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Olsen RJ, Zhu L, Mangham RE, Faili A, Kayal S, Beres SB, Musser JM. A Chimeric Penicillin Binding Protein 2X Significantly Decreases in Vitro Beta-Lactam Susceptibility and Increases in Vivo Fitness of Streptococcus pyogenes. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:1397-1406. [PMID: 35843262 PMCID: PMC9552024 DOI: 10.1016/j.ajpath.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
All tested strains of Streptococcus pyogenes (group A streptococcus, GAS) remain susceptible to penicillin. However, GAS strains with amino acid substitutions in penicillin-binding proteins that confer decreased susceptibility to beta-lactam antibiotics have been identified recently. This discovery raises concerns about emergence of beta-lactam antibiotic resistance in GAS. Whole genome sequencing recently identified GAS strains with a chimeric penicillin-binding protein 2X (PBP2X) containing a recombinant segment from Streptococcus dysgalactiae subspecies equisimilis (SDSE). To directly test the hypothesis that the chimeric SDSE-like PBP2X alters beta-lactam susceptibility in vitro and fitness in vivo, an isogenic mutant strain was generated and virulence assessed in a mouse model of necrotizing myositis. Compared with naturally occurring and isogenic strains with a wild-type GAS-like PBP2X, strains with the chimeric SDSE-like PBP2X had reduced susceptibility in vitro to nine beta-lactam antibiotics. In a mouse model of necrotizing myositis, the strains had identical fitness in the absence of benzylpenicillin treatment. However, mice treated intermittently with a subtherapeutic dose of benzylpenicillin had significantly more colony-forming units recovered from limbs infected with strains with the chimeric SDSE-like PBP2X. These results show that mutations such as the PBP2X chimera may result in significantly decreased beta-lactam susceptibility and increased fitness and virulence. Expanded diagnostic laboratory surveillance, genome sequencing, and molecular pathogenesis study of potentially emergent beta-lactam antibiotic resistance among GAS are needed.
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Affiliation(s)
- Randall J Olsen
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York.
| | - Luchang Zhu
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York
| | - Regan E Mangham
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
| | - Ahmad Faili
- Inserm, CIC 1414, Rennes, France; Faculty of Pharmacy, Université Rennes 1, Rennes, France; CHU de Rennes, Rennes, France
| | - Samer Kayal
- Inserm, CIC 1414, Rennes, France; CHU de Rennes, Rennes, France; Faculty of Medicine, Université Rennes 1, Rennes, France
| | - Stephen B Beres
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
| | - James M Musser
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas; Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York
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Davies HD, Jackson MA, Rice SG, Byington CL, Maldonado YA, Barnett ED, Campbell JD, Lynfield R, Munoz FM, Nolt D, Nyquist AC, O’Leary S, Rathore MH, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE, LaBella CR, Brooks MA, Canty GS, Diamond A, Hennrikus W, Logan K, Moffatt KA, Nemeth B, Pengel B, Peterson A, Stricker P. Infectious Diseases Associated With Organized Sports and Outbreak Control. Pediatrics 2017; 140:peds.2017-2477. [PMID: 28947608 DOI: 10.1542/peds.2017-2477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete's primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions.
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Affiliation(s)
- H. Dele Davies
- Pediatric Infectious Diseases and Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mary Anne Jackson
- Infectious Diseases, Children’s Mercy Kansas City and Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Stephen G. Rice
- Sports Medicine, Jersey Shore University Medical Center and Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, Neptune, New Jersey
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4
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Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, Park DY, Kim HJ, Kim DY, Lee HJ, Shin HY, You YK, Park DA, Kim SW. Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections. Infect Chemother 2017; 49:326-352. [PMID: 29299900 PMCID: PMC5754344 DOI: 10.3947/ic.2017.49.4.326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 12/20/2022] Open
Abstract
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
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Affiliation(s)
- Young Kyung Yoon
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chan Soon Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Wook Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Kyurin Hwang
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University hospital Seoul, Seoul, Korea
| | - Sei Young Lee
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Do Yang Park
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Hyun Jun Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology, Ajou University, School of Medicine, Suwon, Korea
| | - Dong Young Kim
- Korean Society of Otorhinolaryngology-Head and Neck Surgery, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Hyun Jong Lee
- Korean Association of Otorhinolaryngologists, Seoul, Korea
| | - Hyun Young Shin
- Korean Association of Family Medicine, Seoul, Korea.,Department of Family Medicine, Myongji Hospital, Seonam University, College of Medicine, Goyang, Korea
| | - Yong Kyu You
- Korean Medical Practitioners Association, Seoul, Korea.,Department of Internal Medicine, Nammoon Medical Clinic, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Shin Woo Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Korean Society for Chemotherapy, Seoul, Korea.,Department of Internal Medicine, Kungpook National University, School of Medicine, Daegu, Korea.
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5
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Zhao X, Chen Z, Gu G, Guo Z. Recent advances in the research of bacterial glucuronosyltransferases. J Carbohydr Chem 2016. [DOI: 10.1080/07328303.2016.1205597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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6
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Talan DA, Lovecchio F, Abrahamian FM, Karras DJ, Steele MT, Rothman RE, Krishnadasan A, Mower WR, Hoagland R, Moran GJ. A Randomized Trial of Clindamycin Versus Trimethoprim-sulfamethoxazole for Uncomplicated Wound Infection. Clin Infect Dis 2016; 62:1505-1513. [PMID: 27025829 PMCID: PMC4885652 DOI: 10.1093/cid/ciw177] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the United States, visits for skin infections greatly increased. Staphylococci and streptococci are considered predominant causes of wound infections. Clindamycin and trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed, but the efficacy of TMP-SMX has been questioned. METHODS We conducted a randomized, double-blind, superiority trial at 5 US emergency departments. Patients >12 years of age with an uncomplicated wound infection received oral clindamycin 300 mg 4 times daily or TMP-SMX 320 mg/1600 mg twice daily, each for 7 days. We compared the primary outcome, wound infection cure at 7-14 days, and secondary outcomes through 6-8 weeks after treatment, in the per-protocol population. RESULTS Subjects had a median age of 40 years (range, 14-76 years); 40.1% of wound specimens grew MRSA, 25.7% methicillin-susceptible S. aureus, and 5.0% streptococci. The wound infection was cured at 7-14 days in 187 of 203 (92.1%) clindamycin-treated and 182 of 198 (91.9%) TMP-SMX-treated subjects (difference, 0.2%; 95% confidence interval [CI], -5.8% to 6.2%; P = not significant). The clindamycin group had a significantly lower rate of recurrence at 7-14 days (1.5% vs 6.6%; difference, -5.1%; 95% CI, -9.4% to -.8%) and through 6-8 weeks following treatment (2.0% vs 7.1%; difference, -5.1%; 95% CI, -9.7% to -.6%). Other secondary outcomes were statistically similar between groups but tended to favor clindamycin. Adverse event rates were similar. CONCLUSIONS In settings where MRSA is prevalent, clindamycin and TMP-SMX produce similar cure and adverse event rates among patients with an uncomplicated wound infection. Further study evaluating differential effects of antibiotics on recurrent infection may be warranted. CLINICAL TRIALS REGISTRATION NCT00729937.
