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Streptococcal toxic shock syndrome by an iMLS resistant M type 77 Streptococcus pyogenes in the Netherlands

J Gooskens1, A J De Neeling, R J Willems

  • 1Department of Medical Microbiology, Centre of Infectious Diseases, University Medical Centre of Leiden, Bilthoven, The Netherlands. j.gooskens@lumc.nl

Scandinavian Journal of Infectious Diseases
|March 15, 2005
PubMed

Insights

Group A Streptococcus (GAS) resistant to macrolide-lincosamide-streptogramin B antibiotics (MLS) is increasing. This study reports the first case of MLS-resistant GAS causing streptococcal toxic shock syndrome (STSS).

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genetics

Background:

  • Group A Streptococcus (GAS) resistance to macrolide-lincosamide-streptogramin B (MLS) antibiotics is rising in Europe.
  • Streptococcal toxic shock syndrome (STSS) is a severe, life-threatening GAS infection.
  • MLS resistance in GAS strains associated with STSS has not been previously documented.

Observation:

  • A patient presented with STSS caused by an inducible MLS (iMLS) resistant T28 M77 Streptococcus pyogenes strain.
  • The resistant strain carried the ermA [subclass TR] gene.
  • A retrospective analysis identified M77 GAS strains, with 3.1% incidence over two years, and 12% of these M77 strains (specifically T28 serotype) exhibited MLS resistance due to the ermA [TR] gene.

Findings:

  • All analyzed M77 isolates belonged to sequence type 63, indicating a common clonal origin.
  • The MLS resistance gene (ermA [TR]) was found in 12% of the M77 strains examined.
  • MLS-resistant strains were isolated from blood, suggesting association with invasive disease.

Implications:

  • This is the first report of MLS-resistant GAS causing STSS.
  • The findings suggest horizontal gene transfer of the ermA [TR] gene is more likely than the spread of a resistant clone.
  • Continued surveillance is crucial to monitor the emergence and spread of antibiotic-resistant GAS strains, particularly those causing invasive infections like STSS.

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