A common clone of erythromycin-resistant Streptococcus pneumoniae in Greece and the UK

Fotopoulou, Niki; Tassios, Panayotis T.; Beste, Dany J. V.; Ioannidou, Sofia; Efstratiou, A; Lawrence, Elliot R.; Papaparaskevas, J.; George, Robert C.; Legakis, Nicholas J.

doi:10.1046/j.1469-0691.2003.00689.x

Cited by 16 publications

(17 citation statements)

References 28 publications

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“…In Europe, it is now being increasingly reported from France and Spain. The present study shows that in France (87.5%), Spain (77.3%), Switzerland (80%), and Poland (100%), strains are predominantly erm(B) positive, whereas high levels of mef(A)-positive strains are reported from Greece (100%) and Germany (33.3%), confirming the findings of other investigators (6,7,20,21,25,26). Notably, none of the strains was found to be mef(A)-and erm(B)-negative, suggesting the absence of one of the recently described new macrolide resistance mechanisms, such as mutations in the 23S rRNA or alterations in ribosomal proteins L4 and L22.…”

Section: Discussionsupporting

confidence: 91%

Molecular Epidemiology of Macrolide-Resistant Streptococcus pneumoniae Isolates in Europe

et al. 2005

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In many European countries, the level of pneumococcal resistance to macrolides has now passed the level of resistance to penicillin G. A total of 82 erythromycin A-resistant isolates of Streptococcus pneumoniae were collected by 11 laboratories in seven European countries. All of the isolates were tested for antimicrobial susceptibility, analyzed for clonal relatedness by multilocus sequence typing, and characterized for macrolide resistance genotypes. The prevalence of the macrolide resistance genotypes varied substantially between countries. In France (87.5% of all strains), Spain (77.3%), Switzerland (80%), and Poland (100%), strains were predominantly erm(B) positive, whereas higher levels of mef(A)-positive strains were reported from Greece (100%) and Germany (33.3%). Macrolide resistance was caused by the oligoclonal spread of some multilocus sequence types, but significant differences in clonal distribution were noted between France and Spain, countries from which high levels of macrolide resistance have been reported. Overall, sequence type 81 (Spain23F-1 clone) was by far the most widespread. The mainly erm(B)-positive serotype 14 clone (sequence type 143), first reported in Poland in the mid-1990s, is now widespread in France.

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Section: Discussionsupporting

confidence: 91%

Molecular Epidemiology of Macrolide-Resistant Streptococcus pneumoniae Isolates in Europe

et al. 2005

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“…The increase in the M phenotype among pneumococci reported in some European countries has been associated with the England 14 -9 clone of serotype 14, which harbors the mefA subclass of the mefA gene (1,5,8,16). In our study, serotype 14 was also the most frequently serotype found, but the Spain 9V -3 clone of serotype 14 with mefE was more prevalent than the England 14 -9 clone with mefA.…”

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confidence: 49%

“…The England 14 -9 clone, first described in the United Kingdom (11), is characterized by the presence of the mefA subclass mefA gene, which is part of a genetic element (Tn1207.1) that has been found in strains from Italy and the United Kingdom (1,5). This clone is an important cause of meningitis throughout the United Kingdom (1,11), and it has been recently described in Italy (16), Greece (8), and now in Spain, suggesting the spread of this clone among Mediterranean countries.…”

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Distribution of Subclasses mefA and mefE of the mefA Gene among Clinical Isolates of Macrolide-Resistant (M-Phenotype) Streptococcus pneumoniae , Viridans Group Streptococci, and Streptococcus pyogenes

Ardanuy¹,

Tubau²,

Liñares

et al. 2005

Antimicrob Agents Chemother

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“…Clones England 14 -9 and Taiwan 19F -14 are the major contributors to the worldwide dissemination of M phenotype strains (7, 12; http://www.mlst.net). The England 14 -9 clone harboring mef(A) has been described as being predominant among M phenotype pneumococci isolated in England, Italy, and Greece (1,9). In contrast, the strains of the England 14 -9 clone described in the United States carried the mef(E) gene (12).…”

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confidence: 99%

Clonal Spread of mef -Positive Macrolide-Resistant Streptococcus pneumoniae Isolates Causing Invasive Disease in Adults in Germany

Linden

Al‐Lahham

Haupts

et al. 2007

Antimicrob Agents Chemother

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Isolates (3,845) obtained from German adults with invasive pneumococcal disease between 1992 and 2004 were investigated. Of these, 430 isolates (11.2%) were erythromycin A nonsusceptible. Macrolide resistance genotypes and multilocus sequence types were determined. Among the isolates, 35.6% were erm(B) positive and 63.5% were mef positive. Over the study period, the frequency of resistance rose significantly from 2.2 to 17.0% (P < 0.001). A serotype 14, sequence type 9 clone was the most widespread.Streptococcus pneumoniae continues to be a significant cause of morbidity and mortality in humans. The worldwide increase in antibiotic resistance in pneumococci has become a serious infectious-disease problem within the last 20 years. Macrolide resistance in S. pneumoniae is usually caused by the presence of the erm(B) or the mef(E) or mef(A) resistance determinant. The erm(B) gene encodes a 23S rRNA methylase that confers resistance to 14-, 15-, and 16-member-ring macrolides, lincosamides, and streptogramin B. The mef(E) and mef(A) genes, which are carried by different genetic elements, encode an efflux pump that leads to resistance to 14-and 15-member-ring macrolides (the M phenotype) (14,20). Other rare mechanisms of macrolide resistance are changes in a highly conserved region of domain V of 23S rRNA, which plays a key role in macrolide binding, and in ribosomal proteins L4 and L22 (3, 5, 18, 21).Multilocus sequence typing (MLST) is a recently developed technique that produces unambiguous molecular typing data by using the sequences of seven loci to obtain an allelic profile of each strain (6, 11; http://www.mlst.net). The present study used this technique to analyze the genetic relatedness of clinical erythromycin A-resistant strains of S. pneumoniae isolated from adults with invasive pneumococcal disease in Germany.The German National Reference Center for Streptococci received consecutive isolates from 126 clinical microbiological laboratories throughout Germany. Inclusion criteria were isolation from an individual of Ͼ16 years and isolation from a normally sterile body site.MIC testing, serotyping, the determination of resistance genotypes and phenotypes, and MLST of 62 randomly selected macrolide-resistant strains were performed as described previously (11, 13).Multilocus sequence types were analyzed using the program eBURST, which displays relationships between closely related isolates of a bacterial species or population. eBURST, unlike cluster diagrams, trees, or dendrograms, uses a simple but appropriate model of bacterial evolution in which an ancestral (or founding) genotype increases in frequency in the population and, while doing so, begins to diversify to produce a cluster of closely related genotypes that are all descended from the founding genotype. This cluster of related genotypes is referred to as a clonal complex (8; http://eburst.mlst.net). A phylogenetic tree using maximum likelihood was created with the program Puzzle (19; http://genius.dkfz-heidelberg.de).A total of 3,845 isolates were con...

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A common clone of erythromycin-resistant Streptococcus pneumoniae in Greece and the UK

Abstract: The present study showed that erythromycin resistance among the S. pneumoniae isolates was mostly owing to the efflux mechanism and suggested a possible clonal spread of serotype 14 erythromycin-resistant S. pneumoniae strains between Greece and the UK.

Cited by 16 publications

References 28 publications

Molecular Epidemiology of Macrolide-Resistant Streptococcus pneumoniae Isolates in Europe

Molecular Epidemiology of Macrolide-Resistant Streptococcus pneumoniae Isolates in Europe

Distribution of Subclasses mefA and mefE of the mefA Gene among Clinical Isolates of Macrolide-Resistant (M-Phenotype) Streptococcus pneumoniae , Viridans Group Streptococci, and Streptococcus pyogenes

Clonal Spread of mef -Positive Macrolide-Resistant Streptococcus pneumoniae Isolates Causing Invasive Disease in Adults in Germany

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