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Affiliation(s)
- David A Talan
- Department of Emergency Medicine
- Division of Infectious Diseases, Department of Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA
| | - Frank Lovecchio
- Department of Emergency Medicine, Maricopa Medical Center, University of Arizona and Mayo Graduate School of Medicine, Phoenix
| | | | - David J Karras
- Department of Emergency Medicine, Temple University Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Mark T Steele
- Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City School of Medicine
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - William R Mower
- Department of Emergency Medicine, Ronald Reagan Medical Center, David Geffen School of Medicine at UCLA
| | | | - Gregory J Moran
- Department of Emergency Medicine
- Division of Infectious Diseases, Department of Medicine, Olive View-UCLA Medical Center, David Geffen School of Medicine at UCLA
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7
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Choi JH, Yang NR, Lee WJ, Lee H, Choi EH, Lee HJ. Distribution of emm types among group A Streptococcus isolates from children in Korea. Diagn Microbiol Infect Dis 2015; 82:26-31. [DOI: 10.1016/j.diagmicrobio.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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8
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Santos C, Alerhand S, Koyfman A. Does the Choice of Antibiotic Affect Outcome in Strep Throat? Ann Emerg Med 2015; 65:564-5. [DOI: 10.1016/j.annemergmed.2014.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Indexed: 11/28/2022]
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9
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Affiliation(s)
- Judith M Martin
- University of Pittsburgh School of Medicine, Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, 3414 Fifth Ave., 3 Floor CHOB, Pittsburgh, PA 15213, , 412-692-7028
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10
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Chlebicki MP, Oh CC. Recurrent Cellulitis: Risk Factors, Etiology, Pathogenesis and Treatment. Curr Infect Dis Rep 2014; 16:422. [DOI: 10.1007/s11908-014-0422-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev 2014. [PMID: 24696436 DOI: 10.1128/cmr.00101-13)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Streptococcus pyogenes, also known as group A Streptococcus (GAS), causes mild human infections such as pharyngitis and impetigo and serious infections such as necrotizing fasciitis and streptococcal toxic shock syndrome. Furthermore, repeated GAS infections may trigger autoimmune diseases, including acute poststreptococcal glomerulonephritis, acute rheumatic fever, and rheumatic heart disease. Combined, these diseases account for over half a million deaths per year globally. Genomic and molecular analyses have now characterized a large number of GAS virulence determinants, many of which exhibit overlap and redundancy in the processes of adhesion and colonization, innate immune resistance, and the capacity to facilitate tissue barrier degradation and spread within the human host. This improved understanding of the contribution of individual virulence determinants to the disease process has led to the formulation of models of GAS disease progression, which may lead to better treatment and intervention strategies. While GAS remains sensitive to all penicillins and cephalosporins, rising resistance to other antibiotics used in disease treatment is an increasing worldwide concern. Several GAS vaccine formulations that elicit protective immunity in animal models have shown promise in nonhuman primate and early-stage human trials. The development of a safe and efficacious commercial human vaccine for the prophylaxis of GAS disease remains a high priority.
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12
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Walker MJ, Barnett TC, McArthur JD, Cole JN, Gillen CM, Henningham A, Sriprakash KS, Sanderson-Smith ML, Nizet V. Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev 2014; 27:264-301. [PMID: 24696436 PMCID: PMC3993104 DOI: 10.1128/cmr.00101-13] [Citation(s) in RCA: 556] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Streptococcus pyogenes, also known as group A Streptococcus (GAS), causes mild human infections such as pharyngitis and impetigo and serious infections such as necrotizing fasciitis and streptococcal toxic shock syndrome. Furthermore, repeated GAS infections may trigger autoimmune diseases, including acute poststreptococcal glomerulonephritis, acute rheumatic fever, and rheumatic heart disease. Combined, these diseases account for over half a million deaths per year globally. Genomic and molecular analyses have now characterized a large number of GAS virulence determinants, many of which exhibit overlap and redundancy in the processes of adhesion and colonization, innate immune resistance, and the capacity to facilitate tissue barrier degradation and spread within the human host. This improved understanding of the contribution of individual virulence determinants to the disease process has led to the formulation of models of GAS disease progression, which may lead to better treatment and intervention strategies. While GAS remains sensitive to all penicillins and cephalosporins, rising resistance to other antibiotics used in disease treatment is an increasing worldwide concern. Several GAS vaccine formulations that elicit protective immunity in animal models have shown promise in nonhuman primate and early-stage human trials. The development of a safe and efficacious commercial human vaccine for the prophylaxis of GAS disease remains a high priority.
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Affiliation(s)
- Mark J. Walker
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Timothy C. Barnett
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Jason D. McArthur
- School of Biological Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jason N. Cole
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
| | - Christine M. Gillen
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Anna Henningham
- School of Chemistry and Molecular Biosciences and the Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
| | - K. S. Sriprakash
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Martina L. Sanderson-Smith
- School of Biological Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
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13
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Horseman M, Bowman JD. Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis? Infect Dis Ther 2013; 2:175-85. [PMID: 25134480 PMCID: PMC4108108 DOI: 10.1007/s40121-013-0019-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 12/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become the dominant strain of Staphylococcus aureus in many communities of the United States. As a result, many clinicians are now empirically covering for this pathogen in the treatment of various skin and soft-tissue infections. Should this practice apply to cellulitis? In order to answer this question, we defined cellulitis and reviewed the pathogenesis, microbiology, and current studies of inpatient and outpatient antimicrobial therapy. The current evidence suggests empirical MRSA coverage for community-acquired cellulitis may not be necessary in non-purulent (non-suppurative) forms of this infection. Most cases are non-purulent and not amenable to culture although antibody studies indicate streptococci are the most common etiologic agents. Current studies of antimicrobial therapy tend to agree with this finding. Empirical beta-lactam therapy directed primarily at streptococci appears sufficient for non-purulent cellulitis regardless of the prevalence of MRSA in the community.
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Affiliation(s)
- Michael Horseman
- Department of Pharmacy Practice, Rangel College of Pharmacy, Texas A&M Health Science Center, MSC 131, 1010 West Avenue B, Kingsville, TX, 78363-8202, USA
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Bowen AC, Lilliebridge RA, Tong SYC, Baird RW, Ward P, McDonald MI, Currie BJ, Carapetis JR. Is Streptococcus pyogenes resistant or susceptible to trimethoprim-sulfamethoxazole? J Clin Microbiol 2012; 50:4067-72. [PMID: 23052313 PMCID: PMC3502963 DOI: 10.1128/jcm.02195-12] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 10/04/2012] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter β-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ≤ 1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing.
