Decline in Erythromycin Resistance in Group A Streptococci from Acute Pharyngitis due to Changes in the<i>emm</i>Genotypes Rather Than Restriction of Antibiotic Use

Koh, Eun-Ha; Kim, Sun Joo

doi:10.3343/kjlm.2010.30.5.485

Cited by 18 publications

(24 citation statements)

References 22 publications

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“…Some countries have a high proportion of mefA-positive isolates, whereas in other countries, erm genes dominate, leading to higher levels of clindamycin resistance. There is also temporal variation in the distribution of the mefAencoded and erm-encoded phenotypes within the same geographic region (496)(497)(498)(499)(500). Studies in Finland, Spain, and Italy have shown a strong correlation between macrolide usage and resistance of GAS (501)(502)(503).…”

Section: Resistance To Macrolidesmentioning

confidence: 99%

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

et al. 2014

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SUMMARY 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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Section: Resistance To Macrolidesmentioning

confidence: 99%

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

et al. 2014

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“…However, the drug production data from pharmaceutical companies witnessed a gradual increase in the availability of new macrolides, such as azithromycin, clarithromycin, and roxythromycin during the same period [14]. It is still unexplained why there was a drop in the ERY and CLI resistance rate in GAS during the last several years in Korea.…”

Section: Discussionmentioning

confidence: 99%

“…The resistance rates to these antibiotics exceeded 95% in China recently [7]. On the other hand, there were several reports on the decrease of the antibiotic resistance rate lately, including in Korea [14], Spain [15,16], Finland [17], and Japan [18].…”

Section: Discussionmentioning

confidence: 99%

“…Although the study period was similar between this multicenter study and the study of acute pharyngitis in Jinju, 2009 [14] (Fig. 1), the distributions of emm genotypes were quite different.…”

Section: Discussionmentioning

confidence: 99%

“…The authors reported a change in the antibiotic resistance rate and emm genotypes from acute pharyngitis in Jinju over a 7-year period [14]. The peak period of macrolide resistance seemed to have been 2002 in Korea [5,6,14].…”

Section: Discussionmentioning

confidence: 99%

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Multicenter Study of Molecular Epidemiology and Antibiotic Resistance of Group A Streptococci in 2008-2009 in Korea

Kim

Koh

Kim

et al. 2011

Korean J Clin Microbiol

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Background: Group A Streptococcus (GAS) is responsible for a wide spectrum of human diseases. We investigated the distribution of emm types and antibiotic resistance rates of GAS from clinical specimens in several Korean medical centers. Methods: A total of 192 strains of GAS from throat, blood, and other specimens collected in Seoul, Busan, Ulsan, Iksan, and Jeju were studied in [2008][2009]. The emm genotypes were identified using PCR and sequencing. Antimicrobial susceptibility testing was performed by disk diffusion method. Phenotypes of macrolide resistance were evaluated, and macrolide resistance genes were determined by PCR. Results: The emm89 (33.9%) was most frequently detected, followed by emm1 (12.5%), emm12 (8.3%), emm4 (7.8%), and emm75 (7.3%). The distribution of emm types did not show a close relation to the type of specimen and was different for each area. The resistance rates to erythromycin (ERY) and clindamycin (CLI) were 4.6% and 3.7%, respectively. Among the nine ERY-resistant strains, the rate of constitutive resistance was 88.9%, compared with 11.1% for the M phenotype. Five of the ERY-resistant strains were emm28. Conclusion: This multicenter study reveals heterogenous emm genotypes by geographic area. Rates of resistance to ERY and CLI were low, and most of the ERY-resistant strains showed a constitutive macrolide-lincosamide-streptogramin B (cMLSB) phenotype. (Korean J Clin Microbiol 2011;14:85-90)

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