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Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020-2021

Lillie M Powell, Soo Jeon Choi, Chloe E Chipman

    Emerging Infectious Diseases
    |April 20, 2023
    PubMed

    Insights

    Macrolide resistance is a growing concern in invasive group A Streptococcus (iGAS) infections, impacting treatment options. This study highlights a high prevalence of resistant strains in West Virginia, USA.

    Area of Science:

    • Microbiology
    • Infectious Diseases
    • Antimicrobial Resistance

    Background:

    • Invasive group A Streptococcus (iGAS) infections are typically treated with clindamycin and beta-lactam antibiotics.
    • Treatment efficacy may be compromised by macrolide, lincosamide, and streptogramin B (MLSB) resistance phenotypes in iGAS strains.

    Purpose of the Study:

    • To investigate the prevalence and characteristics of MLSB-resistant iGAS isolates in West Virginia.
    • To identify the genetic mechanisms conferring macrolide resistance and assess associated resistance patterns.

    Main Methods:

    • emm typing of 76 iGAS isolates from 66 patients (2020-2021) following CDC guidelines.
    • Genotypic and phenotypic assessment of antibiotic resistance, including macrolide resistance genes (ermT, ermA, ermB, mefA).

    Main Results:

    • 76% of iGAS isolates exhibited simultaneous resistance to erythromycin and clindamycin.
    • emm92 and emm11 isolates were universally resistant to erythromycin and clindamycin.
    • Macrolide resistance was linked to ermT, ermA, ermB, and mefA genes.
    • Macrolide-resistant iGAS strains frequently showed co-resistance to tetracycline and aminoglycosides.
    • Socioeconomic status was associated with iGAS infection vulnerability.

    Conclusions:

    • A significant predominance of macrolide-resistant iGAS isolates was observed.
    • A shift in emm type distribution compared to historical data suggests evolving iGAS epidemiology.
    • The findings underscore the need for ongoing surveillance of antibiotic resistance in iGAS.
    Keywords:
    Streptococcus pyogenesUnited StatesWest Virginiaantimicrobial resistancebacteriaclindamycinconstitutivedrug resistanceemm92erythromycininducibleinvasive group A Streptococcusstreptococci

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