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Affiliation(s)
- Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
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15
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Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 Suppl 1:1-28. [PMID: 22432746 DOI: 10.1111/j.1469-0691.2012.03766.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.
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16
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Phelps KE, Steele RW. Fever and stiff neck. Clin Pediatr (Phila) 2012; 51:193-6. [PMID: 21868593 DOI: 10.1177/0009922811417305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Pharyngitis. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7151797 DOI: 10.1016/b978-1-4377-2702-9.00027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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van Zitteren LMLM, Arents NLA, Halbertsma F. Group-A-streptococcal meningitis in a 7-year-old child--a rare pathogen in a non-immune compromised patient. BMJ Case Rep 2011; 2011:bcr.10.2011.4896. [PMID: 22674699 DOI: 10.1136/bcr.10.2011.4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case is presented of meningitis in a 7-year-old female child caused by Group A streptococcus (GAS), a rare bacterial cause of meningitis, with a high rate of morbidity (46%) and mortality (10%). GAS is susceptible for empiric antibiotic therapy aimed at the most prevalent pathogens of meningitis. As GAS meningitis is typically associated with ear-nose-throat (ENT) infections, specific search for a reservoir is advised. Bacterial typification often demonstrates M-protein gene sequence type (EMM type) 1.0 associated with upper respiratory tract infections and also severe, invasive GAS infections. Follow-up investigation including neurologic developmental status and audiologic testing is necessary. Although GAS is a very uncommon cause of acute bacterial meningitis in children, high morbidity and mortality have been reported. Being associated with ENT infections, a search for a GAS reservoir is proposed. GASs are susceptible for common empiric antibiotic therapies in meningitis. Follow-up investigation is necessary.
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Broderick MP, Hansen CJ, Russell KL, Kaplan EL, Blumer JL, Faix DJ. Serum penicillin G levels are lower than expected in adults within two weeks of administration of 1.2 million units. PLoS One 2011; 6:e25308. [PMID: 21991307 PMCID: PMC3186770 DOI: 10.1371/journal.pone.0025308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/31/2011] [Indexed: 11/19/2022] Open
Abstract
When introduced in the 1950s, benzathine penicillin G (BPG) was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS) for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90) of 0.016 µg/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 µg/ml, and by day 15<0.01 µg/ml. Levels in more than 50% of the subjects were below 0.02 µg/ml on day 9, and <.01 µg/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2½ weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.
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Affiliation(s)
- Michael P Broderick
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Naval Health Research Center, San Diego, California, United States of America.
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Methicillin-resistant Staphylococcus aureus in wound cultures recovered from a combat support hospital in Iraq. ACTA ACUST UNITED AC 2010; 69 Suppl 1:S102-8. [PMID: 20622603 DOI: 10.1097/ta.0b013e3181e44b57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Staphylococcus aureus infections complicate care of combat-related injuries and can independently result in skin and soft-tissue infections during deployments or training. Community-associated methicillin-resistant S. aureus (CA-MRSA) strains seem to produce severe disease but retain susceptibility to many oral antimicrobials. This study characterizes 84 MRSA isolates recovered from wound cultures at a combat support hospital in Iraq. METHODS MRSA strains recovered from December 2007 through March 2009 were analyzed. Antimicrobial resistance testing was determined by broth microdilution and the BD Phoenix Automated Microbiology System. The genotypic pattern was analyzed by pulsed-field gel electrophoresis and polymerase chain reaction identification of resistance and virulence genes. RESULTS No MRSA isolates from wound cultures were resistant to vancomycin. The most active oral antistaphylococcal agents were tetracycline (95% susceptibility), trimethoprim-sulfamethoxazole (94%), and clindamycin (94%). Of agents not typically recommended as monotherapy, 98% of isolates were susceptible to rifampin, 91% to moxifloxacin, and 60% to levofloxacin. The most common pulsed-field type (PFT) was USA300 (79%). The typical staphylococcal cassette chromosome mec IV elements carrying the CA-MRSA resistance genes were present in 88% of the isolates. Panton-Valentine leukocidin virulence genes were identified in 88% of isolates, including 100% of PFT USA300. The virulence gene associated with an arginine catabolic mobile element was present in 75% of isolates, including 94% of PFT USA300. CONCLUSION This study is the first genotypic and phenotypic characterization of CA-MRSA recovered from wound cultures in a deployed combat hospital. The pattern noted was similar to that seen in soldiers stationed in the United States.
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Abstract
Sore throat is a common medical complaint seen by the emergency practitioner, internist, pediatrician, and otolaryngologist. The differential for sore throat is vast. However, with a directed history this can often be narrowed down to 2 to 3 possible diagnoses. By paying particular attention to the associated symptoms and duration of symptoms, common self-limited etiologies like viral pharyngitis and nonstreptococcal tonsillitis can be distinguished from those that require more investigation, such as supraglottitis and tonsillar cancer. A sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor.
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Affiliation(s)
- Teresa V Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
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Feng L, Lin H, Ma Y, Yang Y, Zheng Y, Fu Z, Yu S, Yao K, Shen X. Macrolide-resistant Streptococcus pyogenes from Chinese pediatric patients in association with Tn916 transposons family over a 16-year period. Diagn Microbiol Infect Dis 2010; 67:369-75. [DOI: 10.1016/j.diagmicrobio.2010.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 03/16/2010] [Accepted: 03/30/2010] [Indexed: 12/30/2022]
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Zavadska D, Bērziņa D, Drukaļska L, Pugacova N, Miklasevics E, Gardovska D. Macrolide resistance in group A beta haemolytic Streptococcus isolated from outpatient children in Latvia. APMIS 2010; 118:366-70. [PMID: 20477812 DOI: 10.1111/j.1600-0463.2010.02607.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Group A streptococci (GAS) are responsible for up to 30% of cases of pharyngitis in children, and such children do not benefit from treatment with antibiotics. During the last decade, increased resistance to macrolides has emerged as a critical issue in the treatment of GAS pharyngitis. The objective of this study was to determine the antimicrobial resistance of group A beta haemolytic Streptococcus isolated from outpatient children. From 2002 to 2006, 96 GAS strains were obtained from the pharynx of outpatients having symptoms of acute pharyngitis. Antibiotic resistance was determined by disc susceptibility tests according to CLSI standards. The presence of ermA, ermB and mefA was established by the amplification of streptococcal DNA with specific primers. Antimicrobial susceptibility tests revealed that all the strains tested were sensitive to vancomycin, linezolid, penicillin and ceftriaxone. Simultaneously, high levels of resistance to macrolides were evident; 78% of the isolates were resistant to clindamycin and erythromycin. No significant change in the yearly or seasonal incidence of resistance was observed. We describe high antimicrobial resistance of GAS to macrolides in outpatient children (78%), which can be explained by the frequent use of macrolides in the treatment of such individuals. Therefore, macrolides should not be the first drug of choice.
