1
|
Reijtman V, Gagetti P, Faccone D, Fossati S, Sommerfleck P, Hernández C, Bernáldez P, Lopardo H, Corso A. Macrolide resistance in Streptococcus pneumoniae isolated from Argentinian pediatric patients suffering from acute otitis media. Rev Argent Microbiol 2014; 45:262-6. [PMID: 24401781 DOI: 10.1016/s0325-7541(13)70034-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/02/2013] [Indexed: 10/25/2022] Open
Abstract
Macrolide-resistant Streptococcus pneumoniae emerged in Argentina in 1995, representing 26% of invasive infection isolates in children under 5 years old. The objectives of this study were to describe the prevalence of ermB and mefA genes in macrolide-resistant S. pneumoniae isolates from acute otitis media (AOM) and to determine their genetic relatedness. Between May 2009 and August 2010, 126 S. pneumoniae isolates from 324 otherwise healthy children with a first episode of AOM were included. Twenty six of these isolates (20.6%) were resistant to erythromycin. Most frequent serotypes were: 14 (46.2%), 6A (23.1%), 19F (7.7%) and 9V (7.7%). Twenty (76.9%) carried the mefA gene, 5 (19.2%) have the ermB gene, and 1 (3.9%) both ermB + mefA. Ten clonal types were identified, mostly related to Sweden(15A)-25/ST782 (SLV63), CloneB(6A)/ST473 and England(14)-9/ ST9. This is the first study assessing the mechanisms of macrolide resistance in pneumococci isolates from pediatric AOM in Argentina and their genetic relatedness.
Collapse
Affiliation(s)
- Vanesa Reijtman
- Servicio de Microbiología, Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Diego Faccone
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Sofía Fossati
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Patricia Sommerfleck
- Servicio de Otorrinolaringología, Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Claudia Hernández
- Servicio de Microbiología, Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Patricia Bernáldez
- Servicio de Otorrinolaringología, Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Horacio Lopardo
- Servicio de Microbiología, Hospital de Pediatría "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina.
| | - Alejandra Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| |
Collapse
|
2
|
Jeevajothi Nathan J, Mohd Desa MN, Thong KL, Clarke SC, Masri SN, Md Yasin R, Mohd Taib N. Genotypic characterization of Streptococcus pneumoniae serotype 19F in Malaysia. INFECTION GENETICS AND EVOLUTION 2013; 21:391-4. [PMID: 24342879 DOI: 10.1016/j.meegid.2013.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/27/2013] [Accepted: 11/30/2013] [Indexed: 11/24/2022]
Abstract
Streptococcus pneumoniae is an epidemiologically important bacterial pathogen. Recently, we reported the antibiotic susceptibility patterns of a limited collection of pneumococcal isolates in Malaysia with a high prevalence of erythromycin resistant strains. In the present study, 55 of the pneumococcal isolates of serotype 19F were further analysed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The generated genotypic patterns were then correlated with the antibiograms previously reported. Forty-seven different PFGE profiles (PTs) were obtained, showing that the isolates were genetically diverse. MLST identified 16 sequence types (STs) with ST-236 being predominant (58.2%), followed by ST-81 (10.3%). Among the ST-236 isolates, 22 were erythromycin resistant S. pneumoniae (ERSP) and 15 were trimethoprim/sulfamethoxazole (TMP/SMX) resistant, while among ST-81, four isolates were ERSP and two were TMP/SMX resistant. The high prevalence of erythromycin resistant serotype 19F isolates of ST-236 in this study has also been reported in other North and South East Asian countries.
Collapse
Affiliation(s)
- Jayakayatri Jeevajothi Nathan
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
| | - Mohd Nasir Mohd Desa
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
| | - Kwai Lin Thong
- Division of Microbiology, Institute of Biological Science, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia; Biomedical Science and Molecular Typing Laboratory, Institute of Graduate Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Stuart C Clarke
- Infectious Disease Epidemiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK; Institute of Life Sciences, University of Southampton, UK; Public Health England, Southampton, UK
| | - Siti Norbaya Masri
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
| | - Rohani Md Yasin
- Specialized Diagnostic Centre, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
| |
Collapse
|
3
|
Molecular resistance mechanisms of macrolide-resistant invasive Streptococcus pneumoniae isolates from Alaska, 1986 to 2010. Antimicrob Agents Chemother 2013; 57:5415-22. [PMID: 23959308 DOI: 10.1128/aac.00319-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rapid emergence of antibiotic-resistant pneumococcal strains has reduced treatment options. The aim of this study was to determine antimicrobial susceptibilities, serotype distributions, and molecular resistance mechanisms among macrolide-resistant invasive pneumococcal isolates in Alaska from 1986 to 2010. We identified cases of invasive pneumococcal disease in Alaska from 1986 to 2010 through statewide population-based laboratory surveillance. All invasive pneumococcal isolates submitted to the Arctic Investigations Program laboratory were confirmed by standard microbiological methods and serotyped by slide agglutination and the Quellung reaction. MICs were determined by the broth microdilution method, and macrolide-resistant genotypes were determined by multiplex PCR. Among 2,923 invasive pneumococcal isolates recovered from 1986 to 2010, 270 (9.2%) were nonsusceptible to erythromycin; 177 (66%) erythromycin-nonsusceptible isolates demonstrated coresistance to penicillin, and 167 (62%) were multidrug resistant. The most frequent serotypes among the macrolide-resistant isolates were serotypes 6B (23.3%), 14 (20.7%), 19A (16.7%), 9V (8.9%), 19F (6.3%), 6A (5.6%), and 23F (4.8%). mef and erm(B) genes were detected in 207 (77%) and 32 (12%) of the isolates, respectively. Nineteen (7%) of the erythromycin-nonsusceptible isolates contained both mef and erm(B) genotypes; 15 were of serotype 19A. There was significant year-to-year variation in the proportion of isolates that were nonsusceptible to erythromycin (P < 0.001). Macrolide resistance among pneumococcal isolates from Alaska is mediated predominantly by mef genes, and this has not changed significantly over time. However, there was a statistically significant increase in the proportion of isolates that possess both erm(B) and mef, primarily due to serotype 19A isolates.
Collapse
|
4
|
Risk factors for 30-day mortality in adult patients with pneumococcal bacteraemia, and the impact of antimicrobial resistance on clinical outcomes. Epidemiol Infect 2011; 140:1267-76. [DOI: 10.1017/s0950268811001816] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYThe clinical impact of antimicrobial resistance on the outcome of pneumococcal bacteraemia has remained unclear. This study aimed to evaluate risk factors for mortality and determine the impact of antimicrobial resistance on clinical outcomes. A total of 150 adult patients with pneumococcal bacteraemia were identified over a period of 11 years at Seoul National University Hospital. Of the 150 patients, 122 (81·3%) had penicillin-susceptible (Pen-S) strains and 28 (18·7%) penicillin-non-susceptible (Pen-NS) strains; 43 (28·7%) had erythromycin-susceptible (EM-S) strains and 107 (71·3%) erythromycin-non-susceptible (EM-NS) strains. On multivariate analysis, elevated APACHE II score [odds ratio (OR) 1·24, 95% confidence interval (CI) 1·14–1·34, P<0·001) and presence of solid organ tumour (OR 2·99, 95% CI 1·15–7·80, P=0·025) were independent risk factors for mortality. Neither erythromycin resistance nor penicillin resistance had a significant effect on clinical outcomes. However, for the 76 patients with pneumococcal pneumonia, the time required for defervescence was significantly longer in the EM-NS group than in the EM-S group (5·45±4·39 vs. 2·93±2·56, P=0·03 by log rank test). In conclusion, antimicrobial resistance does not have an effect on mortality in adult patients with pneumococcal bacteraemia.
