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Faggion PI, Isoton G, Possa E, Tasso L. Is the penetration of clindamycin into the masseter muscle really enough to treat odontogenic infections? Clin Oral Investig 2020; 25:3257-3266. [PMID: 33128135 DOI: 10.1007/s00784-020-03656-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aims to determine the penetration of clindamycin into the masseter muscle of rats by microdialysis and correlate with the main microorganisms involved in odontogenic infections. MATERIALS AND METHODS Tissue concentrations of clindamycin in healthy muscle tissue were measured by microdialysis after administration of a single intravenous dose of 51 mg/kg and multiple doses of 17 mg/kg (8/8 h). It was quantified in plasma after a single administration of 51 mg/kg. Microdialysis samples were collected at 30-min intervals and clindamycin was assayed by LC-MS. Pharmacokinetic parameters and tissue penetration were determined. Pharmacokinetic/pharmacodynamic index (ƒ%T > minimum inhibitory concentration (MIC)) was considered to assess dosing regimens. RESULTS The pharmacokinetic parameters determined by non-compartmental plasma analysis for the dose of 51 mg/kg were similar to that determined by compartmental analysis. The maximum free interstitial concentration (Cmax) of clindamycin in muscle tissue was 14.20 (10.63-14.89) and 4.82 (3.35-6.66) mg/L for 51 mg/kg and 17 mg/kg 8/8 h, respectively. In addition, the area under the curve (AUC0-inf) for plasma and tissue of clindamycin were 44.78 (28.82-65.65) and 16.54 (13.83-18.35) h.mg/L for 51 mg/kg, respectively, and the tissue penetration factor determined was 1.10. Considering that the main bacteria that cause odontogenic infections generally present MIC ≤ 0.5 mg/L, the ƒ%T > MIC index is reached when the dose regimen of 17 mg/kg 8/8 h is employed. CONCLUSIONS This investigation showed that clindamycin excellently penetrates muscle tissue of rats. It provides effective antibacterial concentrations at the target site when 17 mg/kg 8/8 h is employed and can be applied to treat the main bacteria causing odontogenic infections. CLINICAL RELEVANCE It reinforces the use of clindamycin in odontogenic infections with significant tissue penetration.
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Affiliation(s)
- Paula I Faggion
- Laboratory of Pharmacokinetics, Health Sciences Postgraduate Program, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Gabriela Isoton
- College of Pharmacy, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Eduarda Possa
- College of Pharmacy, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Leandro Tasso
- Laboratory of Pharmacokinetics, Health Sciences Postgraduate Program, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.
- College of Pharmacy, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.
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Kim YH, Lee SY. Antibiotic Resistance of Viridans Group Streptococci Isolated from Dental Plaques. Biocontrol Sci 2020; 25:173-178. [PMID: 32938847 DOI: 10.4265/bio.25.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Viridans group streptococci (VGS) are a common cause of infective endocarditis, and dental plaque is the major source of these bacteria. The present study examined the antibiotic resistance of 635 VGS isolates obtained from dental plaques. Isolates from supragingival plaques were identified using the rapid ID 32 Strep and mini API reader (bioMérieux, France), and minimal inhibitory concentrations (MICs) were determined by a broth microdilution method. High rates of resistance to ampicillin and tetracycline were detected among the isolates. The most resistant species were Streptococcus sanguinis and Streptococcus salivarius. Among the 635 isolates, 9.1% were resistant to erythromycin, and 20.6% to tetracycline. All isolates were sensitive to vancomycin. Resistance to amoxicillin was observed in 0.2% of all isolates. In this study, we showed the incidence of antimicrobial resistance and the susceptibility patterns among 635 VGS isolates from dental plaque.
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Affiliation(s)
- Yeon-Hee Kim
- Department of Microbiology and Immunology, College of Dentistry, Research Institute of Oral Science, Gangneung-Wonju National University
| | - Si Young Lee
- Department of Microbiology and Immunology, College of Dentistry, Research Institute of Oral Science, Gangneung-Wonju National University
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González E, Zapata AC, Sánchez-Henao DF, Chávez-Vivas M. Resistencia a antibióticos β-lactámicos y eritromicina en bacterias de la cavidad oral. NOVA 2020. [DOI: 10.22490/24629448.3928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción. La microbiota humana como fuente de bacterias y genes de resistencia constituyen un problema de salud pública. En este estudio se investigó la prevalencia de bacilos entéricos Gram negativos resistentes a β-lactámicos y de los Streptococcus del grupo viridans (EGV) con resistencia a eritromicina en la cavidad oral. Métodos. Se realizó un estudio descriptivo de corte transversal con 193 aislamientos de la cavidad oral sana de 178 adultos que asistieron a una Clínica Odontológica de la ciudad de Cali durante el 2018. La evaluación de la sensibilidad antimicrobiana se realizó en 59 bacilos entéricos y 134 EGV y se identificó por PCR los genes que confieren resistencia a β-lactámicos y eritromicina. El análisis estadístico se realizó mediante el empleo del paquete SPSS vs 23. Resultados. El 84,7% de los bacilos entéricos fueron multirresistentes y presentaron genes bla, siendo blaTEM-1 (49,2%) y blaVIM-2 (30,5%,) los más prevalentes. Los EGV fueron resistentes a eritromicina (38,8%) y clindamicina (28,4%). El 18,7% presentaron el fenotipo cMLSβ, 4,5% el iMLSβ y el 14,9% fueron M. El gen ermB se detectó en los cMLSβ, (13,4%) y el gen mef en los M (9,7%). Conclusión. En este estudio se demostró la presencia de EGV y bacilos entéricos resistentes a los antibióticos y portadores de genes de resistencia a eritromicina y genes bla en la cavidad oral sana. La presencia de estas bacterias representa un riesgo para la salud de los individuos portadores y contribuyen a la creciente epidemia de resistencia bacteriana.
