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Trends in antimicrobial susceptibilities among Streptococcus pyogenes from 1996 to 2002 Changes in the prevalence of phenotypes of macrolide resistance



Trends in antimicrobial susceptibilities among Streptococcus pyogenes from 1996 to 2002 Changes in the prevalence of phenotypes of macrolide resistance



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 114



Background: During recent years an increased incidence of erythromycin (ERY) resistance in Streptococcus pyogenes has been reported worldwide. We studied the evolution of antibiotic resistance among S. pyogenes isolated in our laboratory from 1996 to 2002. Methods: A total of 952 isolates recovered during a 7-year period (76 isolates in 1996, 157 in 1997-1998, 113 isolates in 1999, 196 in 2000, 208 in 2001, and 202 isolates in 2002) were included in the study. Susceptibility to penicillin (PEN), ERY, azithromycin (AZM), josamycin (JOS), clindamycin (CLI), tetracycline (TET), and quinupristin-dalfopristin (SYN) was tested by the NCCLS broth microdilution method. Resistance phenotypes of ERY-resistant isolates were determined by the double-disk test. Results: All isolates remained very susceptible to PEN. The rate of resistance to ERY and AZT was 17.1% in 1996, this rate increased to 26.5% in 1999, and to 28.7% in 2002. The TET resistance rate (13-16%) did not change appreciably during the study period. SYN was uniformly active. The incidence of resistance to CLI was low, ranging from 0 to 4%, from 1996 to 2001 and increased to 7.4% towards the end of the study period. The ERY-resistant S. pyogenes isolates in our study were predominantly of the M phenotype, and were susceptible to JOS, the 16-membered macrolide tested, and CLI. However, a slightly decreasing trend in the prevalence of this phenotype was observed during the study (from 92.3% in 1996 to 83.3% in 2000, and to 70.7% in 2002). Conclusions: The increased frequency of ERY resistance in S. pyogenes observed in this study has important therapeutic implications in penicillin-allergic patients. A periodic surveillance of the prevalence of phenotypes of macrolide resistance could be helpful in the choice of an appropriate alternative therapy in these patients.

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