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Affiliation(s)
- Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Riga, Latvia.
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Abstract
PURPOSE OF REVIEW Recently, recommendations from the American Heart Association regarding treatment of streptococcal tonsillo-pharyngitis were revised. This review provides the background for changes that were made in comparison with the group's 1995 recommendations. Recent papers on other issues relating to group A Streptococcus are also reviewed. RECENT FINDINGS For antibiotic treatment of streptococcal tonsillopharyngitis the recommendations for injectable penicillin and for oral erythromycin are downgraded. First choice remains penicillin V but there is increasing acceptance of once-daily amoxicillin. CONCLUSION Streptococcal pharyngitis is still a major infectious disease seen in pediatric office practice. The main job of the practitioner is to make an accurate diagnosis and provide appropriate treatment in timely fashion in order to prevent acute rheumatic fever.
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Jorgensen DM. Single-dose extended-release oral azithromycin vs. 3-day azithromycin for the treatment of group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents: a double-blind, double-dummy study. Clin Microbiol Infect 2010; 15:1103-10. [PMID: 19929975 DOI: 10.1111/j.1469-0691.2009.02718.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The azithromycin immediate-release formulation (AZ-IR) provides effective treatment for group A beta-haemolytic streptococcal pharyngitis in adults. Single-dose therapy with a novel azithromycin extended-release (AZ-ER) formulation could reduce treatment failure and eliminate non-compliance contributing to antimicrobial resistance. A randomized, double-blind, double-dummy, multicentre trial was conducted comparing AZ-ER (single oral 2-g dose) with AZ-IR (3 days, 500 mg once daily) for the treatment of group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents (n = 598). The primary endpoint was bacteriological eradication at test -of-cure (TOC; day 24-28) in the bacteriological per-protocol population (n = 420). Bacteriological eradication was achieved in 85.4% (175/205) and 81.4% (175/215) of subjects in the AZ-ER and AZ-IR groups, respectively (95% CI -3.1-11.1). Clinical cure at TOC occurred in 99.0% of subjects in the AZ-ER group and in 96.7% in the AZ-IR group. At long-term follow-up, bacteriological recurrence was observed in 5.5% (9/163) and 7.7% (12/156), respectively. Both treatments were well tolerated; and most adverse events (AEs) were mild to moderate in intensity. The most frequent treatment-related AE was diarrhoea, or loose stools, in 11% of both treatment groups. AZ-ER-treated and AZ-IR-treated subjects had AE burdens (AE days/patient-year) of 7.6 days and 9.2 days, respectively. A similar trend in favour of AZ-ER was noted for treatment-related diarrhoea burden (1.9 days vs. 2.5 days). A single 2-g dose of AZ-ER is as effective and well tolerated as 3 days of AZ-IR (500 mg once daily) for treating group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents.
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Affiliation(s)
- Judith M Martin
- University of Pittsburgh School of Medicine, Division of Infectious Disease, Pittsburgh, PA 15224, USA.
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McGhee P, Clark C, Kosowska-Shick KM, Nagai K, Dewasse B, Beachel L, Appelbaum PC. In vitro activity of CEM-101 against Streptococcus pneumoniae and Streptococcus pyogenes with defined macrolide resistance mechanisms. Antimicrob Agents Chemother 2010; 54:230-8. [PMID: 19884376 PMCID: PMC2798494 DOI: 10.1128/aac.01123-09] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 10/14/2009] [Accepted: 10/29/2009] [Indexed: 11/20/2022] Open
Abstract
CEM-101 had MIC ranges of 0.002 to 0.016 microg/ml against macrolide-susceptible pneumococci and 0.004 to 1 microg/ml against macrolide-resistant phenotypes. Only 3 strains with erm(B), with or without mef(A), had CEM-101 MICs of 1 microg/ml, and 218/221 strains had CEM-101 MICs of 64 microg/ml, while 17/19 strains had telithromycin MICs of 4 to 16 microg/ml; CEM-101 MICs were 0.015 to 1 microg/ml. By comparison, erm(A) and mef(A) strains had CEM-101 MICs of 0.015 to 0.5 microg/ml, clindamycin and telithromycin MICs of 64 microg/ml. Pneumococcal multistep resistance studies showed that although CEM-101 yielded clones with higher MICs for all eight strains tested, seven of eight strains had clones with CEM-101 MICs that rose from 0.004 to 0.03 microg/ml (parental strains) to 0.06 to 0.5 microg/ml (resistant clones); for only one erm(B) mef(A) strain with a parental MIC of 1 microg/ml was there a resistant clone with a MIC of 32 microg/ml, with no detectable mutations in the L4, L22, or 23S rRNA sequence. Among two of five S. pyogenes strains tested, CEM-101 MICs rose from 0.03 to 0.25 microg/ml, and only for the one strain with erm(B) did CEM-101 MICs rise from 1 to 8 microg/ml, with no changes occurring in any macrolide resistance determinant. CEM-101 had low MICs as well as low potential for the selection of resistant mutants, independent of bacterial species or resistance phenotypes in pneumococci and S. pyogenes.
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Affiliation(s)
- Pamela McGhee
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Catherine Clark
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Klaudia M. Kosowska-Shick
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Kensuke Nagai
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Bonifacio Dewasse
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Linda Beachel
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
| | - Peter C. Appelbaum
- Hershey Medical Center, Hershey, Pennsylvania 17033, Kurume University School of Medicine, Kurume, Japan
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Myers AL, Jackson MA, Selvarangan R, Goering RV, Harrison C. Genetic commonality of macrolide-resistant group A beta hemolytic streptococcus pharyngeal strains. Ann Clin Microbiol Antimicrob 2009; 8:33. [PMID: 19951439 PMCID: PMC2790432 DOI: 10.1186/1476-0711-8-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 12/01/2009] [Indexed: 11/10/2022] Open
Abstract
Background Group A beta hemolytic streptococcus (GABHS) pharyngitis is a common childhood illness. Penicillin remains the gold standard therapy, but macrolides are indicated for the penicillin allergic patient, and are often used for convenience. Methods We conducted a surveillance study of children with pharyngitis and positive streptococcal rapid antigen testing from 10/05 to 10/06 at 2 sites (A & B). Demographics, treatment, and resistance data was collected and compared to previous data from 2002. Erythromycin (EM) resistance was determined by disk diffusion and E-test on 500 isolates. Pulse field gel electrophoresis (PFGE) was performed to measure genetic relatedness of isolates. StatXact version 8 software (Cytel Inc., Cambridge, MA) was utilized to perform Fisher's exact test and exact confidence interval (CI) analysis. Results There were no differences in resistance rates or demographic features, with the exception of race, between sites A & B. EM resistance was 0 in 2002, 3.5% in 2005-06 at site A, and 4.5% in 2005-06 at site B. 3/7 and 3/9 had inducible resistance at A and B respectively. 8 isolates had relatedness ≥80%, 5 of which were 88% homologous on PFGE. Conclusion Community macrolide resistance has increased following increased macrolide use. These results may have treatment implications if use continues to be high.