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Arredondo A, Blanc V, Mor C, Nart J, León R. Azithromycin and erythromycin susceptibility and macrolide resistance genes in Prevotella from patients with periodontal disease. Oral Dis 2019; 25:860-867. [PMID: 30667163 DOI: 10.1111/odi.13043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/01/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To study oral Prevotella spp. isolated from patients with chronic periodontitis, to determine their susceptibility to azithromycin and erythromycin and to screen the presence of macrolide resistance genes therein. MATERIAL AND METHODS Isolates with a Prevotella-like morphology were obtained from subgingival samples of 52 patients with chronic periodontitis. Each isolate was identified to the species level by sequencing of the 16S rRNA gene. In 100 Prevotella spp. isolates, azithromycin and erythromycin susceptibility was determined using the E test method, and the screening of erm(A), erm(B), erm(C), erm(F), erm(G), erm(Q) and mef(A) genes was done by PCR. RESULTS Prevotella intermedia and Prevotella nigrescens were the most identified species (33% each). Minimum inhibitory concentrations (MICs) ranges for both antibiotics were 0.016/0.032 to >256 μg/ml. MIC50 values for azithromycin and erythromycin were 1.5 and 1 μg/ml, respectively, and MIC90 values were >256 μg/ml for both antibiotics. Nineteen per cent of the isolates carried erm(B), and 51% carried erm(F). CONCLUSIONS The MIC values found were high compared to previous studies. erm(F) was greatly prevalent, and we describe for the first time the erm(B) gene in Prevotella spp. The presence of either of the genes seems to be associated with a higher degree of resistance to azithromycin and erythromycin.
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Affiliation(s)
- Alexandre Arredondo
- Department of Microbiology, Dentaid Research Center, Cerdanyola del Vallès, Spain.,Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Vanessa Blanc
- Department of Microbiology, Dentaid Research Center, Cerdanyola del Vallès, Spain
| | - Carolina Mor
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Rubén León
- Department of Microbiology, Dentaid Research Center, Cerdanyola del Vallès, Spain
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Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017; 50:1169-1184. [DOI: 10.1111/iej.12741] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J. J. Segura-Egea
- Department of Endodontics; School of Dentistry; University of Sevilla; Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences; DIBINEM; University of Bologna; Bologna Italy
| | - H. Sunay
- Department of Endodontology; Dental Faculty of Istanbul Kemerburgaz University; Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Research Unit of Oral Health Sciences; Medical Research Center Oulu (MRC Oulu); Oulu University Hospital and University of Oulu; Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical & Life Sciences; Cardiff University; Cardiff UK
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Mayers DL, Sobel JD, Ouellette M, Kaye KS, Marchaim D. Antibiotic Resistance of Non-pneumococcal Streptococci and Its Clinical Impact. ANTIMICROBIAL DRUG RESISTANCE 2017. [PMCID: PMC7123568 DOI: 10.1007/978-3-319-47266-9_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The taxonomy of streptococci has undergone major changes during the last two decades. The present classification is based on both phenotypic and genotypic data. Phylogenetic classification of streptococci is based on 16S rRNA sequences [1], and it forms the backbone of the overall classification system of streptococci. Phenotypic properties are also important, especially for clinical microbiologists. The type of hemolysis on blood agar, reaction with Lancefield grouping antisera, resistance to optochin, and bile solubility remain important for grouping of clinical Streptococcus isolates and therefore treatment options [2]. In the following chapter, two phenotypic classification groups, viridans group streptococci (VGS) and beta-hemolytic streptococci, will be discussed.
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Affiliation(s)
| | - Jack D. Sobel
- Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan USA
| | - Marc Ouellette
- Canada Research Chair in Antimicrobial Resistance, Centre de recherche en Infectiologie, University of Laval, Quebec City, Canada
| | - Keith S. Kaye
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan USA
| | - Dror Marchaim
- Infection Control and Prevention Unit of Infectious Diseases, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Mombelli A, Cionca N, Almaghlouth A, Cherkaoui A, Schrenzel J, Giannopoulou C. Effect of Periodontal Therapy With Amoxicillin–Metronidazole on Pharyngeal Carriage of Penicillin- and Erythromycin-Resistant Viridans Streptococci. J Periodontol 2016; 87:539-47. [DOI: 10.1902/jop.2015.150494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J 2014; 65:4-10. [PMID: 25510967 DOI: 10.1111/idj.12146] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.
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Affiliation(s)
- Sukhvinder S Oberoi
- Department of Public Health Dentistry, Sudha College of Dental Sciences and Research, Faridabad, India
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Roberts AP, Mullany P. Oral biofilms: a reservoir of transferable, bacterial, antimicrobial resistance. Expert Rev Anti Infect Ther 2014; 8:1441-50. [DOI: 10.1586/eri.10.106] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Brenciani A, Tiberi E, Tili E, Mingoia M, Palmieri C, Varaldo PE, Giovanetti E. Genetic determinants and elements associated with antibiotic resistance in viridans group streptococci. J Antimicrob Chemother 2013; 69:1197-204. [PMID: 24343896 DOI: 10.1093/jac/dkt495] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the distribution of erythromycin, tetracycline and chloramphenicol resistance mechanisms and determinants and the relevant genetic environments and elements in viridans group streptococci (VGS). METHODS A total of 263 VGS collected from routine throat swabs in 2010-12 and identified to the species level were studied. Antibiotic resistance determinants and the relevant genetic contexts and elements were determined using amplification and sequencing assays and restriction analysis. RESULTS The investigation provided original information on the distribution of resistance mechanisms, determinants and genetic elements in VGS. Erythromycin-resistant isolates totalled 148 (56.3%; 37 belonging to the cMLS phenotype and 111 belonging to the M phenotype); there were 72 (27.4%) and 7 (2.7%) tetracycline- and chloramphenicol-resistant isolates, respectively. A number of variants of known genetic contexts and elements carrying determinants of resistance to these antibiotics were detected, including the mega element, Φ10394.4, Tn2009, Tn2010, the IQ element, Tn917, Tn3872, Tn6002, Tn916, Tn5801, a tet(O) fragment from ICE2096-RD.2 and ICESp23FST81. CONCLUSIONS These findings shed new light on the distribution of antibiotic resistance mechanisms and determinants and their genetic environments in VGS, for which very few such data are currently available. The high frequency and broad variety of such elements supports the notion that VGS may be important reservoirs of resistance genes for the more pathogenic streptococci. The high rates of macrolide resistance confirm the persistence of a marked prevalence of resistant VGS in Europe, where macrolide resistance is, conversely, declining among the major streptococcal pathogens.
