title: Antimicrobial susceptibility patterns and macrolide resistance genes of viridans group streptococci from normal flora.
abstract: OBJECTIVE
  Our aim was to study the antimicrobial susceptibilities and macrolide resistance mechanisms of viridans group streptococci isolated from the normal flora.
  
  
  METHODS
  In vitro susceptibilities of 16 antimicrobials were studied for 161 viridans streptococci (on average 5.8 isolates per person) from the normal flora of 28 elderly persons. Resistance mechanisms of erythromycin-resistant isolates were studied by the double disc test and PCR.
  
  
  RESULTS
  In all, 16.8% of the isolates were non-susceptible (MIC > or =0.25 mg/L) to penicillin, but none showed high-level resistance (MIC > or =4 mg/L). Resistance to erythromycin, tetracycline, quinupristin/dalfopristin, levofloxacin and moxifloxacin was found in 22.4, 27.3, 13.0, 1.9 and 1.9% of the isolates, respectively. Combined resistance to erythromycin and tetracycline was found in 13.0% of the isolates. Erythromycin-resistant isolates were isolated from 57% of the study persons. Of the erythromycin-resistant isolates 80.6% were of the M phenotype and 19.4% were of the macrolide-lincosamide-streptogramin B (MLSB) phenotype (one isolate with constitutive and six with inducible expression). Isolates with the M phenotype were the least susceptible to telithromycin, a new ketolide. The mef(A) gene was found in the isolates with the M phenotype and the erm(B) gene in the isolates with the MLSB phenotype.
  
  
  CONCLUSIONS
  The distribution of phenotypes among the viridans streptococci resembles that found in Streptococcus pyogenes, with predominance of the M phenotype. However, the coding gene for the MLSB phenotype, erm(B), is the same in viridans streptococci as in Streptococcus pneumoniae. Viridans group streptococci carrying different resistance traits provide a pool of resistant bacteria that may transfer resistance determinants to more pathogenic organisms.
authors.affiliation: Antimicrobial Research Laboratory, National Public Health Institute, PO Box 57, 20521 Turku, Finland. helena.seppala@utu.fi
authors.forename: Helena
authors.initials: H
authors.lastname: Seppälä
authors.forename: Marjo
authors.initials: M
authors.lastname: Haanperä
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Juhaish
authors.forename: Helinä
authors.initials: H
authors.lastname: Järvinen
authors.forename: Jari
authors.initials: J
authors.lastname: Jalava
authors.forename: Pentti
authors.initials: P
authors.lastname: Huovinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004352:Drug Resistance, Microbial / Q000235:genetics*; D006801:Humans; D018942:Macrolides / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D034363:Viridans Streptococci / Q000187:drug effects* / Q000235:genetics*
chemical_list: D018942:Macrolides