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Li X, Gao W, Jia Z, Yao K, Yang J, Tong J, Wang Y. Characterization of Group B Streptococcus Recovered from Pregnant Women and Newborns Attending in a Hospital in Beijing, China. Infect Drug Resist 2023; 16:2549-2559. [PMID: 37138839 PMCID: PMC10150791 DOI: 10.2147/idr.s395942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose We investigate the drug resistance, serotype and multilocus sequence typing (MLST) of Group B streptococcus (GBS) strains obtained from pregnant women and neonates in a hospital in Beijing. Patients and Methods In this cross-sectional study, 1470 eligible pregnant women at a gestational age of 35-37 weeks presented to our department between May 2015 and May 2016 were included. Vaginal and rectal samples from pregnant women together with sampling from neonatal samples were collected to screen GBS. GBS strains were subject to drug resistance and serotype analysis and MLST. Results GBS strains were isolated from 111 pregnant women (7.6%) and 6 neonates (0.99%) from 606 matched neonates. 102 strains from pregnant women and 3 strains from neonates were included in the drug sensitivity test, serotyping and MLST typing. All these strains were susceptible to ampicillin, penicillin, ceftriaxone, vancomycin, linezolid, and meropenem. Sixty strains (58.8%) showed multi-drug resistance. Serious cross-resistance was seen between erythromycin and clindamycin. There were eight serotypes, and 37 strains (36.3%) showed a serotype of type III serving as the major type. All 102 GBS strains isolated from pregnant samples could be divided into 18 STs types. They belonged to five clonal complexes and five single clones, with the predominant type of ST19/III, ST10/Ib, and ST23/Ia, with CC19 as the most common type. Three GBS strains isolated from neonates covered two serotypes (ie type III and Ia) that were consistent with those of the mothers. Conclusion Serotype III was the predominant serotype of GBS in this study. The predominant MLST type was ST19, ST10, and ST23, with ST19/III, ST10/Ib, and ST23/Ia serving as the most prevalent and CC19 as the most common clonal complex. GBS strains from neonates were consistent in the clonal complex, serotype, and MLST with these isolated from the mothers.
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Affiliation(s)
- Xiaoou Li
- Department of Neonatology, Haidian District Maternal and Child Health Care Hospital, Beijing, 100080, People’s Republic of China
| | - Wei Gao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Zhonglan Jia
- Department of Clinical Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, 100080, People’s Republic of China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Jinyan Yang
- Department of Neonatology, Haidian District Maternal and Child Health Care Hospital, Beijing, 100080, People’s Republic of China
| | - Jingjing Tong
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, People’s Republic of China
| | - Yajuan Wang
- Department of Neonatology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, 100020, People’s Republic of China
- Correspondence: Yajuan Wang, Department of Neonatology, Children’s Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-10-85695631, Email
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Gao K, Gao C, Huang L, Guan X, Ji W, Chang CY, McIver DJ, Deng Q, Zhong H, Xie Y, Deng L, Gao F, Zeng L, Liu H. Predominance of III/ST19 and Ib/ST10 Lineages With High Multidrug Resistance in Fluoroquinolone-Resistant Group B Streptococci Isolates in Which a New Integrative and Conjugative Element Was Identified. Front Microbiol 2021; 11:609526. [PMID: 33569045 PMCID: PMC7868321 DOI: 10.3389/fmicb.2020.609526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/31/2023] Open
Abstract
Fluoroquinolone (FQ)-resistant Group B Streptococcus (GBS) has been reported with considerable cross-resistance, worsening the crisis of multidrug-resistant (MDR) GBS in clinical settings. However, national epidemiological data on FQ-resistant GBS in mainland China have not been well-characterized. This study aimed to determine the prevalence of FQ resistance among GBS from neonatal invasive infections and maternal colonization in northern and southern China, to investigate the serotyping, multilocus sequence typing, and antibiotic cross-resistance, and to characterize the mutations in gyrA and parC genes in quinolone resistance-determining region (QRDR). In order to provide a comprehensive view of the location and structure of resistance genes, whole-genome sequencing on III/ST19 MDR isolates were performed. Among 426 GBS, 138 (32.4%) were FQ resistant, with higher prevalence in northern China than in southern China in both neonates (57.8%, 37/64 vs. 21.7%, 39/180) and pregnant women (50.9%, 29/57 vs. 26.4%, 33/125). Serotypes were distributed as III (48.5%), Ib (39.9%), V (6.5%), and Ia (5.1%). Sequence types were mainly ST19 (53.6%) and