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Affiliation(s)
- Andrea Brenciani
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, 60126 Ancona, Italy
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Rotimi VO, Salako NO, Mokaddas E, Philip L, Rajan P. High Frequency of Isolation of Antibiotic-Resistant Oral Viridans Streptococci from Children in Kuwait. J Chemother 2013; 17:493-501. [PMID: 16323437 DOI: 10.1179/joc.2005.17.5.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antimicrobial resistance among the Viridans group of streptococci (VGS) has emerged as a hindrance to effective antibiotic therapy. Our objective was to evaluate the prevalence of antibiotic-resistant VGS in healthy children. Plaque samples were collected from tooth and tongue surfaces of 102 healthy subjects. Serially diluted samples were inoculated onto BHI agar plates and Mitis Salivarius Agar (MSA) plates and incubated as appropriate. Representative colonies were identified to species level by standard methods. Susceptibility of the VGS was performed by determining the minimum inhibitory concentrations (MICs) of 11 antibiotics using Etest. Of the 540 VGS isolates from both sites, 58% were from the tooth surfaces and 42% from the tongue. The most prevalent were S. salivarius (21.5%) and S. sanguis (16.3%). Imipenem and vancomycin had excellent activities. Resistance rates to trimethoprim, amoxicillin, piperacillin, erythromycin, cefuroxime and cephalothin, were 60.7, 40.8, 34.7, 32.6, 27.5 and 25.3%, respectively. Resistance rates to penicillin and clindamycin were 15.9% and 15.4%, respectively. The majority of the erythromycin-resistant isolates were from the tongue; 41% versus 29%. At the species level, 26% and 23% of S. salivarius and 23% and 14% of S. mutans from the tooth and tongue, respectively were resistant to penicillin. The data show species-related and site-related variations in the susceptibility pattern and an emerging high prevalence of antibiotic-resistant VGS. The difference in the susceptibilities between the species underscores the importance of accurate-identification and the need for surveillance of antimicrobial resistance among clinical isolates in our hospitals.
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Affiliation(s)
- V O Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat.
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12
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González-Martínez R, Cortell-Ballester I, Herráez-Vilas JM, Arnau-de Bolós JM, Gay-Escoda C. Antibiotic prescription in the treatment of odontogenic infection by health professionals: a factor to consensus. Med Oral Patol Oral Cir Bucal 2012; 17:e452-6. [PMID: 22143715 PMCID: PMC3476097 DOI: 10.4317/medoral.17504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/23/2011] [Indexed: 11/27/2022] Open
Abstract
Objective: To observe the attitude of dentists and family doctors in prescribing antibiotics for the treatment of dental infections.
Study Design: A poll was performed to determine the differences in the prescription of antibiotics for the treatment of odontogenic infection by dentists and family doctors of the primary care department of the Catalan Health Care Service.
Results: A hundred polls were distributed among family doctors, and another 100 ones among primary care dentists assigned to the Catalan Health Care Service of the Generalitat de Catalunya. Of the total of questionnaires distributed, 63 were retuned and answered from dentists and 71 from family doctors. Eighty-one percent of dentists included in the opinion poll considered amoxicillin as the first antibiotic choice for the treatment of odontogenic infections, while 73.2% of family doctors preferred the combination of amoxicillin and clavulanic acid. With regard to antibiotics of choice in patients allergic to penicillin, 67.7% of family doctors preferred macrolides (25.4% opted for clarithromycin, 25.4% for erythromycin and 16.9% for spiramycin). However, clindamycin was the antibiotic most frequently prescribed by dentists (66.7%), followed by erythromycin (28.6%).
Conclusions: The results of this study show a large discrepancy in the criteria for the treatment of odontogenic infections on the part of leading professionals involved in the management of this condition. Although the most common prescription involved beta-lactam antibiotics in both groups, several significant differences have been detected with regard to the second antibiotic choice.
Key words:Odontogenic infections, antibiotics, antimicrobials.
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Sibley CD, Grinwis ME, Rabin HR, Surette MG. Azithromycin paradox in the treatment of cystic fibrosis airway disease. Future Microbiol 2010; 5:1315-9. [DOI: 10.2217/fmb.10.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Evaluation of: Saiman L, Anstead M, Mayer-Hamblett N et al.: Effect of azithromycin on pulmonary function in patients with cystic fibrosis uninfected with Pseudomonas aeruginosa: a randomized controlled trial. JAMA 303(17), 1707–1715 (2010). Chronic airway infection and inflammation are hallmarks of cystic fibrosis (CF). Disease progression can be described as chronic inflammation punctuated by acute exacerbations with overt immunological responses. Macrolide antibiotics, which have both immunomodulatory and antibacterial activities, have been shown to be beneficial in the management of CF airway disease, although the mechanism of action is unknown. It is also unclear whether all patients, particularly those not colonized with Pseudomonas aeruginosa, benefit from this treatment. In this article, Saiman et al. examine the effects of azithromycin on lung function in pediatric and adolescent CF patients who are not colonized with P. aeruginosa. The data indicate beneficial effects of azithromycin treatment and suggest the mechanisms of action of azithromycin is at least partially independent of P. aeruginosa.
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Affiliation(s)
- Christopher D Sibley
- Department of Microbiology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Margot E Grinwis
- Department of Microbiology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Harvey R Rabin
- Department of Microbiology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
- Department of Medicine & Adult Cystic Fibrosis Clinic, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Michael G Surette
- Department of Biochemistry & Molecular Biology, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
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Bouchami O, Achour W, Ben Hassen A. Prevalence of resistance phenotypes and genotypes to macrolide, lincosamide and streptogramin antibiotics in Gram-positive cocci isolated in Tunisian Bone Marrow Transplant Center. ACTA ACUST UNITED AC 2009; 59:199-206. [PMID: 19481372 DOI: 10.1016/j.patbio.2009.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Accepted: 03/18/2009] [Indexed: 11/30/2022]
Abstract
To investigate the prevalence of resistance to macrolide, lincosamide and streptogramin (MLS) antibiotics in Gram-positive cocci isolated in a Bone Marrow Transplant Center of Tunisia, we tested the antibiotic susceptibility of 172 clinical isolates of Staphylococcus epidermidis, Streptococcus mitis and Enterococcus faecium to macrolide erythromycin and spiramycin, the lincosamide clindamycin and the streptogramin pristinamycin. These three groups of organisms were mostly resistant to macrolides and lincosamide, but were commonly susceptible to pristinamycin. The resistance phenotypes of erythromycin-resistant isolates were determined by the five-disc test with erythromycin, spiramycin, lincomycin, clindamycin and pristinamycin, which showed that most exhibited constitutive MLS resistance. In order to determine the prevalence of the resistance genotypes and the resistance mechanisms, the prevalence of the erythromycin resistance methylase (erm) (A), erm(B), erm(C), msr(A) and macrolide efflux (mef) (A) genes in the erythromycin-resistant isolates was identified by polymerase chain reaction (PCR) analysis. The resistance was due mainly to the presence of ermB in E. faecium (80%), ermC in S. epidermidis (53%) and mefA in S. mitis (65%).
