | | | | | |
Collapse
|
14
|
Wajima T, Chiba N, Morozumi M, Shouji M, Sunaoshi K, Sugita K, Tajima T, Ubukata K. Prevalence of Macrolide Resistance Among Group A Streptococci Isolated from Pharyngotonsillitis. Microb Drug Resist 2014; 20:431-5. [DOI: 10.1089/mdr.2013.0213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takeaki Wajima
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Naoko Chiba
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Michi Shouji
- Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kayoko Sugita
- Department of Clinical Laboratories, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Tajima
- Department of Pediatrics, Hakujikai Memorial Hospital, Tokyo, Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
15
|
Hadjirin NF, Harrison EM, Holmes MA, Paterson GK. Conjugative transfer frequencies of mef(A)-containing Tn1207.3 to macrolide-susceptible Streptococcus pyogenes belonging to different emm types. Lett Appl Microbiol 2014; 58:299-302. [PMID: 24383794 PMCID: PMC4238819 DOI: 10.1111/lam.12213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/09/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Abstract
Abstract Significance and Impact of the Study: The spread of antimicrobial resistance among pathogenic bacteria is an important problem, but the mechanisms of horizontal transfer between strains and species are often poorly understood. For instance, little is known on how macrolide resistance spreads between strains of the human pathogen Strep. pyogenes and why certain strains more commonly display resistance than others. Here, we show that Strep. pyogenes strains vary greatly in their ability to acquire a transposon encoding macrolide resistance by horizontal gene transfer in vitro. These data provide a novel insight into the transfer of antibiotic resistance between bacterial strains and offer an explanation for the differences in the frequency of resistance determinates and resistance seen among clinical isolates.
Collapse
|