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Affiliation(s)
- Angela L Myers
- Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, KC, MO, USA.
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Inference of antibiotic resistance and virulence among diverse group A Streptococcus strains using emm sequencing and multilocus genotyping methods. PLoS One 2009; 4:e6897. [PMID: 19730733 PMCID: PMC2731928 DOI: 10.1371/journal.pone.0006897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 08/12/2009] [Indexed: 11/19/2022] Open
Abstract
Background Group A Streptococcus pyogenes (GAS) exhibits a high degree of clinically relevant phenotypic diversity. Strains vary widely in terms of antibiotic resistance (AbR), clinical severity, and transmission rate. Currently, strain identification is achieved by emm typing (direct sequencing of the genomic segment coding for the antigenic portion of the M protein) or by multilocus genotyping methods. Phenotype analysis, including critical AbR typing, is generally achieved by much slower and more laborious direct culture-based methods. Methodology/Principal Findings We compare genotype identification (by emm typing and PCR/ESI-MS) with directly measured phenotypes (AbR and outbreak associations) for 802 clinical isolates of GAS collected from symptomatic patients over a period of 6 years at 10 military facilities in the United States. All independent strain characterization methods are highly correlated. This shows that recombination, horizontal transfer, and other forms of reassortment are rare in GAS insofar as housekeeping genes, primary virulence and antibiotic resistance determinants, and the emm gene are concerned. Therefore, genotyping methods offer an efficient way to predict emm type and the associated AbR and virulence phenotypes. Conclusions/Significance The data presented here, combined with much historical data, suggest that emm typing assays and faster molecular methods that infer emm type from genomic signatures could be used to efficiently infer critical phenotypic characteristics based on robust genotype: phenotype correlations. This, in turn, would enable faster and better-targeted responses during identified outbreaks of constitutively resistant or particularly virulent emm types.
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Liu X, Shen X, Chang H, Huang G, Fu Z, Zheng Y, Wang L, Li C, Liu L, Shen Y, Yang Y. High macrolide resistance in Streptococcus pyogenes strains isolated from children with pharyngitis in China. Pediatr Pulmonol 2009; 44:436-41. [PMID: 19360846 DOI: 10.1002/ppul.20976] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the macrolide resistance, phenotype, and genotypic characterization of Streptococcus pyogenes isolated from Chinese children with pharyngitis. METHODS Minimal inhibitory concentration (MIC) with nine antibiotics was determined on 188 isolates of S. pyogenes collected from outpatients with pharyngitis in four children's hospitals in different regions of China in 2007. MICs of penicillin, chloramphenicol, cefradine, levofloxacin, macrolide (erythromycin, clarithromycin, azithromycin,), clindamycin, and tetracycline were determined by the microdilution method. The macrolide resistant phenotypes of isolates were determined through a double-disk. The macrolide-resistant genes (mefA, ermB, and ermA) were amplified by polymerase chain reaction (PCR). RESULTS Over 95% were resistant to macrolides, while 92.0% were resistant to tetracycline. We also found that all isolates were sensitive to penicillin, chloramphenicol, cefradine, and levofloxacin. Among the 173 erythromycin resistant strains, 171 (98.8%) were assigned to the cMLS phenotype, while the remaining 2 (1.2%) were assigned to the iMLS phenotype. Among the 171 cMLS isolates, 168 isolates (98.2%) had the ermB gene accounting for 98.2%. Meanwhile, 2 iMLS isolates had the ermA gene. Macrolides were highly resistant to ermB positive strains (MIC(90) > 256 microg/ml). Neither the M-phenotype nor the mefA gene was detected. Meanwhile, our studies of multiple centers showed that consumption of macrolides from 2000 to 2006 was very high. CONCLUSION The main phenotype is cMLS, and the ermB gene code is the main resistance mechanism against macrolides in S. pyogenes. The high rate of macrolide resistance to S. pyogenes was observed, which may be correlated with the overuse of these antibiotics in China.
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Affiliation(s)
- Xiaorong Liu
- Beijing Children's Hospital affiliated to Capital Medical University, Beijing 100045, China
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Suzumoto M, Hotomi M, Billal DS, Fujihara K, Harabuchi Y, Yamanaka N. A scoring system for management of acute pharyngo-tonsillitis in adults. Auris Nasus Larynx 2008; 36:314-20. [PMID: 18774249 PMCID: PMC7126418 DOI: 10.1016/j.anl.2008.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 05/28/2008] [Accepted: 07/02/2008] [Indexed: 11/06/2022]
Abstract
Objectives The aim of this study was to develop and evaluate a scoring system for the management of acute pharyngo-tonsillitis. Methods We conducted a prospective study between May 2004 and June 2005. Patients with acute pharyngo-tonsillitis were evaluated for causative pathogens and were assessed clinical symptoms and pharyngo-tonsillar finding by a clinical scoring system. Results A total 214 adult patients were enrolled in this study. Streptococcus pyogenes were identified at 13.6%. Thirty-one viruses were also identified by PCR. They were adenovirus (4.8%), influenza virus (1.0%), RS virus (6.3%), and human metapneumovirus (2.9%). Numbers of total white blood cells and levels of C-reactive protein showed a significant positive correlation with clinical scores (p < 0.001) and were also higher in cases with S. pyogenes. The clinical scores rapidly improved after the antimicrobial treatments in moderate cases and severe cases. Conclusion The current study strongly suggested that the clinical scoring system reflected disease severity well and would be very useful for evaluating clinical course and decision making for the antimicrobial treatment of acute pharyngo-tonisllitis.
