Macrolide Resistance inStreptococcus pyogenesIsolates from Throat Infections in the Region of Aachen, Germany

Abstract

Macrolide-resistance was assessed in 216 consecutive Streptococcus pyogenes isolates from throat infections in the region of Aachen, Germany. Seventeen isolates were resistant to erythromycin: 12 isolates revealed a macrolide (M) phenotype and harbored mefA, and five strains expressed an inducible macrolide-lincosamide-streptogramin B (MLSB) phenotype of which four strains harbored ermA(TR) and one strain contained ermB(AM). Telithromycin (HMR 3647) and quinupristin/dalfopristin remained active particularly against the ermA(TR)-containing S. pyogenes isolates studied. Random amplified polymorphic DNA analysis identified multiple clones among erythromycin-resistant strains, but did not discriminate beyond the emm-type. mefA was present in three isolates either with emm2, emm12, or emm75, and in nine isolates with emm4. All four strains with ermA(TR) contained emm77, and the single strain with ermB(AM) harbored emm1. Despite the relative low rate of macrolide-resistance, these data suggest that at least three different macrolide-resistance determinants are prevalent in Germany and that mefA has spread rapidly into multiple clones of S. pyogenes.

Macrolide-Resistant Streptococcus pneumoniae and Streptococcus pyogenes in the Pediatric Population in Germany during 2000-2001

“…Prior to the early 1990s, penicillin resistance remained uncommon among clinical isolates of S. pneumoniae in Germany despite the emergence of this problem in many parts of Europe, e.g., Hungary, Spain, and France (2). In contrast, decreased susceptibility to macrolides in S. pyogenes and to ␤-lactams and macrolides in S. pneumoniae has only recently been reported in Germany (4,21,23) and is comparable to resistance rates reported from The Netherlands (10) and Northern European countries (18). Highly penicillin-resistant strains are extremely rare in Germany, as documented by this and other studies.…”

“…Brandt et al recently reported macrolide resistance to be present in 17 of 216 (7.9%) S. pyogenes strains isolated from throat infections in the Aachen region of Germany between January 1997 and July 1997 (4). Again, these data suggest that, as for pneumococci, the frequency of macrolide resistance is increasing in Germany.…”

“…The following primer pairs were used: 5Ј-TTA TAA CCG GCA AGG AGA-3Ј and 5Ј-GCT TCA GCA CCT GTC TTA ATT GAT-3Ј for erm(A), 5Ј-AAA (C/T)TG ATT TTT (A/T)GT AAA-3Ј and 5Ј-AGG TAA AGG GCA TTT-3Ј for erm(B), and 5Ј-CTA TGA CAG CCT CAA TGC G-3Ј and 5Ј-ACC GAT TCT ATC AGC AAA G-3Ј for mef(A) (4). Nucleotide sequences for 23S rRNA and L4 and L22 ribosomal proteins in Escherichia coli and S. pneumoniae were obtained from the Institute for Genome Research website (http://www.tigr.org/.).…”

Erythromycin-Resistant Group A Streptococcal Isolates Recovered in Sofia, Bulgaria, from 1995 to 2001

“…Since we have not encountered emm12.10 elsewhere, it is possible that the population from which we obtained these GAS isolates is relatively segregated. However, except for types emm117, emm33, and emm43 (subtype emm43.4), all of the sequences described in this study have been associated with erythromycin resistance in other countries (2,5,8,15; B. Beall, unpublished data), indicating that the majority of erythromycin-resistant GAS strains could have originated in other countries prior to their introduction into Sofia.…”

Erythromycin-Resistant Pharyngeal Isolates of Streptococcus pyogenes Recovered in Italy

“…We found that macrolide resistance within our sample set of 127 resistant isolates, with the exception of a single erm(B)-positive type emm5.3 isolate, was restricted to sof-positive strains (Table 2) which have been estimated to comprise about 65% of invasive and noninvasive GAS isolates recovered in the United States (B. Beall, unpublished data). Analysis of the published literature concerning macrolide resistance in GAS revealed similar results in Chile, Canada, Finland, Germany, Spain, and Sweden in that each study primarily described macrolide resistance in sof-positive types (including types M2, M4, M11, M12, M22, M28, M58, M73, M75, and M77) (6,12,19,21,27,28,40). (For a compilation of sof PCR-positive types and opacity factor-positive types, see references 4 and 20.)…”