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Affiliation(s)
- O Bouchami
- Laboratoire du Centre National de Greffe de Moelle Osseuse, 1006 Tunis, Tunisia.
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Antibiotic Resistance of Non-Pneumococcal Streptococci and Its Clinical Impact. ANTIMICROBIAL DRUG RESISTANCE 2009. [PMCID: PMC7122742 DOI: 10.1007/978-1-60327-595-8_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Viridans streptococci (VGS) form a phylogenetically heterogeneous group of species belonging to the genus Streptococcus (1). However, they have some common phenotypic properties. They are alfa- or non-haemolytic. They can be differentiated from S. pneumoniae by resistance to optochin and the lack of bile solubility (2). They can be differentiated from the Enterococcus species by their inability to grow in a medium containing 6.5% sodium chloride (2). Earlier, so-called nutritionally variant streptococci were included in the VGS but based on the molecular data they have now been removed to a new genus Abiotrophia (3) and are not included in the discussion below. VGS belong to the normal microbiota of the oral cavities and upper respiratory tracts of humans and animals. They can also be isolated from the female genital tract and all regions of the gastrointestinal tract (2, 3). Several species are included in VGS and are listed elsewhere (2, 3). Clinically the most important species belonging to the VGS are S. mitis, S. sanguis and S. oralis.
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Pigrau C, Almirante B, Rodriguez D, Larrosa N, Bescos S, Raspall G, Pahissa A. Osteomyelitis of the jaw: resistance to clindamycin in patients with prior antibiotics exposure. Eur J Clin Microbiol Infect Dis 2008; 28:317-23. [DOI: 10.1007/s10096-008-0626-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 08/26/2008] [Indexed: 11/28/2022]
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Influence of azithromycin and clarithromycin on macrolide susceptibility of viridans streptococci from the oral cavity of healthy volunteers. Eur J Clin Microbiol Infect Dis 2008; 27:1087-92. [DOI: 10.1007/s10096-008-0547-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 04/28/2008] [Indexed: 10/22/2022]
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Tomasi C, Koutouzis T, Wennström JL. Locally Delivered Doxycycline as an Adjunct to Mechanical Debridement at Retreatment of Periodontal Pockets. J Periodontol 2008; 79:431-9. [DOI: 10.1902/jop.2008.070383] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guay D. Update on clindamycin in the management of bacterial, fungal and protozoal infections. Expert Opin Pharmacother 2007; 8:2401-44. [PMID: 17927492 DOI: 10.1517/14656566.8.14.2401] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lincomycin and clindamycin are the only members of the relatively small lincosamide antimicrobial class marketed for use in humans. This paper only reviews data regarding clindamycin, with an emphasis on data published over the last decade. Clindamycin exhibits a broad spectrum of antimicrobial activity, including Gram-positive aerobes/anaerobes, Gram-negative anaerobes and select protozoa (Toxoplasma gondii, Plasmodium falciparum, Babesia spp.) and fungi (Pneumocystis jiroveci). It still enjoys use in the therapy and prophylaxis of a large number of bacterial, protozoal and fungal infections, despite > 40 years of clinical use. However, the spectre of resistance by an increasing number of microorganisms is beginning to cast a shadow over the future use of this valuable agent. With the emergence and spread of infections due to community-acquired methicillin-resistant Staphylococci (for which clindamycin is a first-line agent), it is hoped that the issues of resistance can be mitigated and the use of clindamycin extended for at least the foreseeable future.
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Affiliation(s)
- David Guay
- University of Minnesota, College of Pharmacy, Weaver-Densford Hall 7-148, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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Beres SB, Musser JM. Contribution of exogenous genetic elements to the group A Streptococcus metagenome. PLoS One 2007; 2:e800. [PMID: 17726530 PMCID: PMC1949102 DOI: 10.1371/journal.pone.0000800] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 07/31/2007] [Indexed: 11/29/2022] Open
Abstract
Variation in gene content among strains of a bacterial species contributes to biomedically relevant differences in phenotypes such as virulence and antimicrobial resistance. Group A Streptococcus (GAS) causes a diverse array of human infections and sequelae, and exhibits a complex pathogenic behavior. To enhance our understanding of genotype-phenotype relationships in this important pathogen, we determined the complete genome sequences of four GAS strains expressing M protein serotypes (M2, M4, and 2 M12) that commonly cause noninvasive and invasive infections. These sequences were compared with eight previously determined GAS genomes and regions of variably present gene content were assessed. Consistent with the previously determined genomes, each of the new genomes is ∼1.9 Mb in size, with ∼10% of the gene content of each encoded on variably present exogenous genetic elements. Like the other GAS genomes, these four genomes are polylysogenic and prophage encode the majority of the variably present gene content of each. In contrast to most of the previously determined genomes, multiple exogenous integrated conjugative elements (ICEs) with characteristics of conjugative transposons and plasmids are present in these new genomes. Cumulatively, 242 new GAS metagenome genes were identified that were not present in the previously sequenced genomes. Importantly, ICEs accounted for 41% of the new GAS metagenome gene content identified in these four genomes. Two large ICEs, designated 2096-RD.2 (63 kb) and 10750-RD.2 (49 kb), have multiple genes encoding resistance to antimicrobial agents, including tetracycline and erythromycin, respectively. Also resident on these ICEs are three genes encoding inferred extracellular proteins of unknown function, including a predicted cell surface protein that is only present in the genome of the serotype M12 strain cultured from a patient with acute poststreptococcal glomerulonephritis. The data provide new information about the GAS metagenome and will assist studies of pathogenesis, antimicrobial resistance, and population genomics.