ST10 (39.1%), followed by ST12 (1.4%), ST17 (1.4%), ST23 (1.4%), and 0.7% each of ST27, ST188, ST197, and ST597. ST19 isolates were more prevalent in southern China than in northern China in both neonates (64.1%, 25/39 vs. 27.0%, 10/37) and pregnant women (81.8%, 27/33 vs. 41.4%, 12/29), whereas ST10 isolates were more common in northern China than in southern China in both neonates (64.9%, 24/37 vs. 20.5%, 8/39) and pregnant women (58.6%, 17/29 vs. 15.2%, 5/33). Serotype III isolates were mainly ST19 (89.6%, 60/67), while Ib isolates were largely ST10 (94.5%, 52/55). Sequencing data revealed several mutations in QRDR, including Ser81Leu in gyrA (99.2%, 130/131), Ser79Phe or Tyr in parC (76.2%, 48/63), and a previously unreported Ile218Thr and Ile219Phe double mutation pattern (49.2%, 31/63) in parC. ST10 isolates were associated with Ser79Phe (84%, 21/25), while ST19 isolates were limited to Ser79Tyr (95.7%, 22/23). A new integrative and conjugative element (ICE) harboring tetM and gyrA genes was identified in a III/ST19 isolate. This study investigates the molecular characteristics of FQ-resistant GBS in northern and southern China, emphasizing the need for continuous surveillance geographically and further research to characterize the mechanisms of ICE transfer.
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Affiliation(s)
- Kankan Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chunyan Gao
- Clinical Laboratory, Tangshan Municipal Women and Children's Hospital, Tangshan, China
| | - Lianfen Huang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoshan Guan
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China
| | - Chien-Yi Chang
- School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - David J McIver
- Global Health Group, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Qiulian Deng
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huamin Zhong
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yongqiang Xie
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lei Deng
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fei Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lanlan Zeng
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiying Liu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Ali MM, Woldeamanuel Y, Asrat D, Fenta DA, Beall B, Schrag S, McGee L. Features of Streptococcus agalactiae strains recovered from pregnant women and newborns attending different hospitals in Ethiopia. BMC Infect Dis 2020; 20:848. [PMID: 33198686 PMCID: PMC7668015 DOI: 10.1186/s12879-020-05581-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background Streptococcus agalactiae (Group B Streptococcus, GBS) serotypes, sequence types, and antimicrobial resistance profile vary across different geographic locations affecting disease patterns in newborns. These differences are important considerations for vaccine development efforts and data from large countries in Africa is limited. The aim of this study was to determine serotypes and genotypes of GBS isolates from pregnant women and their newborns in Ethiopia. Methods A hospital based cross-sectional study was conducted at three hospitals in Ethiopia from June 2014 to September 2015. Out of 225 GBS isolates, 121 GBS were recovered, confirmed and characterized at CDC’s Streptococcus Laboratory using conventional microbiology methods and whole genome sequencing. Results Of the 121 isolates, 87 were from rectovaginal samples of pregnant women, 32 from different body parts of their newborns and 2 from blood of newborns with suspected sepsis. There were 25 mother-infant pairs and 24 pairs had concordant strains. The most prevalent serotypes among mothers and/or their babies were II, Ia and V (41.5, 20.6, 19.5 and 40.6%, 25 and 15.6%, respectively). Multilocus sequence typing (MLST) on 83 isolates showed ST10 (24; 28.9%) and ST2 (12; 14.5%) as most predominant sequence types. All GBS strains were susceptible to penicillin, cefotaxime and vancomycin, which correlated to the presence of wildtype PBP2x types and the lack of known vancomycin-resistance genes. Tetracycline resistance was high (73; 88%, associated primarily with tetM, but also tetO and tetL). Five isolates (6%) were resistant to erythromycin and clindamycin and 3 isolates were fluoroquinolone-resistant, containing associated mutations in gyrA and parC genes. All isolates were positive for one of four homologous Alpha/Rib family determinants and 1–2 of the three main pilus types. Conclusions Predominant serotypes were II, Ia, and V. A limited number of clonal types were identified with two STs accounting for about half of the isolates. All strains collected in this study were susceptible to beta-lactam antibiotics and vancomycin. Typical of most GBS, these isolates were positive for single alpha-like family protein, serine-rich repeat gene, as well as 1–2 pilus determinants. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05581-8.
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Affiliation(s)
- Musa Mohammed Ali
- Hawassa University College of Medicine and Health Sciences, School of Medical laboratory Science, Hawassa, Ethiopia.
| | - Yimtubezinash Woldeamanuel
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
| | - Demissie Assegu Fenta
- Hawassa University College of Medicine and Health Sciences, School of Medical laboratory Science, Hawassa, Ethiopia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers of Disease Control and Prevention (CDC), Atlanta, USA
| | - Stephanie Schrag
- Respiratory Diseases Branch, Centers of Disease Control and Prevention (CDC), Atlanta, USA
| | - Lesley McGee
- Respiratory Diseases Branch, Centers of Disease Control and Prevention (CDC), Atlanta, USA
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Hayes K, O'Halloran F, Cotter L. A review of antibiotic resistance in Group B Streptococcus: the story so far. Crit Rev Microbiol 2020; 46:253-269. [PMID: 32363979 DOI: 10.1080/1040841x.2020.1758626] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal disease worldwide, and invasive disease in adults is becoming more prevalent. Currently, some countries adopt an intrapartum antibiotic prophylaxis regime to help prevent the transmission of GBS from mother to neonate during delivery. This precaution has reduced the incidence of GBS-associated early-onset disease; however, rates of late-onset disease and stillbirths associated with GBS infections remain unchanged. GBS is still recognized as being universally susceptible to beta-lactam antibiotics; however, there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries. Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst GBS, with several countries noting increased resistance rates in recent years. Moreover, resistance to other antibiotic classes, such as fluoroquinolones and aminoglycosides, also continues to rise. In instances where patients are allergic to penicillin and second-line antibiotics are ineffective, vancomycin is administered. While vancomycin, a last resort antibiotic, still remains largely effective, there have been two documented cases of vancomycin resistance in GBS. This review provides a comprehensive analysis of the prevalence of antibiotic resistance in GBS and outlines the specific resistance mechanisms identified in GBS isolates to date.
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Arias B, Kovacec V, Vigliarolo L, Suárez M, Tersigni C, Müller L, Lopardo H, Bonofiglio L, Mollerach M. Fluoroquinolone-Resistant Streptococcus agalactiae Invasive Isolates Recovered in Argentina. Microb Drug Resist 2019; 25:739-743. [PMID: 30676886 DOI: 10.1089/mdr.2018.0246] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Streptococcus agalactiae or group B Streptococcus (GBS) is an important pathogen in neonates and nonpregnant individuals. Epidemiological studies of GBS resistance to fluoroquinolones (FQs) in Latin America are scarce. This study aimed to determine the local prevalence of FQ resistance in the frame of a national, prospective multicenter study of invasive GBS infections and to investigate mechanisms of resistance, serotype distribution, and clonal relationships among resistant isolates. Methods: From July 2014 to July 2015, 162 invasive GBS isolates were collected from 86 health care centers in 32 Argentinean cities. All isolates were screened for FQ nonsusceptibility using a five-disc scheme: levofloxacin (LVX), ciprofloxacin, norfloxacin (NOR), ofloxacin, and pefloxacin (PF). LVX minimal inhibitory concentration (MIC) was determined by the agar dilution method. Sequencing of internal regions of gyrA and parC genes was performed. Capsular typing and genetic characterization of nonsusceptible isolates were assessed by latex agglutination, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing. Results: Twenty-four of one hundred sixty-two GBS isolates exhibited no inhibition zones to all tested FQs with an MIC range of 16-32 mg/L for LVX, and one isolate with MIC = 1 mg/L showed no inhibition zones around NOR and PF discs. In all resistant isolates, point mutations were detected in both genes. Serotype Ib was prevalent (88%). One PFGE type accounted for 84% of the FQ-resistant isolates and belonged to serotype Ib, sequence type 10. Conclusions: The prevalence of FQ resistance was 14.8% likely to be associated with dissemination of an ST10/serotype Ib clone. The unexpected high rate of resistance emphasizes the relevance for continuous surveillance of GBS epidemiology and antibiotic susceptibility.