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Affiliation(s)
- Masaki Suzumoto
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 811-1 Wakayama-shi, Wakayama 641-8510, Japan
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Smith K, Ednie LM, Appelbaum PC, Hawser S, Lociuro S. Antistreptococcal activity of AR-709 compared to that of other agents. Antimicrob Agents Chemother 2008; 52:2279-82. [PMID: 18362189 PMCID: PMC2415763 DOI: 10.1128/aac.01620-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/12/2008] [Accepted: 03/15/2008] [Indexed: 11/20/2022] Open
Abstract
Against 300 strains of pneumococci and 100 group A streptococci of differing beta-lactam, macrolide, and quinolone resistance phenotypes, AR-709 was very active, with all MICs being < or =2 microg/ml. Furthermore, AR-709 was active against strains that were both susceptible and resistant to trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Kathy Smith
- Department of Pathology, Hershey Medical Center, Hershey, PA 17033, USA
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Pharmacodynamic analysis and clinical trial of amoxicillin sprinkle administered once daily for 7 days compared to penicillin V potassium administered four times daily for 10 days in the treatment of tonsillopharyngitis due to Streptococcus pyogenes in children. Antimicrob Agents Chemother 2008; 52:2512-20. [PMID: 18332170 DOI: 10.1128/aac.00132-07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An a priori pharmacokinetic/pharmacodynamic (PK/PD) target of 40% daily time above the MIC (T >MIC; based on the MIC(90) of 0.06 microg/ml for Streptococcus pyogenes reported in the literature) was shown to be achievable in a phase 1 study of 23 children with a once-daily (QD) modified-release, multiparticulate formulation of amoxicillin (amoxicillin sprinkle). The daily T >MIC achieved with the QD amoxicillin sprinkle formulation was comparable to that achieved with a four-times-daily (QID) penicillin VK suspension. An investigator-blinded, randomized, parallel-group, multicenter study involving 579 children 6 months to 12 years old with acute streptococcal tonsillopharyngitis was then undertaken. Children were randomly assigned 1:1 to receive either the amoxicillin sprinkle (475 mg for ages 6 months to 4 years, 775 mg for ages 5 to 12 years) QD for 7 days or 10 mg/kg of body weight of penicillin VK QID for 10 days (up to the maximum dose of 250 mg QID). Unexpectedly, the rates of bacteriological eradication at the test of cure were 65.3% (132/202) for the amoxicillin sprinkle and 68.0% (132/194) for penicillin VK (95% confidence interval, -12.0% to 6.6%). Thus, neither antibiotic regimen met the minimum criterion of > or =85% eradication ordinarily required by the U.S. FDA for first-line treatment of tonsillopharyngitis due to S. pyogenes. The results of subgroup analyses across demographic characteristics and current infection characteristics and by age/weight categories were consistent with the primary-efficacy result. The clinical cure rates for amoxicillin sprinkle and penicillin VK were 86.1% (216/251) and 91.9% (204/222), respectively (95% confidence interval, -11.6% to -0.4%). The results of a post hoc PD analysis suggested that a requirement for 60% daily T >MIC(90) more accurately predicted the observed high failure rates for bacteriologic eradication with the amoxicillin sprinkle and penicillin VK suspension studied. Based on the association between longer treatment courses and maximal bacterial eradication rates reported in the literature, an alternative composite PK/PD target taking into consideration the duration of therapy, or total T >MIC, was considered and provides an alternative explanation for the observed failure rate of amoxicillin sprinkle.
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Unexpected individual clinical site variation in eradication rates of group a streptococci by penicillin in multisite clinical trials. Pediatr Infect Dis J 2007; 26:1110-6. [PMID: 18043447 DOI: 10.1097/inf.0b013e31814615ac] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previously, we reported an unexpectedly large percentage of failures by penicillin to eradicate group A streptococci (GAS) from the upper respiratory tract. Because penicillin has been the recommended therapy for the treatment of GAS pharyngitis, our report prompted controversy. Data from clinical trials in which our laboratory has participated demonstrated marked variation in GAS eradication rates among clinical sites. The reasons for such variation have never been adequately examined. We performed statistical analyses of site variation in eradication rates to assess the potential effect on reported reduced penicillin efficacy. METHODS Penicillin GAS eradication rates were compared using data from 4 large multisite pharyngitis treatment trials (75 clinical sites; 1158 subjects). Variation in eradication rates among clinical sites was statistically evaluated [chi(2) tests and generalized estimating equation (GEE) regression models]. RESULTS There was significant site-to-site variation in GAS eradication rates in each of the trials (range, 17-100%; P < 0.005) as well as between separate trials (mean range, 58-69%; P < 0.033). GEE modeling indicated that GAS eradication rates were significantly higher for clinical sites participating in more than one clinical trial. CONCLUSIONS The statistically significant site-to-site variation in penicillin eradication rates was related to factors (dependencies) at individual sites. Such factors may affect assessment of therapeutic efficacy and indicate a necessity for considering clinical site variation before reporting pooled efficacy data from multiple sites; combined data may result in misleading clinical implications. This is the first report documenting significant variation resulting from individual clinical site-related factors and offers a possible explanation for reduced penicillin eradication.
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Guss J, Kazahaya K. Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol 2007; 71:943-8. [PMID: 17418426 DOI: 10.1016/j.ijporl.2007.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 03/05/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the microbiology, particularly the prevalence of MRSA, in pediatric patients with community-acquired bacterial lymphadenitis. Long considered a nosocomial organism, methicillin-resistant Staphylococcus aureus (MRSA) has recently emerged as a cause of community-acquired infections. Resistance to other classes of antibiotics, including clindamycin, is prevalent amongst S. aureus, as well. METHODS A retrospective review of the medical records and culture results of patients under the age of 18 who underwent trans-cervical surgical drainage of abscessed lymph nodes between the years 2000 and 2006. RESULTS Sixty-two patients were identified for whom microbiology data were available. Six infections were classified as parapharyngeal on imaging; the remainder involved cervical chain lymph nodes. Forty-nine patients grew microorganisms on culture while 13 collections had no growth. The most common organism was S. aureus (63% of positive cultures); followed by beta-hemolytic group A Streptococcus (22%). Of S. aureus isolates, 27% were oxacillin-resistant (MRSA). All MRSA isolates were sensitive to clindamycin and trimethoprim/sulfamethoxazole; 63% were sensitive to ciprofloxacin, and 25% sensitive to erythromycin. Of methicillin-sensitive S. aureus isolates, 100, 86, and 82% were sensitive to trimethoprim/sulfamethoxazole, clindamycin, and ciprofloxacin, respectively. All MRSA isolates were identified during the latter half of the study period (2003-2006); none grew prior to 2003. CONCLUSIONS MRSA is a common pathogen in community-acquired lymphadenitis, and its incidence is rising. Resistance to clindamycin, a drug commonly used to treat MRSA, is prevalent amongst methicillin-sensitive S. aureus. This has important implications regarding the empiric treatment of lymphadenitis in children.
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Affiliation(s)
- Joel Guss
- Department of Otorhinolaryngology-Head & Neck Surgery, The University of Pennsylvania, 5 Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, United States.
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Koliou M, Ioannou Y, Efstratiou A, Hannidou N, Pieri V, Alexandrou M, Soteriades ES. Circulating serotypes and antimicrobial sensitivity of Streptococcus pyogenes isolates from children in Cyprus. Clin Microbiol Infect 2007; 13:645-7. [PMID: 17378928 DOI: 10.1111/j.1469-0691.2007.01705.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The most common T-serotypes among group A streptococci (n = 88) isolated from pharyngeal samples of children referred to a tertiary hospital in Cyprus for pharyngitis or scarlet fever during a 14-month period (2003-2004) were T28 (25%), T8/25/Imp19 (22.7%) and T12 (9.1%). All 88 isolates were sensitive to penicillin and clindamycin, but 1.1% and 18.2% of isolates were resistant to erythromycin and tetracycline, respectively. Macrolide consumption was estimated at 1.7 defined daily doses/1000 inhabitants/day. The low percentage of resistance to macrolides may have been related, at least in part, to the low consumption of macrolides.