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Affiliation(s)
- Stephen B. Beres
- Center for Molecular and Translational Human Infectious Diseases Research, The Methodist Hospital Research Institute, Houston, Texas, United States of America
| | - James M. Musser
- Center for Molecular and Translational Human Infectious Diseases Research, The Methodist Hospital Research Institute, Houston, Texas, United States of America
- * To whom correspondence should be addressed. E-mail:
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Hawkyard CV, Koerner RJ. The use of erythromycin as a gastrointestinal prokinetic agent in adult critical care: benefits versus risks. J Antimicrob Chemother 2007; 59:347-58. [PMID: 17289772 DOI: 10.1093/jac/dkl537] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Erythromycin A, the first macrolide, was introduced in the 1950s and after years of clinical experience it still remains a commonly relied upon antibiotic. In the past, pharmacodynamic characteristics of macrolides beyond antimicrobial action such as anti-inflammatory and immune-modulating properties have been of scientific and clinical interest. The function of erythromycin as a prokinetic agent has also been investigated for a range of gastrointestinal motility disorders and more recently within the context of critically ill patients. Prokinetic agents are drugs that increase contractile force and accelerate intraluminal transit. Whilst the anti-inflammatory action may be a desirable side effect to its antibiotic action, using erythromycin A merely for its prokinetic effect alone raises the concern about promoting emergence of macrolide resistance. The objectives of this review article are: (i) to briefly summarize the modes and epidemiology of macrolide resistance, particularly in respect to that found in the Streptococcus species (a potential reservoir for the dissemination of macrolide resistance on the critical care unit); (ii) to discuss in this context the evidence for conditions promoting bacterial resistance against macrolides; and (iii) to assess the potential clinical benefit of using erythromycin A as a prokinetic versus the risks of promoting emergence of macrolide resistance in the clinical setting. We conclude, that in view of the growing weight of evidence demonstrating the potential epidemiological impact of the increased use of macrolides upon the spread of resistance, versus a lack of sufficient and convincing evidence that erythromycin A is a superior prokinetic agent to potential alternatives in the critically ill patient population, at this stage we do not advocate the use of erythromycin A as a prokinetic agent in critically ill patients unless they have failed all other treatment for impaired gastrointestinal dysmotility and are intolerant of metoclopramide. Further large and methodologically robust studies are needed to ascertain the effectiveness of erythromycin A and other alternative agents in the critically ill.
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Affiliation(s)
- Catherine V Hawkyard
- Department of Medical Microbiology, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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22
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Westling K, Julander I, Ljungman P, Jalal S, Nord CE, Wretlind B. Viridans group streptococci in blood culture isolates in a Swedish university hospital: antibiotic susceptibility and identification of erythromycin resistance genes. Int J Antimicrob Agents 2006; 28:292-6. [PMID: 16938436 DOI: 10.1016/j.ijantimicag.2006.05.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 05/19/2006] [Accepted: 05/24/2006] [Indexed: 11/24/2022]
Abstract
One hundred and twenty-nine isolates of viridans group streptococci in blood cultures from patients with septicaemia or endocarditis isolated between 1998 and 2003 were tested for antibiotic susceptibility to penicillin, ciprofloxacin, clindamycin, dalbavancin, daptomycin, erythromycin, linezolid, tigecycline, trimethoprim/sulphamethoxazole and vancomycin. Reduced susceptibility to penicillin (minimum inhibitory concentration (MIC) > or =0.25 microg/mL) was found in 18% of the isolates, and 4% of the strains were resistant to penicillin (MIC> or =4.0 microg/mL). Nineteen percent of the isolates had reduced susceptibility to erythromycin (MIC> or =0.5 microg/mL), among which ermB and mefA were found in 40% and 80%, respectively. Strains sequenced as Streptococcus mitis by rnpB had a high degree of non-susceptibility to erythromycin (32%) and penicillin (21%). The level of penicillin resistance in this Swedish study was lower compared with studies from other countries where the antibiotic pressure might be higher than in Sweden. Susceptibility to newer antibiotics was high; all strains were susceptible to dalbavancin, daptomycin, linezolid and vancomycin.
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Affiliation(s)
- Katarina Westling
- Department of Medicine, Division of Infectious Diseases, Karolinska University Hospital/Huddinge, Karolinska Institutet, I 73, SE-141 86 Stockholm, Sweden.
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Update on the prevalence and spread of macrolide- and lincosamide-resistant staphylococcal and streptococcal species. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.revmedmi.0000174306.26027.e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Klaassen CHW, Mouton JW. Molecular detection of the macrolide efflux gene: to discriminate or not to discriminate between mef(A) and mef(E). Antimicrob Agents Chemother 2005; 49:1271-8. [PMID: 15793097 PMCID: PMC1068581 DOI: 10.1128/aac.49.4.1271-1278.2005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen 6532 SZ, The Netherlands.
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25
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Oteo J, Lázaro E, de Abajo FJ, Baquero F, Campos J. Antimicrobial-resistant invasive Escherichia coli, Spain. Emerg Infect Dis 2005; 11:546-53. [PMID: 15829192 PMCID: PMC3320321 DOI: 10.3201/eid1104.040699] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance System. A network of 32 Spanish hospitals, serving approximately 9.6 million persons, submitted antimicrobial-susceptibility data on 7,098 invasive Escherichia coli species (2001-2003). Resistance to ampicillin, cotrimoxazole, ciprofloxacin, gentamicin, and tobramycin was found at rates of 59.9%, 32.6%, 19.3%, 6.8%, and 5.3%, respectively. Resistance to multiple drugs increased from 13.8% in 2001 to 20.6% in 2003 (p <0.0001). Antimicrobial consumption data were obtained from the Spanish National Health System. In spite of decreased cephalosporin and beta-lactam use, overall extended-spectrum beta-lactamase production increased from 1.6% (2001) to 4.1% (2003) (p <0.0001), mainly due to the rising prevalence of cefotaximases. Resistance to ciprofloxacin significantly increased, mostly in community-onset infections, which coincided with a rise in community quinolone use. Cotrimoxazole resistance remained stable at approximately 30%, even though its use was dramatically reduced.
