Antimicrobial Use and Colonization with Erythromycin‐ResistantStreptococcus pneumoniaein Greece during the First 2 Years of Life

Abstract

We evaluated nasopharyngeal colonization with erythromycin-resistant Streptococcus pneumoniae during the first 2 years of life in central and southern Greece. Of 2448 children studied from February 1997 to February 1999, 766 (31%) carried 781 pneumococcal isolates. Ninety-five (3.9%) of the children attended day care centers. Eighteen percent of the pneumococci were resistant to erythromycin (minimal inhibitory concentration 1 to >128 microg/mL), with 67.9% of them carrying the erm(B) gene and 29.2% mef(A) gene products. Four strains possessed neither the erm(B) nor the mef(A) gene. Multidrug resistance occurred in 97% and 40% of isolates carrying the erm(B) and mef(A) gene, respectively. An association was found between the erm(B) gene and serotypes 6B and 23F and between the mef(A) gene and serotypes 14 and 19F. A significant relationship existed between carriage of erythromycin-resistant pneumococci and use of macrolides or beta-lactams in the previous 3 months; the association was strongest when macrolide therapy was administered during the last month (odds ratio, 5.92; P=.0001). The findings indicate the necessity of a judicious use of both macrolides and beta-lactams in young children to reduce the colonization with erythromycin-resistant pneumococci and the subsequent spread of such strains to the community.

Molecular Epidemiology of Penicillin-Susceptible Non-β-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

“…We studied a collection of 128 S. pneumoniae isolates susceptible to penicillin but resistant to erythromycin and/or other non-␤-lactam agents; the isolates were recovered from nasopharyngeal cultures obtained from children during two independent studies in Greece (3,30,31). The first study was performed in 338 children attending seven day care centers in the city of Patras in southwestern Greece during the 2-month period from December 1995 to February 1996.…”

“…Isolation, identification, and susceptibility testing of the Greek S. pneumoniae isolates were performed by applying standard methods as described previously (30,31). Penicillin and erythromycin MICs for the Greek isolates were determined by the E-test method (AB Biodisk, Solna, Sweden).…”

“…During the period from December 1995 to February 1996, 24% of the pneumococci isolated from healthy carriers attending day care centers were demonstrated to be penicillin-susceptible, non-␤-lactamresistant isolates (29). In a recent study in which 2,448 children younger than 2 years old living in various areas in Greece were screened during a 2-year period (1997 to 1999) for pneumococcal carriage, 15% of the pneumococci appeared to have reduced susceptibility to non-␤-lactam agents (31).…”

Non-Antibiotic Treatment for Pediatric Outpatients With Common Cold Inhibits the Emergence of Drug Resistant Pneumococci

“…Worldwide, risk factors for the carriage of resistant S. pneumoniae have been well investigated in the last couple of decades [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] and those studies reported that the most influencing factor was the previous use of antibiotics. Unnecessary use of antibiotics had been thought to cause this emergence of antibiotic resistant S. pneumoniae.…”

Antimicrobial Susceptibility and Macrolide Resistance Inducibility of Streptococcus pneumoniae Carrying erm (A), erm (B), or mef (A)

“…The presence of genes coding for macrolide resistance was studied by PCR as described previously (8,12,13 (14,15), were evaluated for their susceptibility to 10 antibiotics representing different classes of antimicrobial agents. These agents were 14-member (erythromycin and clarithromycin), 15-member (azithromycin), and 16-member ring macrolides (miocamycin), lincosamides (clindamycin), streptogramins (quinupristin/dalfopristin), ketolides (telithromycin), penicillin G, tetracycline, and chloramphenicol.…”