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Affiliation(s)
- Bárbara Arias
- 1 Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, Argentina
| | - Verónica Kovacec
- 1 Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, Argentina
| | - Laura Vigliarolo
- 2 Universidad Nacional de La Plata, Facultad de Ciencias Exactas, Buenos Aires, Argentina
| | - Mariana Suárez
- 2 Universidad Nacional de La Plata, Facultad de Ciencias Exactas, Buenos Aires, Argentina
| | - Carina Tersigni
- 2 Universidad Nacional de La Plata, Facultad de Ciencias Exactas, Buenos Aires, Argentina
| | - Loana Müller
- 1 Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, Argentina
| | - Horacio Lopardo
- 2 Universidad Nacional de La Plata, Facultad de Ciencias Exactas, Buenos Aires, Argentina
| | - Laura Bonofiglio
- 1 Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, Argentina.,3 CONICET, Buenos Aires, Argentina
| | - Marta Mollerach
- 1 Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Microbiología, Inmunología, Biotecnología y Genética, Cátedra de Microbiología, Buenos Aires, Argentina.,3 CONICET, Buenos Aires, Argentina
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Simoni S, Vincenzi C, Brenciani A, Morroni G, Bagnarelli P, Giovanetti E, Varaldo PE, Mingoia M. Molecular Characterization of Italian Isolates of Fluoroquinolone-Resistant Streptococcus agalactiae and Relationships with Chloramphenicol Resistance. Microb Drug Resist 2017; 24:225-231. [PMID: 28783417 DOI: 10.1089/mdr.2017.0139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A total number of 368 clinical isolates of Streptococcus agalactiae (group B Streptococcus, GBS) were collected in 2010-2016 from three hospitals in a region of central Italy. Fluoroquinolone (FQ)-resistant isolates were selected using levofloxacin. Levofloxacin-resistant (LR) strains (11/368, 2.99%) were characterized for several features, and their FQ resistance was analyzed phenotypically and genotypically using seven additional FQs. Their gyrA and parC quinolone resistance-determining regions were sequenced. Of the 11 LR isolates, 10 showed high-level and 1 low-level resistance. The former isolates exhibited higher minimal inhibitory concentrations also of the other FQs and all shared one amino acid substitution in ParC (Ser79Phe) and one in GyrA (Ser81Leu); only Ser79Phe in ParC was detected in the low-level LR isolate. The 11 LR strains exhibited distinctive relationships between their susceptibilities to non-FQ antibiotics and typing data. Remarkably, despite the very rare occurrence of chloramphenicol resistance in S. agalactiae, no <4 of the 11 LR isolates were chloramphenicol-resistant. Studies of GBS resistance to FQs in Europe remain scarce, notwithstanding the emergence of multidrug-resistant isolates. The incidence of LR GBS isolates is still limited in Italy, consistent with the moderate (though growing) rates reported in Europe, and much lower than the very high rates reported in East Asia. The intriguing relationships between FQ and chloramphenicol resistance deserve further investigation.
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Affiliation(s)
- Serena Simoni
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
| | - Chiara Vincenzi
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy .,2 Clinical Microbiology Laboratory, Torrette Regional Hospital , Ancona, Italy
| | - Andrea Brenciani
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
| | - Gianluca Morroni
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
| | - Patrizia Bagnarelli
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
| | - Eleonora Giovanetti
- 3 Department of Life and Environmental Sciences, Polytechnic University of Marche , Ancona, Italy
| | - Pietro E Varaldo
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
| | - Marina Mingoia
- 1 Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School , Ancona, Italy
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Lu B, Fang Y, Fan Y, Chen X, Wang J, Zeng J, Li Y, Zhang Z, Huang L, Li H, Li D, Zhu F, Cui Y, Wang D. High Prevalence of Macrolide-resistance and Molecular Characterization of Streptococcus pyogenes Isolates Circulating in China from 2009 to 2016. Front Microbiol 2017. [PMID: 28642756 PMCID: PMC5463034 DOI: 10.3389/fmicb.2017.01052] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Streptococcus pyogenes, or group A Streptococcus, is a pathogen responsible for a wide range of clinical manifestations, from mild skin and soft tissue infections and pharyngitis to severe diseases. Its epidemiological characteristics should be comprehensively under surveillance for regulating the national prevention and treatment practice. Herein, a total of 140 S. pyogenes, including 38 invasive and 102 noninvasive isolates, were collected from infected patients in 10 tertiary general hospitals from 7 cities/provinces in China during the years 2009–2016. All strains were characterized by classical and molecular techniques for its emm types/subtypes, virulent factors and antibiotic resistance profiling. Of 140 isolates, 15 distinct emm types and 31 subtypes were detected, dominated by emm12 (60 isolates, 42.9%), emm1(43, 30.7%), and emm89 (10, 7.1%), and 8 new emm variant subtypes were identified. All strains, invasive or not, harbored the superantigenic genes, speB and slo. The other virulence genes, smeZ, speF, and speC accounted for 96.4, 91.4, and 87.1% of collected isolates, respectively. Further multilocus sequence typing (MLST) placed all strains into 22 individual sequence types (STs), including 4 newly-identified STs (11, 7.9%). All isolates were phenotypically susceptible to penicillin, ampicillin, cefotaxime, and vancomycin, whereas 131(93.5%), 132(94.2%), and 121(86.4%) were resistant to erythromycin, clindamycin, and tetracycline, respectively. Our study highlights high genotypic diversity and high prevalence of macrolide resistance of S. pyogenes among clinical isolates circulating in China.