Collapse
|
5
|
Zhang B, Gertz RE, Liu Z, Li Z, Fu W, Beall B. Characterization of highly antimicrobial-resistant clinical pneumococcal isolates recovered in a Chinese hospital during 2009-2010. J Med Microbiol 2011; 61:42-48. [PMID: 21873379 DOI: 10.1099/jmm.0.035675-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ninety-one consecutive pneumococcal isolates (primarily from sputum), recovered in Chongqing Southwest Hospital during a 12 month period in 2009-2010 from individuals of all ages with suspected cases of pneumococcal disease, were subjected to PCR-serotyping, Quellung reaction serotyping, antimicrobial-susceptibility testing and multilocus sequence typing (MLST). Although 20 different serotypes were observed, most isolates (69, 75.8 %) were of serotypes included in the pneumococcal 13-valent conjugate vaccine (PCV13), including 33 of the 46 (71.7 %) isolates recovered from individuals less than 5 years of age. The prevalent serotypes were 19F (34 %), 19A (9.9 %), 6B (9.9 %), 23F (7.7 %), 14 (6.6 %) and 6A (4.4 %). PCR-determined serotypes were in agreement with Quellung testing, with the exception of two serotype 33C isolates. Most or all isolates within each PCV13 serotype were represented by one genotype, with the globally disseminated MLST sequence types (STs) ST271, ST320, ST90 and ST81 each accounting for the highly resistant isolates within serotypes 19F, 19A, 6B and 23F, respectively. Sixty-six (72.5 %) isolates were resistant to combinations of β-lactam antibiotics (BLAs). A total of 63 of these 66 (95.5 %) BLA-resistant isolates were of serotypes included in PCV13; however, 3 serogroup 15 isolates were also BLA-resistant. Most isolates (88/91 = 96.7 %) were resistant to erythromycin and clindamycin. The majority of isolates were also resistant to tetracycline (76, 84 %) and to cotrimoxazole (67, 74 %). This work revealed that the majority of antimicrobial-resistant isolates (50/91 = 54.9 %) recovered in this Chinese hospital were represented by four global clones. Serotypes for these as well as more obscure strains were readily determined by using PCR.
Collapse
Affiliation(s)
- Bo Zhang
- Chongqing Southwest Hospital, Chongqing, PR China
| | - Robert E Gertz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyong Liu
- Chongqing Southwest Hospital, Chongqing, PR China
| | - Zhongya Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Weiling Fu
- Chongqing Southwest Hospital, Chongqing, PR China
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
6
|
Lee KK, Ryoo NH, Kim ST, Chae SL, Huh HJ. [Evaluation of the BD phoenix automated microbiology system SMIC/ID-2 panel for antimicrobial susceptibility testing of Streptococcus pneumoniae]. Korean J Lab Med 2009; 29:212-7. [PMID: 19571618 DOI: 10.3343/kjlm.2009.29.3.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the emergence of antimicrobial resistance among Streptococcus pneumoniae, a more accurate and automated antimicrobial susceptibility testing method is essential. We evaluated the BD Phoenix Automated Microbiology System (Becton Dickinson Diagnostic Systems, USA) SMIC/ID-2 panel for antimicrobial susceptibility testing of S. pneumoniae. METHODS A total of 113 clinical strains of S. pneumoniae (88 penicillin susceptible strains, 8 intermediate strains, and 17 resistant strains by 2008 CLSI criteria) were tested. Minimum inhibitory concentrations (MICs) for penicillin, cefotaxime, clindamycin, erythromycin, levofloxacin, trimethoprim/ sulfamethoxazole, tetracycline, and vancomycin were determined by Etest (AB Biodisk, Sweden) and Phoenix System. The results obtained by Phoenix system were compared to those obtained by Etest. RESULTS The overall essential agreement of MICs (within one dilution of MICs) defined by the Phoenix and Etest was 92.3%. Neither very major errors nor major errors were produced, and minor errors were 6.5%. Minor errors were frequently observed in susceptibility testings for penicillin (22.1%), cefotaxime (12.4%), and trimethoprim/sulfamethoxazole (11.5%). CONCLUSIONS The Phoenix SMIC/ID-2 panel provided a simple and rapid susceptibility testing for S. pneumoniae, and the results were in a good agreement with those of Etest. The Phoenix system appears to be an effective automated system in clinical microbiology laboratories.
