Patterns of Macrolide Resistance Determinants among Community-Acquired
            <i>Streptococcus pneumoniae</i>
            Isolates over a 5-Year Period of Decreased Macrolide Susceptibility Rates

Oster, Philipp; Zanchi, Alessandra; Cresti, Stefania; Lattanzi, Maria; Montagnani, Francesca; Cellesi, C; Rossolini, Gian María

doi:10.1128/aac.43.10.2510

Cited by 90 publications

(53 citation statements)

References 18 publications

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“…In two Belgian studies, 8.5% and 9.1% of pneumococcal isolates were resistant by active efflux [14,15]. In Italy, where the incidence of macrolide resistance in pneumococci has recently increased, only 5.8-10% of erythromycin-resistant pneumococci carried mefE determinants [16,17]. By contrast, in Japan, where some 16-membered macrolides are commercially available, 40% of erythromycin-resistant pneumococci display an M phenotype [18].…”

Section: Discussionmentioning

confidence: 99%

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Macrolide Resistance Phenotypes and Genotypes in French Clinical Isolates of Streptococcus pneumoniae

Angot

Vergnaud

Auzou

et al. 2000

EJCMID

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The aim of this study was to analyze the mechanisms of macrolide resistance in French clinical isolates of Streptococcus pneumoniae. A total of 838 strains of pneumococci were isolated in 1997 in Normandy, a region of western France, by 19 microbiology laboratories. Fifty-three percent had displayed diminished susceptibility to penicillin G and 50% were resistant to erythromycin. From this collection, 92 penicillin-intermediate or -resistant and 18 penicillin-susceptible strains resistant to erythromycin were studied. The presence of erm genes coding for ribosomal methylases and of mefE-like genes responsible for macrolide efflux was screened by a multiplex polymerase chain reaction and confirmed by DNA/DNA hybridization. Of the 110 strains studied, 108 were cross-resistant to erythromycin, spiramycin and clindamycin, including 105 strains containing ermB-related genes and three strains that contained a combination of ermB-and mefE-related genes. Two strains apparently susceptible to clindamycin but resistant to spiramycin also contained ermBrelated genes. No strain was resistant to erythromycin alone or contained only a mef-like gene. Therefore, resistance to erythromycin is mostly related to ribosomal methylation in this region of France.

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Section: Discussionmentioning

confidence: 99%

“…Consumption of 14-, 15-and 16-membered macrolides in Normandy is shown in Table 4. In 1997, 16-membered macrolides represented one-third of the total consumption of macrolides in adults and half the consumption in children.…”

Section: Consumption Of Macrolides In the Community Inmentioning

confidence: 99%

Macrolide Resistance Phenotypes and Genotypes in French Clinical Isolates of Streptococcus pneumoniae

Angot

Vergnaud

Auzou

et al. 2000

EJCMID

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“…Recently, low-level resistance to 14-and 15-membered macrolides, and susceptibility to lincosamides and streptogramin B, have been described in S. pneumoniae and S. pyogenes (M phenotype) [14,[16][17][18][19]26,27]. This resistance is determined by the presence of the membrane-bound efflux protein, encoded by the mef genes, mef(A) or mef(E) [14,[16][17][18][19]26,27].…”

Section: Macrolide-resistant Mechanismsmentioning

confidence: 99%

“…Three principal mechanisms are responsible for the acquired erythromycin resistance in streptococci: ribosomal target modification, either enzymatically or by mutation; key ribosomal protein mutations; and active cell-membrane efflux [14][15][16][17][18][19][20]. The ribosomal target modification is most often due to methylation of the adenine at position 2058 of the domain V of the 23S rRNA [2••,20].…”

Section: Macrolide-resistant Mechanismsmentioning

confidence: 99%

The use of macrolides in treatment of upper respiratory tract infections

Wierzbowski¹,

Hoban²,

Hisanaga³

et al. 2006

Curr Allergy Asthma Rep

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Antimicrobial resistance is a growing problem among upper respiratory tract pathogens. Resistance to beta-lactam drugs among Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes is increasing. As safe and well-tolerated antibiotics, macrolides play a key role in the treatment of community-acquired upper respiratory tract infections (RTIs). Their broad spectrum of activity against gram-positive cocci, such as S. pneumoniae and S. pyogenes, atypical pathogens, H. influenzae (azithromycin and clarithromycin), and Moraxella catarrhalis, has led to the widespread use of macrolides for empiric treatment of upper RTIs and as alternatives for patients allergic to beta-lactams. Macrolide resistance is increasing among pneumococci and recently among S. pyogenes, and is associated with increasing use of the newer macrolides, such as azithromycin. Ribosomal target modification mediated by erm(A) and erm(B) genes and active efflux due to mef(A) and mef(E) are the principal mechanisms of resistance in both S. pneumoniae and S. pyogenes. Recently, ribosomal protein and RNA mutations have been found to be responsible for acquired resistance to macrolides in S. pneumoniae, S. pyogenes, and H. influenzae. Although macrolides are only weakly active against macrolide-resistant streptococci species, producing an efflux pump (mef), and are inactive against pathogens with ribosomal target modification (erm), treatment failures are uncommon. Therefore, macrolide therapy, for now, remains a good alternative for treatment of upper RTIs; however, continuous monitoring of the local resistance patterns is essential.

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“…A different determinant, the mefE gene, encodes for the efflux system and confers low-level resistance to macrolides (M-type resistance pattern). There seems to be a wide geographic variation in the macrolide resistance pattern, with the MLSB-type predominating in some areas and the M-type in others [21].…”

Section: Mechanisms Of Resistancementioning

confidence: 99%

Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

Rocha

Baleeiro

Tunkel

2000

Curr Infect Dis Rep

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Infectious diseases, such as pneumococcal pneumonia, which were almost invariably lethal in the pre-antibiotic era, caused radically less mortality with the advent of antimicrobial chemotherapy. However, the use, misuse, and abuse of these agents have led to the emergence of antimicrobial resistance. In the past, pneumococci were all exquisitely sensitive to penicillin G. By the late 1960s, penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) was being described. Since then, this problem has achieved epidemic proportions in many areas of the world, including the United States. Many experts no longer consider penicillin an acceptable therapy for patients suspected of having invasive pneumococcal disease, especially if the central nervous system (CNS) is involved. Recommendations for therapy are based on theoretical concerns, in vitro susceptibility testing, animal data, and a few, scattered reports of penicillin failure in patients with invasive disease.

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Patterns of Macrolide Resistance Determinants among Community-Acquired Streptococcus pneumoniae Isolates over a 5-Year Period of Decreased Macrolide Susceptibility Rates

Cited by 90 publications

References 18 publications

Macrolide Resistance Phenotypes and Genotypes in French Clinical Isolates of Streptococcus pneumoniae

Macrolide Resistance Phenotypes and Genotypes in French Clinical Isolates of Streptococcus pneumoniae

The use of macrolides in treatment of upper respiratory tract infections

Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

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