title: Macrolide, lincosamide and tetracycline susceptibility and emm characterisation of invasive Streptococcus pyogenes isolates in Israel.
abstract: Group A beta-haemolytic streptococcus (GAS) causes a variety of infections, including life-threatening illnesses. Although the species is uniformly penicillin susceptible, resistance to other antibiotics is becoming more common. We studied the prevalence of resistance and associated factors in a nationwide, prospective, population-based study of invasive infections in Israel. Isolates were collected in collaboration with 24 hospitals in Israel during 1996-1999. Minimal inhibitory concentrations (MICs) of erythromycin (ERY), clindamycin (CLI) and tetracycline (TET) were determined as well as ERY and TET resistance phenotypes and genotypes. Five hundred isolates were examined: 136 (27.2%) were not susceptible to TET, 10 (2.0%) to ERY and 5 (1%) to CLI. ERY resistance was associated with emm types 12 and 83 (P<0.001 for both). MICs of TET had a bimodal distribution distinguishing sensitive and resistant populations. Non-susceptibility to TET was mainly due to the presence of tet(M) and was associated with T types 3, 3/13/B3624 and 9 and emm types 9, 33, 64, 73, 74, 76, 77 and 83. TET susceptibility was associated with T types 1, 2 and 11, emm types 1-4, 11, 12, 22, 26 and 75 and the presence of speA and speC. In Israel, resistance of invasive GAS isolates to ERY remains low and is associated with specific T and emm types, as is TET resistance. TET resistance is less frequent than previously reported in Israel and is associated with a lower prevalence of speA and speC.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Nir-Paz
authors.forename: Colin
authors.initials: C
authors.lastname: Block
authors.forename: David
authors.initials: D
authors.lastname: Shasha
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Korenman
authors.forename: Zeev
authors.initials: Z
authors.lastname: Gorodnitzky
authors.forename: Joseph
authors.initials: J
authors.lastname: Jaffe
authors.forename: Merav
authors.initials: M
authors.lastname: Ron
authors.forename: Ayelet
authors.initials: A
authors.lastname: Michael-Gayego
authors.forename: Ronit
authors.initials: R
authors.lastname: Cohen-Poradosu
authors.forename: Mervyn
authors.initials: M
authors.lastname: Shapiro
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004917:Erythromycin / Q000494:pharmacology; D007557:Israel / Q000453:epidemiology; D055231:Lincosamides; D018942:Macrolides / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D013290:Streptococcal Infections / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000276:immunology; D013752:Tetracycline / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001425:Bacterial Outer Membrane Proteins; D055231:Lincosamides; D018942:Macrolides; D004917:Erythromycin; D013752:Tetracycline