Collapse
Affiliation(s)
- Kyo Kwan Lee
- Department of Laboratory Medicine, Dongguk University International Hospital, Ilsandong-Gu, Goyang, Korea
| | | | | | | | | |
Collapse
|
7
|
Mitchell SC, Ruby JD, Moser S, Momeni S, Smith A, Osgood R, Litaker M, Childers N. Maternal transmission of mutans Streptococci in severe-early childhood caries. Pediatr Dent 2009; 31:193-201. [PMID: 19552223 PMCID: PMC3173944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE This study utilized multiple genetic analyses to detect evidence of maternal MS acquisition in children with S-ECC. METHODS Twenty-seven mother/child pairs were selected from children with 5-ECC preceding dental rehabilitation under general anesthesia. Plaque samples were collected from the mother, child, and the child's carious lesion. Arbitrarily primed-polymerase chain reaction (AP-PCR) genotyped 6-8 MS isolates from each plaque sample, and unique genotypes were identified. Representative MS isolates with unique genotypes were characterized by pulsed-field gel electrophoresis (PFGE). Cluster analysis using the Dice band-based similarity coefficient was used to generate dendrograms from gel bonding patterns. A Dice coefficient >70% indicated similarity or match among PFGE genotypes. RESULTS In 26% (7/27) of mother/child pairs, all of the child's isolates matched the mother. In 15% (4/27), some of the child's genotypes matched the mother, and in 59% (16/27), no isolates matched the mother. Maternal transmission was a mode of MS acquisition in 41% (11/27) of mother/child pairs, while acquisition from non-maternal sources occurred in 74% (20/27). CONCLUSIONS MS genotypes that did not match maternal strains were identified in the majority of children (74%) within this S-ECC population. Evidence of maternal transmission was detected in 41% of mother/child pairs.
Collapse
Affiliation(s)
- Stephen C Mitchell
- Department of Pediatric Dentistry, School of Dentistry, The University of Alabama at Birmingham, Birmingham, USA.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Bae S, Lee K. Distribution of capsular serotypes and macrolide resistance mechanisms among macrolide-resistant Streptococcus pneumoniae isolates in Korea. Diagn Microbiol Infect Dis 2009; 63:213-6. [DOI: 10.1016/j.diagmicrobio.2008.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 10/02/2008] [Accepted: 10/03/2008] [Indexed: 11/29/2022]
|
9
|
Genotypes of macrolide-resistant pneumococci from children in southwestern Japan: raised incidence of strains that have both erm(B) and mef(A) with serotype 6B clones. Diagn Microbiol Infect Dis 2008; 62:16-22. [DOI: 10.1016/j.diagmicrobio.2007.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 10/16/2007] [Accepted: 10/19/2007] [Indexed: 11/22/2022]
|
10
|
Artiles F, Horcajada-Herrera I, Noguera-Catalán J, Álamo-Antúnez I, Bordes-Benítez A, Lafarga-Capuz B. Resistencia antibiótica a los macrólidos en Streptococcus pneumoniae en las islas de Gran Canaria y Lanzarote: mecanismos moleculares y relación con serogrupos. Enferm Infecc Microbiol Clin 2007; 25:570-5. [DOI: 10.1157/13111183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Khan SN, Kim BJ, Kim HS. Synthesis and antimicrobial activity of 7-fluoro-3-aminosteroids. Bioorg Med Chem Lett 2007; 17:5139-42. [PMID: 17658254 DOI: 10.1016/j.bmcl.2007.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/29/2007] [Accepted: 07/02/2007] [Indexed: 11/23/2022]
Abstract
A series of 7-fluoro-3-aminosteroids were synthesized and their in vitro antimicrobial activities were evaluated against Gram-positive and Gram-negative bacteria. The nucleophilic fluorination of several 7beta-hydroxysteroids by diethylaminosulfur trifluoride in n-pentane, followed by reductive amination of the resulting 7-fluoro-3-ketosteroids with spermidine in the presence of NaBH(3)CN, afforded 7-fluoro-3-aminosteroids in high yield. Compound 25 showed the highest antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, and Escherichia coli.
Collapse
Affiliation(s)
- Sharaf Nawaz Khan
- Department of Applied Chemistry, Kyungpook National University, Daegu 702-701, Republic of Korea
| | | | | |
Collapse
|
12
|
Hung SW, Wang SL, Tu CY, Tsai YC, Chuang ST, Shieh MT, Liu PC, Wang WS. Antibiotic susceptibility and prevalence of erythromycin ribosomal methylase gene, erm(B) in Streptococcus spp. Vet J 2007; 176:197-204. [PMID: 17400007 DOI: 10.1016/j.tvjl.2007.02.008] [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: 10/31/2006] [Revised: 01/25/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate drug resistance and the genetic relatedness of erythromycin-resistant Streptococcus spp. from different animals and humans in Taiwan. Cumulatively, 248 isolates were collected from 15 animal species and human patients and the susceptibilities of the isolates to six antimicrobial agents including azithromycin (AZI), clarithromycin (CLAR), erythromycin (ERY), spiramycin (SPIR), amoxicillin (AMO), and enrofloxacin (ENRO) were determined by the agar dilution method. The results indicated that resistance among the 248 strains was highest for SPIR, followed by ENRO, CLAR, ERY, AZI, and AMO. The most common resistotypes of the isolates from mammals and aquatic animals were AZI-CLAR-ERY-SPIR (27.5%) and SPIR (55.1%), respectively. The presence of ERY-resistant genes was confirmed by PCR. The erm gene was amplified from 28 isolates (20.6%) by PCR for further investigation. The predominant erm gene in the ERY-resistant isolates was the erm(B) gene. The phylogenetic analysis of the erm(B) gene results indicated that there was a close genetic relationship among all the strains but the genotypic clusters did not show clear segregation of the isolates according to the source or region.
Collapse
Affiliation(s)
- Shao-Wen Hung
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, 250, Kuo-Kuang Road, Taichung City 402, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
13
|
DiPersio LP, DiPersio JR, Beach JA, DeFine LA. Rise of Streptococcus pneumoniae isolates containing both erm(B) and mef(E) genes from an adult tertiary care community hospital system. Diagn Microbiol Infect Dis 2006; 55:327-31. [PMID: 16626911 DOI: 10.1016/j.diagmicrobio.2006.01.030] [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] [Received: 11/07/2005] [Revised: 01/19/2006] [Accepted: 01/23/2006] [Indexed: 11/17/2022]
Abstract
The emergence of macrolide- and lincosamide-resistant Streptococcus pneumoniae is a worldwide concern. Of particular interest is the increasing prevalence of erythromycin and clindamycin-resistant isolates containing both erm(B) and mef genes. This study determined the prevalence of erythromycin and clindamycin resistance in 596 clinical S. pneumoniae isolates from 2 adult tertiary care hospitals over a 4-year period (2001-2004). Erythromycin resistance increased from 24% to 34%, but S. pneumoniae isolates resistant to clindamycin as well as to erythromycin increased from 3% in 2001 to 15.5% in 2004 (5-fold increase). Among erythromycin-resistant isolates, those also resistant to clindamycin (MLS(B) phenotype) increased 3-fold (12.8-45%). Of forty-one erythromycin/clindamycin-resistant S. pneumoniae isolates tested, 29 (71%) contained both erm(B) and mef(E) genes. Pulsed-field gel electrophoresis performed on 28 erm(B) + mef(E) positive isolates identified 2 predominant and possibly related clones, which made up 64% of the isolates.
