title: Emergence of the M phenotype of erythromycin-resistant pneumococci in South Africa.
abstract: Erythromycin-resistant pneumococci have been isolated in South Africa since 1978; however, from 1987 to 1996, resistance to macrolides was only detected in 270 (2.7%) of 9,868 blood or cerebrospinal fluid (CSF) pneumococcal isolates, most of which were obtained from the public sector. In South Africa, macrolide use in the public sector is estimated at 56% of that in the private sector. Most erythromycin-resistant strains (89%) exhibited resistance to erythromycin and clindamycin (macrolide-lincosamide-streptogramin B phenotype). In the United States, most erythromycin-resistant pneumococci exhibit the newly described M phenotype (resistance to erythromycin alone), associated with the mefE gene. The M phenotype in South Africa increased significantly in the last 10 years, from 1 of 5,115 to 28 of 4,735 of blood and CSF isolates received from 1987 to 1991 compared with 1992 to 1996 (p = 5 x 10(-7)). These data suggest that, although macrolide resistance in pneumococci remains low in the public sector, the mefE gene is rapidly emerging in South Africa.
authors.affiliation: South African Institute for Medical Research, Johannesburg, South Africa. 174carol@chiron.wits.ac.za
authors.forename: C A
authors.initials: CA
authors.lastname: Widdowson
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics; D018432:Drug Resistance, Multiple; D004917:Erythromycin / Q000494:pharmacology*; D005798:Genes, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010641:Phenotype; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012703:Serotyping; D013019:South Africa / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin