Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India

Introduction: In penicillin allergic patients, macrolides are the most commonly used antibiotics for treating streptococcal infections, irrespective of the higher resistance rates. The objective of this study was to evaluate the comparative prevalence, phenotypes, and genetic determinants of macrol...

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Main Authors: Tintu Abraham, Sujatha Sistla
Format: Article
Language:English
Published: The Journal of Infection in Developing Countries 2017-09-01
Series:Journal of Infection in Developing Countries
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Online Access:https://jidc.org/index.php/journal/article/view/9132
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author Tintu Abraham
Sujatha Sistla
author_facet Tintu Abraham
Sujatha Sistla
author_sort Tintu Abraham
collection DOAJ
description Introduction: In penicillin allergic patients, macrolides are the most commonly used antibiotics for treating streptococcal infections, irrespective of the higher resistance rates. The objective of this study was to evaluate the comparative prevalence, phenotypes, and genetic determinants of macrolide resistance and associated emm types among different clinical isolates of Streptococcus pyogenes. Methodology: A total of 173 Streptococcus pyogenes isolates were examined for macrolide resistance phenotype by double-disc test, resistance determinants by multiplex PCR and emm genotyping. Results: Erythromycin resistance was found in 51.4% of isolates, with MIC90 ≥ 256 µg/mL Inducible phenotype was commonly found (iMLS, 67.4%) followed by the M phenotype (32.5%). Among these isolates, 65.1% harboured ermB and 32.5% mefA as sole macrolide resistance gene, whereas presence of both, ermB plus mefA was observed in 2.2% cases. The most common types among resistant strains were emm63 (11.2%), emm44 (6.7%), emm42 (5.6%), and emm75.3, emm82, emm85, emm92, emm111.1 (4.4% each). Statistically significant association was observed between emm63, emm44 and erythromycin resistance (p ≤ 0.05). Association of these emm types and macrolide resistance have not been reported earlier. Conclusion: Higher macrolide resistance in this study can be attributed to overuse and misuse of this antibiotic. These findings indicate that macrolides should not be empirically used for treating severe streptococcal infections.
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spelling doaj-art-575cf955fbec462c804af3a3bc3d0cf22025-08-20T02:14:17ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802017-09-01110910.3855/jidc.9132Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, IndiaTintu Abraham0Sujatha Sistla1Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IndiaJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India Introduction: In penicillin allergic patients, macrolides are the most commonly used antibiotics for treating streptococcal infections, irrespective of the higher resistance rates. The objective of this study was to evaluate the comparative prevalence, phenotypes, and genetic determinants of macrolide resistance and associated emm types among different clinical isolates of Streptococcus pyogenes. Methodology: A total of 173 Streptococcus pyogenes isolates were examined for macrolide resistance phenotype by double-disc test, resistance determinants by multiplex PCR and emm genotyping. Results: Erythromycin resistance was found in 51.4% of isolates, with MIC90 ≥ 256 µg/mL Inducible phenotype was commonly found (iMLS, 67.4%) followed by the M phenotype (32.5%). Among these isolates, 65.1% harboured ermB and 32.5% mefA as sole macrolide resistance gene, whereas presence of both, ermB plus mefA was observed in 2.2% cases. The most common types among resistant strains were emm63 (11.2%), emm44 (6.7%), emm42 (5.6%), and emm75.3, emm82, emm85, emm92, emm111.1 (4.4% each). Statistically significant association was observed between emm63, emm44 and erythromycin resistance (p ≤ 0.05). Association of these emm types and macrolide resistance have not been reported earlier. Conclusion: Higher macrolide resistance in this study can be attributed to overuse and misuse of this antibiotic. These findings indicate that macrolides should not be empirically used for treating severe streptococcal infections. https://jidc.org/index.php/journal/article/view/9132Macrolide resistancePhenotypes and genotypesStreptococcus pyogenesphenotypes and genotypesemm types
spellingShingle Tintu Abraham
Sujatha Sistla
Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
Journal of Infection in Developing Countries
Macrolide resistance
Phenotypes and genotypes
Streptococcus pyogenes
phenotypes and genotypes
emm types
title Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
title_full Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
title_fullStr Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
title_full_unstemmed Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
title_short Molecular epidemiology of macrolide resistant Group A streptococci from Puducherry, India
title_sort molecular epidemiology of macrolide resistant group a streptococci from puducherry india
topic Macrolide resistance
Phenotypes and genotypes
Streptococcus pyogenes
phenotypes and genotypes
emm types
url https://jidc.org/index.php/journal/article/view/9132
work_keys_str_mv AT tintuabraham molecularepidemiologyofmacrolideresistantgroupastreptococcifrompuducherryindia
AT sujathasistla molecularepidemiologyofmacrolideresistantgroupastreptococcifrompuducherryindia