title: Phenotypes of macrolide resistance of group A streptococci isolated from outpatients in Bavaria and susceptibility to 16 antibiotics.
abstract: The purpose of the present study was to determine the antimicrobial resistance among Streptococcus pyogenes in Bavaria, Germany. Five hundred and forty isolates of S. pyogenes were collected from patients with tonsillopharyngitis. Of these, 425 isolates were obtained from children and 115 from adult patients. All isolates were tested for susceptibility to macrolides, clindamycin, penicillin and 10 other commonly prescribed antimicrobial agents, using broth microdilution tests. All isolates were fully susceptible to penicillin, amoxicillin and cephalosporins; 16.1% of the isolates were resistant to tetracycline. MIC(90) values of erythromycin, clarithromycin, azithromycin and josamycin were 16, 4, 16 and 0.5 mg/L. The overall resistance rate of S. pyogenes to erythromycin, clarithromycin and azithromycin was 13.3%. All isolates resistant to erythromycin were also resistant to clarithromycin and azithromycin, and vice versa. Erythromycin resistance rates were higher in adult patients (19.1%) than in children (11.8%). The resistance rate to josamycin was only 1.5%, a value similar to that of clindamycin (1.1%). Among the 72 erythromycin-resistant isolates the M phenotype of macrolide resistance predominated (78%), while percentages of cMLS(B) (8%) and iMLS(B) (14%) phenotypes were low. Of the iMLS(B) strains (n = 10), the majority were of the subtype C (n = 8). The M phenotype was associated with a low, and the iMLS(B)-C phenotype with a high, rate of resistance to tetracycline. Conclusively, present data point to rising macrolide resistance among S. pyogenes in Bavaria.
authors.affiliation: Department of Internal Medicine I, Division of Infectious Diseases and Chemotherapy, University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Sauermann
authors.forename: Rainer
authors.initials: R
authors.lastname: Gattringer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Graninger
authors.forename: Astrid
authors.initials: A
authors.lastname: Buxbaum
authors.forename: Apostolos
authors.initials: A
authors.lastname: Georgopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016009:Chi-Square Distribution; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D018942:Macrolides; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D010045:Outpatients; D010612:Pharyngitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D010641:Phenotype; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D014069:Tonsillitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides