Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India

et al. 2020

BMC Infect Dis

Background: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. Methods: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA), emm (M proteincoding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). Results: A total of 297 GAS isolates were collected. The susceptibility of the isolates to penicillin, ceftriaxone, and levofloxacin was 100%. The resistance rate to erythromycin and clindamycin was 98.3 and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%), speC (92.59%), speG (91.58%), ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm1 possessed speA, speC, speG, speJ, speM, ssa, and smeZ, while emm12 possessed speC, speG, speH, speI, speM, ssa, and smeZ superantigens. Conclusions: The prevalent strain of GAS isolates in Beijing has a high resistance rate to macrolides; however, penicillin can still be the preferred antibiotic for treatment. Erythromycin resistance was predominantly mediated by ermB. The common emm types were emm12 and emm1. There was a correlation between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence are imperative.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial resistance of group a streptococcus recovered from patients in Beijing, China

Zhou

et al. 2020

BMC Infect Dis

“…had both ermB and mefA [8]. The drug resistance rate of erythromycin and clindamycin in Korea decreased from 51.0% and 33.7% in 2002 to 9.8% and 8.8% in 2004, respectively.…”

Section: Emm Type and Superantigen Distributionmentioning

confidence: 97%

“…Penicillin is the preferred clinical treatment of GAS infection, while erythromycin is the first alternative antibiotic for patients allergic to penicillin, followed by clindamycin. The drug resistance rate to macrolides, used as alternative antibiotics, is gradually increasing, which might be related to the overuse of such antibiotics [7,8]. Our previous study has shown high frequency of resistance to erythromycin, clindamycin, and tetracycline in GAS [9].…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Children

Zhang

et al. 2020

Preprint

Background: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children’s Hospital in Beijing.Methods: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children’s Hospital, Capital Institute of Pediatrics, who were diagnosed as scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of common antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes ( ermB, ermA, mefA ), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR).Results: A total of 297 GAS strains were collected. The sensitivity of the strains to penicillin, ceftriaxone, and levofloxacin was 100%. The rate of antimicrobial resistance to erythromycin and clindamycin were 98.3% and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%) , speC (92.59%), speG (91.58%), and ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm 1 possessed speA, speC, speG, speJ, speM, ssa, and smeZ, while emm 12 possessed speC, speG, speH, speI, speM, ssa, and smeZ superantigens. Conclusions: The prevalent strain of GAS isolates in Beijing has a high antimicrobial resistance rate to macrolides, while penicillin can still be used as the preferred treatment choice. The primary mechanism of resistance to erythromycin is related to the expression of ermB . The common emm types were e mm 12 and emm 1. A correlation was established between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence is imperative.

“…Penicillin is the preferred clinical treatment of GAS infection, while erythromycin is the first alternative antibiotic for patients allergic to penicillin, followed by clindamycin. The drug resistance rate to macrolides, used as alternative antibiotics, is gradually increasing, which might be related to the overuse of such antibiotics [7,8]. In our previous study, 95 isolates were recovered from suppurative tonsillitis, acute glomerulonephritis, scarlet fever and streptococcal dermatitis.…”

mentioning

confidence: 99%

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

Zhang

et al. 2020

Preprint

Background: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. Methods: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes ( ermB, ermA, mefA ), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). Results: A total of 297 GAS strains were collected. The susceptibility of the strains to penicillin, ceftriaxone, and levofloxacin was 100%. The rate of antimicrobial resistance to erythromycin and clindamycin was 98.3% and 96.6%, respectively. The dominant emm types were Streptococcus pyogenes (Lancefield group A streptococcus; GAS) is a major pathogen causing infectious diseases in children. It causes suppurative and non-suppurative diseases, such as erysipelas, suppurative tonsillitis, scarlet fever, rheumatic fever, and glomerulonephritis [1]. Globally, there are about 616 million cases of GAS pharyngitis every year, among which, 17,800 cases are new infections, and about 517,000 patients with severe GAS are deceased every year [2]. Recently, the positive rate of GAS was estimated at 21.2% in the pharyngeal culture of patients diagnosed as "streptococcal infection/tonsillitis/angina" [3]. Moreover, the incidence of streptococcal pharyngitis is common in children aged 0-14 years. From 2012 to 2014, the average number of positive cases of streptococcal culture was 2685.1/100,000 children in Beijing, including 1652.7 outpatient visits [4]. In 2011, scarlet fever broke out in mainland China and Hong Kong, with a sharp increase in incidence [5,6]. Penicillin is the preferred clinical treatment of GAS infection, while erythromycin is the first alternative antibiotic for patients allergic to penicillin, followed by clindamycin. The drug resistance rate to macrolides, used as alternative antibiotics, is gradually increasing, which might be related to the overuse of such antibiotics [7,8]. In our previous study, 95 isolates were recovered from suppurative tonsillitis, acute glomerulonephritis, scarlet fever and streptococcal dermatitis. The resistance rates of the isolates to erythromycin, clindamycin and tetracycline were 98.9%, 100%, 94.7% respectively [9] .The M protein encoded by the emm gene is the main pathogenic factor of GAS, and different types vary in pathogenicity. Therefore, emm typing is employed to track outbreak and routinely mo...