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Tetracycline and macrolide co-resistance in Streptococcus pyogenes: co-selection as a reason for increase in
Hans Ulrik K Nielsen1, Anette M Hammerum, Kim Ekelund
1Statens Serum Institut, 2300 Copenhagen S, Denmark. hun@ssi.dk
Abstract:
In Denmark, tetracycline resistance in Streptococcus pyogenes is frequent (>30%) whereas macrolide resistance is low (<5%). The aim of this study was to investigate the genetic background of tetracycline- and macrolide resistance in macrolide-resistant S. pyogenes (MRSP) and to investigate the correlation between the use of macrolide and tetracycline and macrolide resistance using international data. A total of 133 MRSP isolates were received at Statens Serum Institut from nine Danish clinical microbiology laboratories between. November 2000, and November 2002. The macrolide-resistance genes, erm(B), erm(A), and mef(A) were detected in 46%, 18%, and 32% of the tested MRSP isolates, respectively. In 4% of MRSP isolates, none of the MR genes were detected. Tetracycline resistance was found in 52% of MRSP. Tetracycline resistance was encoded by either tet(M) or tet(O). erm(B) and mef(A) were associated with tet(M). Sixteen different T types were detected among the 133 MRSP. Analysis of the importance of antibiotic use for development of macrolide resistance in S. pyogenes showed no correlation with macrolide use alone (p = 0.15) but a significant correlation (p = 0.03) for the combination of macrolide and tetracycline use. The frequency of macrolide resistance in Danish S. pyogenes was low and mainly due to erm genes. A high frequency of macrolide-tetracycline coresistance in S. pyogenes is found in many countries including Denmark, hence tetracycline use must be considered as a co-factor in selection of MRSP.
Insights
Macrolide resistance in Streptococcus pyogenes is low in Denmark, often linked with tetracycline resistance genes. Combined macrolide and tetracycline use significantly correlates with macrolide-resistant S. pyogenes (MRSP) development.
Area of Science:
- Microbiology
- Molecular Biology
- Epidemiology
Background:
- Tetracycline resistance is common in Danish Streptococcus pyogenes, while macrolide resistance is infrequent.
- Macrolide-resistant S. pyogenes (MRSP) isolates were studied to understand resistance mechanisms and correlations with antibiotic use.
- International data was analyzed to investigate the link between macrolide and tetracycline usage and macrolide resistance.
Purpose of the Study:
- To investigate the genetic basis of tetracycline and macrolide resistance in MRSP.
- To examine the correlation between macrolide and tetracycline use and the prevalence of macrolide resistance in S. pyogenes.
Main Methods:
- 133 MRSP isolates collected between November 2000 and November 2002 were analyzed.
- Macrolide resistance genes (erm(B), erm(A), mef(A)) and tetracycline resistance genes (tet(M), tet(O)) were detected using molecular methods.
- Statistical analysis was performed to correlate antibiotic usage patterns with macrolide resistance.
Main Results:
- The macrolide resistance genes erm(B), erm(A), and mef(A) were found in 46%, 18%, and 32% of MRSP isolates, respectively.
- Tetracycline resistance, mediated by tet(M) or tet(O), was present in 52% of MRSP isolates, frequently associated with erm(B) and mef(A).
- A significant correlation was observed between the combined use of macrolides and tetracyclines and the development of macrolide resistance in S. pyogenes (p = 0.03).
Conclusions:
- Macrolide resistance in Danish S. pyogenes is primarily driven by erm genes.
- The high frequency of macrolide-tetracycline co-resistance suggests tetracycline use is a significant co-factor in selecting for MRSP.
- Antibiotic stewardship programs should consider the impact of tetracycline use on macrolide resistance in S. pyogenes.
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