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Affiliation(s)
- M Koliou
- Infectious Diseases Research Laboratory, Department of Pediatrics, Archbishop Makarios Hospital, Nicosia, Cyprus.
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Richter SS, Heilmann KP, Beekmann SE, Miller NJ, Miller AL, Rice CL, Doern CD, Reid SD, Doern GV. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis 2006; 41:599-608. [PMID: 16080080 DOI: 10.1086/432473] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 04/06/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Increased levels of macrolide-resistant Streptococcus pyogenes in focal regions of the United States have been reported. The purpose of this study was to determine the antimicrobial susceptibility of a large collection of S. pyogenes isolates from throughout the United States and to elucidate the mechanisms of resistance and genetic relatedness of macrolide-resistant isolates. METHODS During 2002-2003, a total of 1885 S. pyogenes clinical isolates were obtained from 45 US medical centers. Susceptibility to penicillin, cefdinir, erythromycin, azithromycin, clarithromycin, clindamycin, telithromycin, and levofloxacin was determined. Macrolide resistance phenotypes were determined by double-disk diffusion, and macrolide resistance genotypes were determined by polymerase chain reaction and sequencing. All macrolide-resistant isolates and all isolates recovered from sterile sites were further characterized by pulsed-field gel electrophoresis (PFGE) and emm typing. RESULTS The majority (85%) of isolates were pharyngeal. Resistance was detected to erythromycin (6.8% of isolates), azithromycin (6.9%), clarithromycin (6.6%), clindamycin (0.5%), telithromycin (0.2%), and levofloxacin (0.05%). The macrolide-resistance phenotype distribution was as follows: macrolide-lincosamide-streptogramin B (MLSB), 56% of isolates (inducible, 47%; constitutive, 9%); and M, 44%. The genotypes detected were as follows: ermA, 46% of isolates (95% with inducible MLSB phenotype); mefA, 43% (all with M phenotype); and ermB, 8.5% (45% with inducible MLSB and 45% with constitutive MLSB). Three isolates with constitutive MLSB phenotypes had 23S ribosomal RNA mutations. The 129 erythromycin-resistant isolates belonged to 28 emm types and 44 PFGE patterns, with 51% of the isolates in 4 major PFGE clones each associated with a predominant emm type (emm75, emm58, emm12, and emm114) and resistance genotype (mefA or ermA)). CONCLUSIONS The population of macrolide-resistant S. pyogenes isolates in the United States is small, but it includes several large clones with potential for expansion.
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Affiliation(s)
- Sandra S Richter
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242-1009, USA.
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40
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Abstract
Pneumococcal conjugate vaccine use has caused a decrease in the incidence of recurrent and refractory acute otitis media in the United States and a shift in the predominant pathogens. Now Haemophilus influenzae is the most commonly isolated organism (about 60% of the total), and more than half the strains make beta-lactamase, rendering them resistant to amoxicillin. Penicillin nonsusceptible pneumococci, the main target of antibiotic therapy in the 1990s, has become a much less common isolate (10%- 25% of the total). These changes impact antibiotic selection for acute otitis media. Penicillin treatment of group A streptococcal tonsillopharyngitis does not meet the minimum United States Food and Drug Administration standards for first-line treatment, which is 85% or greater eradication at the end of therapy. Recent results with amoxicillin suggest its efficacy is also waning. Cephalosporins have the highest bacteriologic and clinical efficacy. This has implications for optimal antibiotic therapy.
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Affiliation(s)
- Michael E Pichichero
- Department of Microbiology and Immunology, Pediatrics and Medicine, University of Rochester Medical Center, Elmwood Pediatric Group, Rochester, New York 14642, USA
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41
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Abstract
Group A streptococci (GAS) are gram positive cocci that can be divided into more than 100 M-serotypes or emm types based on their M proteins. Their virulence is related directly to the M protein on the cell surface that inhibits phagocytosis. Although it is more commonly thought of in the context of causing clinical illness, Streptococcus pyogenes can colonize the pharynx and skin. Infections due to GAS include pharyngitis, impetigo, ecthyma, erysipelas, and cellulitis. These infections, as well as the manifestations of invasive disease including streptococcal toxic shock syndrome and necrotizing fasciitis, will be reviewed in this article. Also included will be the nonsuppurative complications of GAS infections, acute rheumatic fever and post streptococcal glomerular nephritis. GAS is an important cause of infections in children in both the ambulatory and hospital settings. Current efforts aimed at the development of a vaccine are warranted but remain in preliminary stages at this time.
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Affiliation(s)
- Judith M Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Division of Infectious Diseases, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
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42
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Brahmadathan KN, Gladstone P. MICROBIOLOGICAL DIAGNOSIS OF STREPTOCOCCAL PHARYNGITIS: LACUNAE AND THEIR IMPLICATIONS. Indian J Med Microbiol 2006. [DOI: 10.1016/s0255-0857(21)02405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pettersen G, Ovetchkine P, Tapiero B. Group A streptococcal meningitis in a pediatric patient following cochlear implantation: report of the first case and review of the literature. J Clin Microbiol 2005; 43:5816-8. [PMID: 16272530 PMCID: PMC1287785 DOI: 10.1128/jcm.43.11.5816-5818.2005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Food and Drug Administration published a public health warning on the association of bacterial meningitis and cochlear implants in June 2002. This article reports the first case of group A streptococcal (GAS) meningitis in a cochlear-implanted patient, followed by a review on cochlear implantation and GAS meningitis.
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Affiliation(s)
- Géraldine Pettersen
- Département de pédiatrie, Services des soins intensifs, Université de Montréal, Canada
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44
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Ellis MW, Lewis JS. Treatment approaches for community-acquired methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis 2005; 18:496-501. [PMID: 16258322 DOI: 10.1097/01.qco.0000186850.54040.fc] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review addresses therapeutic approaches to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections, focusing on recently published data in the English-language medical literature dating from June 2004 to July 2005. RECENT FINDINGS During the reviewed time period, the overall understanding of the epidemiology and virulence of community-acquired MRSA has continued to advance. This same period has also seen numerous works dealing with the newer and emerging anti-staphylococcal antimicrobial agents. Important clinical trials involving linezolid, daptomycin, tigecycline, dalbavancin, and telavancin have been completed. At the same time, owing to the cost of newer agents and the broad susceptibility pattern of community-acquired MRSA, many older antimicrobial agents (long-acting tetracyclines, fluoroquinolones, rifampin, trimethoprim-sulfamethoxazole, and clindamycin) have also been reexamined. SUMMARY As data accumulates, the newer antimicrobial agents active against community-acquired MRSA continue to demonstrate their value. Despite the appeal and abundant publications involving newer agents, older antimicrobials certainly retain a therapeutic role. Considerable work needs to be done prospectively evaluating older agents for community-acquired MRSA disease. The most important therapeutic intervention for the majority of community-acquired MRSA infections is adequate drainage of purulent fluid collections. Antimicrobial selection for community-acquired MRSA infections should be governed by disease severity, susceptibility patterns (especially based on timely clinical specimen culture), clinical response to therapy, and cost.