Collapse
Affiliation(s)
- Linda P DiPersio
- Falor Division of Surgical Research, Summa Health System, Akron, OH 44304, USA
| | | | | | | |
Collapse
|
14
|
Toltzis P, Dul M, O'Riordan MA, Jacobs MR, Blumer J. Serogroup 19 pneumococci containing both mef and erm macrolide resistance determinants in an American city. Pediatr Infect Dis J 2006; 25:19-24. [PMID: 16395097 DOI: 10.1097/01.inf.0000195784.27503.f0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asia has experienced a striking incidence of infection by highly resistant pneumococi containing both principal macrolide resistance determinants, namely, the mef efflux pump and the erm ribosomal methylase. mef/erm-containing pneumococci have not been identified in significant numbers in North America. METHODS Pneumococci were isolated as part of a larger study in Cleveland, OH examining colonization patterns among children randomized to 1 of 4 outpatient antibiotics for acute otitis media. Azithromycin-resistant organisms were tested for the presence of mef and erm sequences by polymerase chain reaction. The clonal relationship of pneumococci containing both genes was determined by pulsed field gel electrophoresis and multilocus sequence testing. Selected characteristics of children harboring mef/erm-containing organisms were compared with other participants of the larger study. RESULTS Of 221 children colonized by pneumococci, 17 (7.7%) were colonized with an organism containing both determinants. All mef/erm-positive organisms demonstrated azithromycin minimum inhibitory concentrations > or =256 microg/mL and were coresistant to all other agents tested. The mef/erm-containing organisms were serotype 19A and 19F, all but 1 of which manifested similar pulsed field gel electrophoresis patterns. Multilocus sequence testing analysis indicated a relationship to the Taiwan-14 macrolide-resistant strain that has spread throughout Eastern Asia. More than one-third of children colonized by a mef/erm-containing organism had received > or =1 dose of conjugate pneumococcal vaccine, a significantly higher proportion than children carrying less resistant organisms (P< 0.01). No other characteristics distinguished children harboring a mef/erm-containing pneumococcus from other children enrolled in the larger study. CONCLUSION Clonally related mef/erm-containing serogroup 19 pneumococci were prominent among otherwise healthy children in a North American metropolitan area. Our findings suggest that spread of these organisms may be poorly contained by immunization.
Collapse
Affiliation(s)
- Philip Toltzis
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | | |
Collapse
|
15
|
Farrell DJ, Jenkins SG, Brown SD, Patel M, Lavin BS, Klugman KP. Emergence and spread of Streptococcus pneumoniae with erm(B) and mef(A) resistance. Emerg Infect Dis 2005; 11:851-8. [PMID: 15963279 PMCID: PMC3367592 DOI: 10.3201/eid1106.050222] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Streptococcus pneumoniae isolates (N = 31,001) were collected from patients with community-acquired respiratory tract infections during the PROTEKT US surveillance study (2000–2003). While the macrolide (erythromycin) resistance rate remained stable at ≈29%, the prevalence of resistant isolates containing both erm(B) and mef(A) increased from 9.7% in year 1 to 16.4% in year 3, with substantial regional variability. Almost all (99.2%) dual erm(B)+mef(A) macrolide-resistant isolates exhibited multidrug resistance, whereas 98.6% and 99.0% were levofloxacin- and telithromycin-susceptible, respectively. These strains were most commonly isolated from the ear or middle-ear fluid of children. Of 152 representative erm(B)+mef(A) isolates, >90% were clonally related to the multidrug-resistant international Taiwan19F-14 clonal complex 271 (CC271). Of 366 erm(B)+mef(A) isolates from the PROTEKT global study (1999–2003), 83.3% were CC271, with the highest prevalence seen in South Africa, South Korea, and the United States. This study confirms the increasing global emergence and rapidly increasing US prevalence of this multidrug-resistant pneumococcal clone.
