title: Emergence and spread of Streptococcus pneumoniae with erm(B) and mef(A) resistance.
abstract: Streptococcus pneumoniae isolates (N = 31,001) were collected from patients with community-acquired respiratory tract infections during the PROTEKT US surveillance study (2000-2003). While the macrolide (erythromycin) resistance rate remained stable at approximately 29%, the prevalence of resistant isolates containing both erm(B) and mef(A) increased from 9.7% in year 1 to 16.4% in year 3, with substantial regional variability. Almost all (99.2%) dual erm(B) + mef(A) macrolide-resistant isolates exhibited multidrug resistance, whereas 98.6% and 99.0% were levofloxacin- and telithromycin-susceptible, respectively. These strains were most commonly isolated from the ear or middle-ear fluid of children. Of 152 representative erm(B)+mef(A) isolates, >90% were clonally related to the multidrug-resistant international Taiwan19F-14 clonal complex 271 (CC271). Of 366 erm(B)+mef(A) isolates from the PROTEKT global study (1999-2003), 83.3% were CC271, with the highest prevalence seen in South Africa, South Korea, and the United States. This study confirms the increasing global emergence and rapidly increasing US prevalence of this multidrug-resistant pneumococcal clone.
authors.affiliation: G.R. Micro Ltd, London, United Kingdom. d.farrell@grmicro.co.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrell
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.forename: Steven D
authors.initials: SD
authors.lastname: Brown
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Lavin
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004917:Erythromycin / Q000494:pharmacology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000494:pharmacology*; D008565:Membrane Proteins / Q000235:genetics; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D018942:Macrolides; C117866:MefA protein, Streptococcus; D008565:Membrane Proteins; D004917:Erythromycin