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Affiliation(s)
- Jesús Oteo
- Instituto de Salud Carlos III, Madrid, Spain
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26
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Rodríguez-Avial I, Rodríguez-Avial C, Culebras E, Picazo JJ. In vitro activity of telithromycin against viridans group streptococci and Streptococcus bovis isolated from blood: antimicrobial susceptibility patterns in different groups of species. Antimicrob Agents Chemother 2005; 49:820-3. [PMID: 15673778 PMCID: PMC547341 DOI: 10.1128/aac.49.2.820-823.2005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of penicillin, erythromycin, clindamycin, and telithromycin were determined against 155 viridans group streptococci (VGS) and 18 Streptococcus bovis blood isolates. Heterogeneity in the susceptibility patterns and macrolide resistance phenotypes and genotypes in the different groups of VGS was detected. We found seven telithromycin-resistant S. bovis isolates all harboring the erm(B) gene.
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Affiliation(s)
- Iciar Rodríguez-Avial
- Servicio de Microbiología Clínica, Hospital Clínico San Carlos, Plaza de Cristo Rey s/n, 28040 Madrid, Spain.
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27
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Cerdá Zolezzi P, Laplana LM, Calvo CR, Cepero PG, Erazo MC, Gómez-Lus R. Molecular basis of resistance to macrolides and other antibiotics in commensal viridans group streptococci and Gemella spp. and transfer of resistance genes to Streptococcus pneumoniae. Antimicrob Agents Chemother 2004; 48:3462-7. [PMID: 15328112 PMCID: PMC514728 DOI: 10.1128/aac.48.9.3462-3467.2004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We assessed the mechanisms of resistance to macrolide-lincosamide-streptogramin B (MLS(B)) antibiotics and related antibiotics in erythromycin-resistant viridans group streptococci (n = 164) and Gemella spp. (n = 28). The macrolide resistance phenotype was predominant (59.38%); all isolates with this phenotype carried the mef(A) or mef(E) gene, with mef(E) being predominant (95.36%). The erm(B) gene was always detected in strains with constitutive and inducible MLS(B) resistance and was combined with the mef(A/E) gene in 47.44% of isolates. None of the isolates carried the erm(A) subclass erm(TR), erm(A), or erm(C) genes. The mel gene was detected in all but four strains carrying the mef(A/E) gene. The tet(M) gene was found in 86.90% of tetracycline-resistant isolates and was strongly associated with the presence of the erm(B) gene. The cat(pC194) gene was detected in seven chloramphenicol-resistant Streptococcus mitis isolates, and the aph(3')-III gene was detected in four viridans group streptococcal isolates with high-level kanamycin resistance. The intTn gene was found in all isolates with the erm(B), tet(M), aph(3')-III, and cat(pC194) gene. The mef(E) and mel genes were successfully transferred from both groups of bacteria to Streptococcus pneumoniae R6 by transformation. Viridans group streptococci and Gemella spp. seem to be important reservoirs of resistance genes.
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Affiliation(s)
- Paula Cerdá Zolezzi
- Department of Microbiology, Zaragoza University School of Medicine, c/ Domingo Miral s/n, 50009 Zaragoza, Spain
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Tomás I, Alvarez M, Limeres J, Otero JL, Saavedra E, López-Meléndez C, Diz P. In vitro activity of moxifloxacin compared to other antimicrobials against streptococci isolated from iatrogenic oral bacteremia in Spain. ACTA ACUST UNITED AC 2004; 19:331-5. [PMID: 15327647 DOI: 10.1111/j.1399-302x.2004.00167.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Systemic dissemination of oral bacteria to distant body sites may be the cause of focal infections. The unsuitable use and overexposure to antimicrobial therapy in clinical dental practice may contribute to the worldwide problem of antimicrobial resistance. The aim of this study was to determine the susceptibilities of streptococci isolated from the bloodstream after dental extractions against penicillin, ampicillin, amoxicillin, erythromycin, clindamycin, and a new fluoroquinolone, moxifloxacin. PATIENTS AND METHODS Eighty-four patients who required dental extractions were studied. Venous blood samples were collected from each patient at baseline (before dental manipulation) and 30 s after dental extractions. The samples were processed in the Bactec 9240. The isolated bacteria were identified by conventional microbiological techniques. The antimicrobial susceptibility of 81 streptococci was determined by the E-test method. The NCCLS performance standards were followed. RESULTS 88.9-92.5% of the streptococci were sensitive to beta-lactam agents tested with a minimum inhibitory concentration (MIC)(90s) ranging from 0.094 to 0.19 mg/l. The resistance to erythromycin and clindamycin was 40.8% (MIC(90HR) = 256 mg/l) and 21% (MIC(90HR) = 256 mg/l), respectively. The MIC(90) to moxifloxacin was 0.125 mg/l. CONCLUSION Most of the streptococci isolated from the bloodstream after dental extractions were susceptible in vitro to penicillin, ampicillin, and amoxicillin. The high percentage of streptococci resistant to erythromycin and clindamycin could restrict their usefulness as prophylactic drugs. All the isolates showed a low MIC of moxifloxacin in vitro, making it a promising antimicrobial alternative for the prevention of streptococcal focal infections associated with certain dental manipulations, when the administration of beta-lactam agents is not indicated.
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Affiliation(s)
- I Tomás
- Department of Special Needs, School of Medicine and Dentistry, Santiago de Compostela University, Spain
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29
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Billal DS, Hotomi M, Yamauchi K, Fujihara K, Tamura S, Kuki K, Sugita R, Endou M, Mukaigawa J, Yamanaka N. Macrolide-resistant genes of Streptococcus pyogenes isolated from the upper respiratory tract by polymerase chain reaction. J Infect Chemother 2004; 10:115-20. [PMID: 15160306 DOI: 10.1007/s10156-004-0302-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 01/20/2004] [Indexed: 11/30/2022]
Abstract
The growing number of macrolide-resistant strains of Streptococcus pyogenes is an increasing problem worldwide. This study evaluated 300 clinical isolates obtained from the upper respiratory tract. Minimal inhibitory concentrations (MICs) of erythromycin (EM), azithromycin (AZM), and clindamycin (CLDM), serotypes, and macrolide resistance genes of mefA, ermB, and ermTR were determined. The genetic relationship of EM-resistant and susceptible strains were also analyzed by pulsed-field gel electrophoresis (PFGE). Twenty-nine (9.7%) EM-resistant S. pyogenes were identified. Of the 29 strains showing resistance to EM, 22 isolates (7.3%, MIC 3.13-12.5 microg/ml) expressed the mefA gene. The predominant serotypes among the mefA-positive isolates were T12, emm9 or T25, emm75-1. The two isolates (0.1%) that possessed the ermB gene were highly resistant to EM (MIC > 100 microg/ml). The remaining five strains (1.6%) possessed the ermTR gene (MIC 3.13-100 microg/ml). Restriction fragment polymorphism analyzed by pulsed-field gel electrophoresis (PFGE) by SmaI and ApaI digestions showed several clones among the mefA-positive S. pyogenes. Our findings suggest that the mefA gene is the predominant mechanism for macrolide resistance and that this gene is horizontally transmitted among M phenotype strains of S. pyogenes. Consequently, macrolides would not be the first drug of choice for treatment of tonsillitis and other S. pyogenes-related diseases. Physicians and researchers need to take into consideration the macrolide resistance of some strains of S. pyogenes.