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Affiliation(s)
- Binghuai Lu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Yujie Fang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and PreventionBeijing, China.,Collaborative Innovation Centre for Diagnosis and Treatment of Infectious DiseasesHangzhou, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship HospitalBeijing, China
| | - Xingchun Chen
- Department of Laboratory Medicine, People's Hospital of Guangxi Zhuang Autonomous RegionNanning, China
| | - Junrui Wang
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical UniversityHohhot, China
| | - Ji Zeng
- Department of Laboratory Medicine, Wuhan Pu Ai Hospital of Huazhong, University of Science and TechnologyWuhan, China
| | - Yi Li
- Department of Laboratory Medicine, Henan Provincial People's HospitalZhengzhou, China
| | - Zhijun Zhang
- Department of Laboratory Medicine, Tai'an City Central Hospital (Tai'an)Shandong, China
| | - Lei Huang
- Department of Laboratory Medicine, First Hospital, Peking UniversityBeijing, China
| | - Hongxia Li
- Department of Laboratory Medicine, Chengdu First People's Hospital (Chengdu)Sichuan, China
| | - Dong Li
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Fengxia Zhu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Yanchao Cui
- Department of Laboratory Medicine, Civil Aviation General Hospital, Peking University Civil Aviation School of Clinical MedicineBeijing, China
| | - Duochun Wang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and PreventionBeijing, China.,Collaborative Innovation Centre for Diagnosis and Treatment of Infectious DiseasesHangzhou, China
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Emergence of the first levofloxacin-resistant strains of Streptococcus agalactiae isolated in Italy. Antimicrob Agents Chemother 2015; 59:2466-9. [PMID: 25666148 DOI: 10.1128/aac.05127-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Of 901 group B streptococcus strains analyzed, 13 (1.4%) were resistant to levofloxacin (MICs of >32 μg/ml for seven isolates, 2 μg/ml for four isolates, and 1.5 μg/ml for four isolates). Mutations in the quinolone resistance-determining regions (QRDRs) of gyrase and topoisomerase IV were identified. A double mutation involving the Ser-81 change to Leu for gyrA and the Ser-79 change to Phe or to Tyr for parC was linked to a high level of fluoroquinolone resistance. In addition, two other mutational positions in parC were observed, resulting in an Asp-83-to-Tyr substitution and an Asp-83-to-Asn substitution. Different mutations were also observed in gyrB, with unknown significance. Most levofloxacin-resistant GBS strains were of serotype Ib and belonged to sequence type 19 (ST19) and clonal complex 19 (CC-19). Most of them exhibited the epsilon gene.