Collapse
|
16
|
Johnson CN, Briles DE, Benjamin WH, Hollingshead SK, Waites KB. Relative fitness of fluoroquinolone-resistant Streptococcus pneumoniae. Emerg Infect Dis 2005; 11:814-20. [PMID: 15963274 PMCID: PMC3367570 DOI: 10.3201/eid1106.040840] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Fluoroquinolone resistance in Streptococcus pneumoniae is primarily mediated by point mutations in the quinolone resistance–determining regions of gyrA and parC. Antimicrobial resistance mutations in housekeeping genes often decrease fitness of microorganisms. To investigate the fitness of quinolone-resistant S. pneumoniae (QRSP), the relative growth efficiencies of 2 isogenic QRSP double mutants were compared with that of their fluoroquinolone-susceptible parent, EF3030, by using murine nasopharyngeal colonization and pneumonia models. Strains containing the GyrA: Ser81Phe, ParC: Ser79Phe double mutations, which are frequently seen in clinical QRSP, competed poorly with EF3030 in competitive colonization or competitive lung infections. However, they efficiently produced lung infection even in the absence of EF3030. The strain containing the GyrA: Ser81Phe, ParC: Ser79Tyr double mutations, which is seen more frequently in laboratory-derived QRSP than in clinical QRSP, demonstrated reduced nasal colonization in competitive or noncompetitive lung infections. However, the strain was equally able to cause competitive or noncompetitive lung infections as well as EF3030.
Collapse
Affiliation(s)
| | - David E. Briles
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Ken B. Waites
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
17
|
Hotomi M, Billal DS, Shimada J, Suzumoto M, Yamauchi K, Fujihara K, Yamanaka N. Increase of Macrolide-Resistant Streptococcus pneumoniae-Expressing mefE or ermB Gene in the Nasopharynx among Children with Otitis Media. Laryngoscope 2005; 115:317-20. [PMID: 15689758 DOI: 10.1097/01.mlg.0000154740.48314.d5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate prevalence of macrolide resistant strains and the genotypes of the resistance among Streptococcus pneumoniae isolated from the nasopharynx of children with otitis media. STUDY DESIGN Retrospective review. METHODS A total of 858 S. pneumoniae isolates were collected from the nasopharynx of pediatric patients with acute otitis media at the clinics of Otolaryngology-Head and Neck Surgery, Wakayama Medical University Hospital and six affiliated hospitals in Wakayama prefecture between January 1998 and December 2002. The antibiotic susceptibility patterns were analyzed for penicillin, erythromycin, and clindamycin according to the National Committee for Clinical Laboratory Standards. Macrolide resistance genes of mefE and ermB were determined by polymerase chain reaction of all S. pneumoniae. RESULTS Of 858 clinical isolates, 259 (30.1%) were strains without ermB or mefE gene, 279 (32.5%) carrying mefE, 292 (34.0%) carrying ermB, and 28 (3.4%) carrying both genes. There was a strong correlation between phenotypes and the presence of macrolide resistance genes. The macrolide resistance genes were especially frequently identified among penicillin-resistant S. pneumoniae. Strains carrying ermB gene gradually increased from 25% in 1998 to 45% in 2002, with a concurrent decrease in strains carrying mefE from 36% in 1998 to 1999 to 19% in 2002. Strains having mefE were frequently identified among children younger than 2 years old. The current finding suggested that high-level ermB-mediated macrolide resistance in S. pneumoniae is increasing at an alarming rate in pediatric patients with otitis media, especially among young children. Physicians should pay close attention to such macrolide-resistant bacterial pathogens in the antimicrobial treatment of pediatric patients with otitis media.
Collapse
Affiliation(s)
- Muneki Hotomi
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama 641-0012, Japan
| | | | | | | | | | | | | |
Collapse
|