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Affiliation(s)
- Dewan S Billal
- Department of Otolaryngology-Head and Neck Surgery, Japan
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Villedieu A, Diaz-Torres ML, Roberts AP, Hunt N, McNab R, Spratt DA, Wilson M, Mullany P. Genetic basis of erythromycin resistance in oral bacteria. Antimicrob Agents Chemother 2004; 48:2298-301. [PMID: 15155239 PMCID: PMC415603 DOI: 10.1128/aac.48.6.2298-2301.2004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We determined the prevalence of erythromycin-resistant bacteria in the oral cavity and identified mef and erm(B) as the most common resistance determinants. In addition, we demonstrate the genetic linkage, on various Tn1545-like conjugative transposons, between erythromycin and tetracycline resistance in a number of isolates.
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Affiliation(s)
- A Villedieu
- Division of Infection and Immunity, Eastman Dental Institute for Oral Health Care Sciences, University College London, 256 Gray's Inn Rd., London WC1X 8LD, United Kingdom
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Cerdá Zolezzi P, Rubio Calvo MC, Millán L, Goñi P, Canales M, Capilla S, Durán E, Gómez-Lus R. Macrolide resistance phenotypes of commensal viridans group streptococci and Gemella spp. and PCR detection of resistance genes. Int J Antimicrob Agents 2004; 23:582-9. [PMID: 15194129 DOI: 10.1016/j.ijantimicag.2003.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 10/29/2003] [Indexed: 11/23/2022]
Abstract
One hundred and sixty viridans group streptococci (VGS) and 26 Gemella spp. resistant to erythromycin were studied to detect macrolide lincosamide and streptogramin B (MLS(B)) phenotypes and to investigate resistance rates to other antibiotics. The M phenotype was most prevalent in both bacterial groups (59.6% in VGS, 69.2% in gemellae) and the iMLS(B) phenotype was found least often (9.3 and 13.9%, respectively). All isolates with M phenotype had the mef(A/E) gene, being prevalent the mef(E) subclass. cMLS(B) and iMLS(B) strains contained the erm(B) gene, alone or in combination with the mef(A/E) gene. Thirteen isolates were intermediately resistant to quinupristin/dalfopristin and 11 strains showed low susceptibility to telithromycin. Linezolid was active against all the isolates tested and tetracycline resistance was the major one in VGS (41.6%) and Gemella spp. (46.2%).
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Affiliation(s)
- P Cerdá Zolezzi
- Department of Microbiology, Faculty of Medicine, Clinical University Hospital "Lozano Blesa", University of Zaragoza, c/Domingo Miral s/n, 50009 Zaragoza, Spain
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Seppälä H, Al-Juhaish M, Järvinen H, Laitinen R, Huovinen P. Effect of prophylactic antibiotics on antimicrobial resistance of viridans streptococci in the normal flora of cataract surgery patients. J Cataract Refract Surg 2004; 30:307-15. [PMID: 15030817 DOI: 10.1016/s0886-3350(03)00617-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effect of prophylactic treatment including vancomycin in the irrigating solution and topical chloramphenicol on antimicrobial resistance in viridans-group streptococci in the normal flora of patients having cataract surgery. SETTING Department of Ophthalmology, Turku University Central Hospital and Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland. METHODS Minimal inhibitory concentrations (MICs) of 15 antimicrobials were determined for 529 viridans streptococci isolated from throat, nasopharyngeal, and conjunctival swabs of 23 patients on 4 sampling occasions: before cataract surgery and 1 day, 1 month, and 3 months after surgery. Resistance mechanisms of erythromycin-resistant isolates were studied by the double-disk test and polymerase chain reaction of resistance genes. RESULTS No statistically significant changes occurred in the proportions of isolates with elevated MICs between different sampling occasions. Resistance to vancomycin or chloramphenicol was not found. Resistance to tetracycline, erythromycin, penicillin, quinupristin-dalfopristin, clindamycin, levofloxacin, and moxifloxacin was found on different sampling occasions in 27.9% to 38.7%, 13.1% to 21.8%, 11.5% to 19.4%, 8.9% to 16.9%, 2.3% to 5.6%, 0% to 2.4%, and 0% to 2.2% of the isolates, respectively. Of the erythromycin-resistant isolates, 80.8% had the M phenotype and mefA gene and 19.2% has the macrolide-lincosamide-streptogramin B phenotype and ermB gene. CONCLUSIONS Development of resistance of viridans streptococci in the normal flora to vancomycin and chloramphenicol during prophylactic use with uneventful cataract surgery is unlikely; the effect on resistance patterns of other antimicrobials is minor. Routine use of prophylactic vancomycin is discouraged, however, because of the lack of scientific proof of its efficacy in preventing postoperative endophthalmitis.
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Affiliation(s)
- Helena Seppälä
- Department of Ophthalmology, Turku City Hospital, Turku, Finland.