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9
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Dang TND, Srinivasan U, Britt Z, Marrs CF, Zhang L, Ki M, Foxman B. Efflux-mediated resistance identified among norfloxacin resistant clinical strains of group B Streptococcus from South Korea. Epidemiol Health 2014; 36:e2014022. [PMID: 25322878 PMCID: PMC4258715 DOI: 10.4178/epih/e2014022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/11/2014] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES: Group B Streptococcus (GBS), a common bowel commensal, is a major cause of neonatal sepsis and an emerging cause of infection in immune-compromised adult populations. Fluoroquinolones are used to treat GBS infections in those allergic to beta-lactams, but GBS are increasingly resistant to fluoroquinolones. Fluoroquinolone resistance has been previously attributed to quinolone resistance determining regions (QRDRs) mutations. We demonstrate that some of fluoroquinolone resistance is due to efflux-mediated resistance. METHODS: We tested 20 GBS strains resistant only to norfloxacin with no mutations in the QRDRs, for the efflux phenotype using norfloxacin and ethidium bromide as substrates in the presence of the efflux inhibitor reserpine. Also tested were 68 GBS strains resistant only to norfloxacin not screened for QRDRs, and 58 GBS strains resistant to ciprofloxacin, levofloxacin or moxifloxacin. Isolates were randomly selected from 221 pregnant women (35-37 weeks of gestation) asymptomatically carrying GBS, and 838 patients with GBS infection identified in South Korea between 2006 and 2008. The VITEK II automatic system (Biomerieux, Durham, NC, USA) was used to determine fluoroquinolone resistance. RESULTS: The reserpine associated efflux phenotype was found in more than half of GBS strains resistant only to norfloxacin with no QRDR mutations, and half where QRDR mutations were unknown. No evidence of the efflux phenotype was detected in GBS strains that were resistant to moxifloxacin or levofloxacin or both. The reserpine sensitive efflux phenotype resulted in moderate increases in norfloxacin minimum inhibitory concentration (average=3.6 fold, range=>1-16 fold). CONCLUSIONS: A substantial portion of GBS strains resistant to norfloxacin have an efflux phenotype.
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Affiliation(s)
- Trang Nguyen Doan Dang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Usha Srinivasan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Zachary Britt
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carl F Marrs
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lixin Zhang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Moran Ki
- Department of Cancer Control and Policy, Graduated School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Betsy Foxman
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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10
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Ryu H, Park YJ, Kim YK, Chang J, Yu JK. Dominance of clonal complex 10 among the levofloxacin-resistant Streptococcus agalactiae isolated from bacteremic patients in a Korean hospital. J Infect Chemother 2014; 20:509-11. [PMID: 24880684 DOI: 10.1016/j.jiac.2014.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 11/18/2022]
Abstract
Streptococcus agalactiae has emerged as an important cause of invasive infection in adults. Forty-nine S. agalactiae isolates (41 from adults and 8 from neonates) were collected during a 4-year period (2010-2013) and analyzed by multilocus sequence typing (MLST). Antibiotic susceptibility to erythromycin, clindamycin and levofloxacin was determined and the determinants of resistance (ermA, ermB, ermC, mefA, lnuB) were detected by PCR and mutation in gyrA, gyrB, parC and parE gene was investigated by sequence analysis. They were resolved into 14 sequence types (STs) and belonged to five clonal complexes (CCs). The distribution of CC was significantly different according to the age group; CC1 (18/41) and CC10 (13/41) was the most common among the adult isolates but CC19 (5/8) was predominant among the neonatal isolates. The resistance rate to erythromycin, clindamycin was 18.4% and 24.5%, respectively. Among the 13 strains resistant to erythromycin and/or clindamycin, two isolates harbored ermA and 10 isolates harbored ermB. The levofloxacin resistance rate was very high (32.7%) and was significantly higher in CC10 (71.4%). All the levofloxacin-resistant isolates had identical gyrA substitution (Ser81Leu) but parC substitution was different according to the CCs. The additional mutation in parE (His221Tyr) was found only in CC19. Continuous monitoring of the fluoroquinolone resistance and genotypic distribution among S. agalactiae is needed.
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Affiliation(s)
- Hyejin Ryu
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yong-Kyun Kim
- Samkwang Medical Laboratories, Seoul, Republic of Korea
| | - Jiyoung Chang
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Kyung Yu
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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11
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Melin P, Efstratiou A. Group B streptococcal epidemiology and vaccine needs in developed countries. Vaccine 2014; 31 Suppl 4:D31-42. [PMID: 23973345 DOI: 10.1016/j.vaccine.2013.05.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
Development of a group B streptococcal vaccine (GBS) vaccine is the most promising approach for the prevention of GBS infections in babies, given the potential adverse effects of intrapartum antibiotic prophylaxis as well as the need for effective prevention of both adult and late perinatal disease. There are numerous prevention strategies at this time but none are 100% effective in the eradication of neonatal early onset GBS disease and there are no preventative strategies for late onset disease. The need for a GBS vaccine is therefore, of utmost importance. Efforts applying genomics to GBS vaccine development have led to the identification of novel vaccine candidates. The publication of GBS whole genomes coupled with new technologies including multigenome screening and bioinformatics has also allowed researchers to overcome the serotype limitation of earlier vaccine preparations in the search of a universal effective vaccine against GBS. This review brings together the key arguments concerning the potential need of a GBS vaccine in developed countries and describes the current status with GBS epidemiology and microbiology in these countries.