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Affiliation(s)
- Michael W Ellis
- Infectious Disease Service MCHE-MDI, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
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Haller M, Fluegge K, Arri SJ, Adams B, Berner R. Association between resistance to erythromycin and the presence of the fibronectin binding protein F1 gene, prtF1, in Streptococcus pyogenes isolates from German pediatric patients. Antimicrob Agents Chemother 2005; 49:2990-3. [PMID: 15980381 PMCID: PMC1168679 DOI: 10.1128/aac.49.7.2990-2993.2005] [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] [Indexed: 11/20/2022] Open
Abstract
A total of 301 German pediatric group A streptococcus isolates were screened for the presence of macrolide resistance and the fibronectin binding protein F1 gene (prtF1) encoding an adhesin and cell invasiveness protein. The prtF1 gene was present significantly more often among macrolide-resistant isolates. The majority of these were not clonally related.
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Affiliation(s)
- Maria Haller
- Department of Pediatrics and Adolescent Medicine, University Hospital of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany
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46
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Green M, Allen C, Bradley J, Dashefsky B, Gilsdorf JR, Marcon MJ, Schutze GE, Smith C, Walter E, Martin JM, Edwards KA, Barbadora KA, Rumbaugh RM, Wald ER. In vitro activity of telithromycin against macrolide-susceptible and macrolide-resistant pharyngeal isolates of group A streptococci in the United States. Antimicrob Agents Chemother 2005; 49:2487-9. [PMID: 15917551 PMCID: PMC1140514 DOI: 10.1128/aac.49.6.2487-2489.2005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In vitro susceptibility testing of 2,797 group A streptococcus (GAS) isolates demonstrated that telithromycin was fully active against all macrolide-susceptible strains and among 80 of 115 macrolide-resistant GAS expressing the M phenotype. Telithromycin resistance was identified in 2 of 45 strains expressing the inducible macrolide-lincosamide-streptogramin B phenotype and four of nine isolates expressing the constitutive macrolide-lincosamide-streptogramin B resistance phenotype.
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Affiliation(s)
- Michael Green
- Department of Pediatrics, MPH Division of Allergy, Immunology and Infectious Diseases, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
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47
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Abstract
Acute pharyngitis is one of the most common illnesses for which children visit primary care physicians. Most cases of acute pharyngitis in children are caused by viruses and are benign and self-limited. Group A beta-hemolytic streptococcus is the most important of the bacterial causes of acute pharyngitis. Strategies for diagnosis and treatment of acute pharyngitis are directed at distinguishing children with viral pharyngitis, who would not benefit from antimicrobial therapy, from children with group A beta-hemolytic streptococcal pharyngitis, for whom antimicrobial therapy would be beneficial. Making this distinction is crucial in attempting to minimize the unnecessary use of antimicrobial agents in children.
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Affiliation(s)
- Michael A Gerber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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48
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Moran GJ, Talan DA. Community-Associated Methicillin-Resistant Staphylococcus aureus: Is It in Your Community and Should It Change Practice? Ann Emerg Med 2005; 45:321-2. [PMID: 15726057 DOI: 10.1016/j.annemergmed.2004.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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49
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Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E, Rippe J, Beyer J, Doktor S, Beall BW. Community-Based Surveillance in the United States of Macrolide-Resistant Pediatric Pharyngeal Group A Streptococci during 3 Respiratory Disease Seasons. Clin Infect Dis 2004; 39:1794-801. [PMID: 15578402 DOI: 10.1086/426025] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 08/17/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 2001, a total of 48% of pharyngeal group A streptococci (GAS) from Pittsburgh children were macrolide resistant. We assessed macrolide resistance, resistance genes, and emm types among GAS in the United States. METHODS In prospective, multicenter, community-based surveillance of pharyngeal GAS recovered from children 3-18 years old during 3 respiratory seasons (the 2000-2001 season, the 2001-2002 season, and the 2002-2003 season), GAS were tested for macrolide resistance and underwent emm gene sequencing. Macrolide-resistant GAS were tested for resistance to clindamycin, and resistance genes were determined. RESULTS Erythromycin resistance was observed in 4.4% of isolates from the 2000-2001 season, 4.3% from the 2001-2002 season, and 3.8% from the 2002-2003 season (P=.80). Clindamycin resistance was found in 1.04% of isolates; annual rates of clindamycin resistance were stable (P=.75). The predominant resistance genotype each year was mef A (65%-76.9%; overall, 70.3%). Resistant isolates included strains representing 8-11 different emm types each year. Heterogeneity of emm subtypes, resistance genes, and clindamycin resistance was evident among resistant isolates within some emm types. Geographic variability in resistance rates was present each year. CONCLUSIONS The macrolide resistance rate among pharyngeal GAS was <5% and was stable over the 3 seasons. However, rates varied among sites each year. There was no evidence of spread of a specific resistant clone, increasing clindamycin resistance, or escalation in median erythromycin MICs.
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Affiliation(s)
- Robert R Tanz
- Division of General Academic Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, USA.
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50
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Kim S, Yong Lee N. Antibiotic Resistance and Genotypic Characteristics of Group A Streptococci Associated with Acute Pharyngitis in Korea. Microb Drug Resist 2004; 10:300-5. [PMID: 15650374 DOI: 10.1089/mdr.2004.10.300] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Group A streptococci (GAS) is the most common pathogen of bacterial pharyngitis. GAS were isolated from pediatric outpatients with symptomatic acute pharyngitis. T typing and emm genotyping were performed for an epidemiologic study. The phenotypes of erythromycin (EM) resistance were evaluated, and the frequencies of ermB, ermTR(A), and mefA genes were determined by polymerase chain reaction. A total of 125 (50.8%) of 246 children yielded GAS. The two most frequent T types were T12 (35.2%) and T nontypeable (30.4%). The most frequent emm type was emm 12 (28.5%), followed by emm75 (18.7%), emm22 (13.0%), emm2 (12.2%), and emm8 (8.1%). The resistance rates to erythromycin and clindamycin were 44.8% and 19.2%, respectively. Among the EM-resistant strains, constitutive resistance, inducible resistance, and the M phenotype were observed in 42.1%, 0%, and 57.9%, respectively. The ermB, ermA, and mefA genes were present in 39.3%, 0%, and 58.9%, respectively. Most of the emm12 strains showed constitutive resistance, while emm18 and emm75 demonstrated the M phenotype. The organisms with other emm genotypes were susceptible to both EM and clindamycin. These results indicate that some emm genotypes might be associated with a specific mechanism of EM resistance.
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Affiliation(s)
- Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
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