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Campos J, Hernando M, Román F, Pérez-Vázquez M, Aracil B, Oteo J, Lázaro E, de Abajo F. Analysis of invasive Haemophilus influenzae infections after extensive vaccination against H. influenzae type b. J Clin Microbiol 2004; 42:524-9. [PMID: 14766811 PMCID: PMC344522 DOI: 10.1128/jcm.42.2.524-529.2004] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Little clinical and microbiological information is available about invasive Haemophilus influenzae infection after widespread vaccination against H. influenzae type b (Hib). We conducted an active community surveillance study on invasive H. influenzae during a 2-year period in a community of more than 5 million people after vaccination against Hib in children was introduced. The median incidence was 16.3 cases/100000 persons per year in children less than 1-year-old and 4.41 cases/100000 persons in children less than <5 years old. The highest incidence in adults was observed in patients greater than 70 years old. Clinical diagnoses included bacteremia, pneumonia, and meningitis. Of the H. influenzae-infected patients, 74.3% had underlying predisposing conditions, including impaired immunity and respiratory diseases. A total of 73.6% of the isolates were nontypeable and 16.5, 6.6, and 3.3% were types b, f, and e, respectively. Infections due to capsulated strains b, e, and f were evenly distributed between children and adults. Ampicillin and cotrimoxazole resistance occurred at frequencies of 24.2 and 48.4%, respectively. Antibiotic resistance was more prevalent in capsulated than in noncapsulated H. influenzae. Invasive isolates were highly resistant to antibiotics that were used infrequently in the community. Nontypeable H. influenzae were genetically much more heterogeneous than capsulated strains. Capsule-deficient mutants (b(-)) were not detected. Plasmid carriage was linked to antibiotic resistance and capsulated strains. Over the study period, the incidence of invasive H. influenzae infections, either encapsulated or not, did not increase. In the post-Hib vaccination era, most invasive infections were due to noncapsulated strains and occurred in the extreme ages of life in patients with predisposing conditions.
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Affiliation(s)
- José Campos
- Instituto de Salud Carlos III División de Fármaco-Vigilancia, Agencia Española del Medicamento, Ministry of Health, Majadahonda. Instituto de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain.
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Ioannidou S, Papaparaskevas J, Tassios PT, Foustoukou M, Legakis NJ, Vatopoulos AC. Prevalence and characterization of the mechanisms of macrolide, lincosamide and streptogramin resistance in viridans group streptococci. Int J Antimicrob Agents 2003; 22:626-9. [PMID: 14659663 DOI: 10.1016/j.ijantimicag.2003.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The presence of erm genes conferring constitutive and inducible resistance, as well as that of the mefA gene conferring only constitutive resistance, was investigated using PCR in 70 erythromycin resistant (MIC>or=1 mg/l) strains of viridans group streptococci (VGS) (18 Streptococcus mitis biotype 1, 16 S. mitis biotype 2, 15 S. oralis, 12 S. salivarius and nine S. sanguis) isolated from the oropharynx of healthy Greek children. All of the 56 isolates belonging to resistance phenotype M harbored the mefA gene. All of the 14 isolates constitutively resistant to macrolides and lincosamides (phenotype CR) harbored the ermB gene. Co-presence of both genes was not observed, whereas class A erm gene (previously known as ermTR) was not detected. Our results are consistent with a possible role of VGS as a reservoir of resistance genes now prevalent in pathogenic species of streptococci.
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Affiliation(s)
- Sofia Ioannidou
- Department of Clinical Microbiology, P. and A. Kyriakou Childrens' Hospital, Athens, Greece
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Norrby-Teglund A, Norrby SR, Low DE. The Treatment of Severe Group A Streptococcal Infections. Curr Infect Dis Rep 2003; 5:28-37. [PMID: 12525288 DOI: 10.1007/s11908-003-0062-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Group A streptococci can cause a variety of diseases ranging from uncomplicated superficial infections to severe systemic infections associated with high morbidity and mortality. Since the late 1980s a drastic resurgence of highly aggressive invasive streptococcal infections, including streptococcal toxic shock syndrome and necrotizing fasciitis, have been noted worldwide. This has prompted intense research in the field and important new information has been gained regarding the pathogenesis and treatment of life-threatening invasive group A streptococcal infections. Exotoxins with superantigenic activities have been identified as central mediators of the systemic effects seen in streptococcal toxic shock syndrome. Novel therapeutic strategies include agents that can inhibit these superantigens, and one promising candidate is intravenous polyspecific immunoglobulin that contains neutralizing antibodies against a wide spectrum of streptococcal superantigens. Intravenous immunoglobulin adjunctive therapy was shown in a case-control study to reduce mortality in patients with streptococcal toxic shock syndrome.
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Affiliation(s)
- Anna Norrby-Teglund
- *Center for Infectious Medicine, Karolinska Institutet, Department of Medicine-I63, Huddinge University Hospital, SE-141 86 Stockholm, Sweden.
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Bingen E, Leclercq R, Fitoussi F, Brahimi N, Malbruny B, Deforche D, Cohen R. Emergence of group A streptococcus strains with different mechanisms of macrolide resistance. Antimicrob Agents Chemother 2002; 46:1199-203. [PMID: 11959545 PMCID: PMC127159 DOI: 10.1128/aac.46.5.1199-1203.2002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mechanisms of resistance to macrolides in seven group A streptococcal (Streptococcus pyogenes) isolates that were the cause of pharyngitis in children who were unsuccessfully treated with azithromycin (10 mg/kg of body weight/day for 3 days) were evaluated. All posttreatment strains were found to be genetically related to the pretreatment isolates by random amplified polymorphism DNA analysis and pulsed-field gel electrophoresis. Two isolates had acquired either a mef(A) or an erm(B) gene, responsible for macrolide efflux and ribosomal modification, respectively. Three isolates displayed mutations in the gene encoding the L4 ribosomal protein that is part of the exit tunnel within the 50S subunit of the bacterial ribosome. In the two remaining posttreatment strains, the mechanisms of macrolide resistance could not be elucidated.
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Affiliation(s)
- Edouard Bingen
- Service de Microbiologie, Hôpital Robert Debré, Paris, France.
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Abstract
The worldwide spread of erythromycin A-resistant streptococci, including Streptococcus pneumoniae, is of concern. Many studies have demonstrated that the viridans group streptococci can be a reservoir of erythromycin A resistance. Within oral streptoccoci, an important difference in the susceptibility pattern has been noted. The purpose of this short editorial is to highlight the importance of this group of bacteria as a reservoir of resistance to erythromycin A and the possible transfer of resistance to S. pneumoniae and S. pyogenes.
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Affiliation(s)
- Jesús Oteo
- Servicio de Microbiología, Hospital de Móstoles, Móstoles, Madrid, Spain.
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