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Affiliation(s)
- Pierrette Melin
- National Reference Centre for Group B Streptococci, Medical Microbiology Department, University Hospital of Liege, Sart Tilman B-23, 4000 Liege, Belgium.
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12
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High prevalence of fluoroquinolone-resistant group B streptococci among clinical isolates in China and predominance of sequence type 19 with serotype III. Antimicrob Agents Chemother 2013; 57:1538-41. [PMID: 23295933 DOI: 10.1128/aac.02317-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A total of 146 group B streptococcus isolates from 8 cities across China belonged to four serotypes. Serotype Ia was more common in children. A high prevalence of resistance was observed for levofloxacin (37.7%), erythromycin (71.2%), clindamycin, (53.4%), and tetracycline (81.5%). The levofloxacin and clindamycin resistances among the 4 serotypes differed significantly. Eighty percent of fluoroquinolone-resistant isolates belonged to the sequence type 19 (ST19)/serotype III clone, with GyrA-ParC-ParE triple substitutions. This clone carried the erm(B), mef(E), and tet(M) genes.
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13
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Barros RR, Kegele FCO, de Paula GR, de Brito MA, Duarte RS. Molecular characterization of the first fluoroquinolone resistant strains of Streptococcus agalactiae isolated in Brazil. Braz J Infect Dis 2012; 16:476-8. [DOI: 10.1016/j.bjid.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/06/2012] [Indexed: 10/27/2022] Open
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14
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Emerging fluoroquinolone resistance in Streptococcus agalactiae in South Korea. Eur J Clin Microbiol Infect Dis 2012; 31:3199-205. [DOI: 10.1007/s10096-012-1685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
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15
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Boswihi SS, Udo EE, Al-Sweih N. Serotypes and antibiotic resistance in Group B streptococcus isolated from patients at the Maternity Hospital, Kuwait. J Med Microbiol 2012; 61:126-131. [DOI: 10.1099/jmm.0.035477-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Samar S. Boswihi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Edet E. Udo
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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16
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Nagano N, Nagano Y, Toyama M, Kimura K, Tamura T, Shibayama K, Arakawa Y. Nosocomial spread of multidrug-resistant group B streptococci with reduced penicillin susceptibility belonging to clonal complex 1. J Antimicrob Chemother 2011; 67:849-56. [PMID: 22210756 DOI: 10.1093/jac/dkr546] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple group B Streptococcus (GBS) isolates with reduced penicillin susceptibility (PRGBS) were recovered from several patients, hence a probable nosocomial transmission of PRGBS in a hospital setting was suspected. METHODS Ten PRGBS recovered from eight patients in a general hospital were characterized. Sequence analysis of genes for penicillin-binding proteins (PBPs) and quinolone resistance-determining regions (QRDRs) of gyrA, gyrB and parC was performed, and the macrolide resistance genes were detected by PCR. Genetic relatedness among the isolates was examined by PFGE and multilocus sequence typing. RESULTS All the PRGBS had the key amino acid substitution V405A, together with F395L, R433H, H438Y and G648A in PBP 2X and T567I in PBP 2B. A 23S rRNA methylase gene, erm(B), was also found in all 10 PRGBS strains. PFGE analysis revealed considerable genetic relatedness among the isolates. Isolates of pulsotype I were obtained from four patients in ward A and one patient in ward B, while isolates of pulsotypes II and III were obtained from two patients in ward B and one patient in ward C, respectively. Isolates of pulsotype I were resistant to levofloxacin (MIC >8 mg/L) and had the following amino acid substitutions in the QRDRs: S81L in GyrA, E476K in GyrB and S79Y in ParC. However, pulsotype II strains resistant to levofloxacin (MIC 8 mg/L) had no change in GyrA, but changes in GyrB (E476K) and ParC (S79Y). All 10 PRGBS strains belonged to serotype VI and ST458 (where ST stands for sequence type). CONCLUSIONS This is the first description of the nosocomial spread of multidrug-resistant PRGBS strains belonging to the genetic lineage ST458.
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Affiliation(s)
- Noriyuki Nagano
- Department of Bacteriology II, National Institute of Infectious Diseases, 4-7-1 Musashi-murayama, Tokyo 208-0011, Japan
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