Short communicationDistribution and antibacterial susceptibility of macrolide resistance genotypes in Streptococcus pneumoniae: PROTEKT Year 5 (2003–2004)
Introduction
Among the antibacterials available for treating community-acquired respiratory tract infections (RTIs), macrolides remain one of the most commonly prescribed. However, the number of pneumococcal strains showing in vitro resistance to this class of antibacterials has increased dramatically across the world in the last decade [1], [2]. Although the link between resistance measured in the laboratory and adverse clinical outcome has not been fully substantiated to date, an increasing number of reports of treatment failure associated with macrolide-resistant pneumococcal infections [3], [4] have raised concern over the continued clinical utility of the macrolides. It has been suggested that the importance of macrolide resistance for clinical outcomes may depend on the strength of macrolide resistance in the strain causing infection. There are a number of macrolide resistance mechanisms, which differ in the level of resistance conferred. Determining the epidemiology of resistance mechanisms may therefore be important for predicting the efficacy of macrolide use in different countries.
Pneumococcal macrolide resistance is usually mediated via one of two major mechanisms [5]. The first involves modification of ribosomal macrolide target sites by methylases encoded by erm(B). The erm(B) genotype is the most common mechanism globally and is associated with high-level erythromycin resistance (minimum inhibitory concentrations (MICs) ≥256 μg/mL). The second major form of resistance, prevalent in North America and some other countries, involves drug efflux encoded by the mef(A) gene.
Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin (PROTEKT) is a global, longitudinal, international surveillance study designed primarily to compare the antibacterial activity of the ketolide telithromycin with other antibacterials. The study focuses on antibacterial resistance among common respiratory tract pathogens, including Streptococcus pneumoniae, and has successfully tracked temporal changes in resistance epidemiology using genotyping and other methodology [2], [6], [7], [8]. The current analysis, covering isolates collected during the 2003–2004 respiratory season (Year 5 of PROTEKT), provides an update of geographic and demographic patterns in the distribution and antibacterial susceptibility of pneumococcal macrolide resistance genotypes.
Section snippets
Bacterial isolates
S. pneumoniae isolates, deemed pathogenic on isolation, were collected in 38 countries and 122 centres during PROTEKT Year 5 (2003–2004). The isolates were collected from adult and paediatric outpatients with the following community-acquired RTIs: bacterial sinusitis; acute otitis media; pharyngitis; community-acquired pneumonia; acute bacterial exacerbations of chronic bronchitis; and acute exacerbations of chronic obstructive pulmonary disease. Isolates collected from hospitalised patients
Results and discussion
A total of 7083 S. pneumoniae isolates were collected in 38 countries during Year 5 of PROTEKT. Overall, 37.2% (2638/7083) of the isolates were erythromycin-resistant S. pneumoniae (ERSP). The rate of erythromycin resistance showed considerable geographic variability (Table 1), ranging from <10% in Brazil, Colombia, Czech Republic, Portugal, Russia and Sweden to >50% in France, South Africa and countries in the Far East.
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Carriage and Transmission of Macrolide Resistance Genes in Patients With Chronic Respiratory Conditions and Their Close Contacts
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2017, Journal of Infection and Public HealthCitation Excerpt :The erm(B) gene was reported as predominant in several regions, such as Belgium (91.5%), France (90%), Spain (88.3%), Serbia (82.4%), Hungary (82.4%), Poland (80.8%), China (76.5%), Japan (58%) and Italy (55.8%) [23]. However, the mef(A) gene was found as more prevalent in UK (70.8%), Greece (66.2%), Australia (59.5%), Finland (55.4%), USA (55.2%), and Germany (53.2%) [19]. The countries with a high prevalence of the dual resistance mechanism in pneumococci were South Korea and South Africa.
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2014, Medecine et Maladies InfectieusesCitation Excerpt :The ermB gene related to the phenotype MLSB was the most frequent, followed by a much lower frequency of the gene mefA related to the phenotype M. The predominance of the ermB gene was reported in Tunisia and in Europe [3,6], whereas in the USA and in Australia the gene mefA is the most frequent [6]. The genotype (ermB + mefA), usually observed in South Africa [6], is far less frequent (< 10% of our strains).