Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 14, Issue 12, Pages 1152-1159Publisher
ELSEVIER SCI LTD
DOI: 10.1111/j.1469-0691.2008.02104.x
Keywords
Clonal types; macrolide resistance; Portugal; resistance prevalence; sequence types; Streptococcus pyogenes
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Funding
- Fundacao para a Ciencia e Tecnologia, Portugal [SFRH/BPD/21746/2005]
- Fundacao Calouste Gulbenkian, Portugal
- Fundacao para a Ciencia e a Tecnologia [PTDC/SAUESA/72321/2006]
- GlaxoSmithKline Portugal
- Fundação para a Ciência e a Tecnologia [SFRH/BPD/21746/2005] Funding Source: FCT
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Macrolide resistance among Streptococcus pyogenes (group A streptococci) in Portugal was stable during 1998-2003, but a rapid inversion in the dominant phenotypes was noted in the same period, with a sharp decrease in the proportion of isolates presenting the MLSB phenotype and a concomitant increase in isolates presenting the M phenotype. The characterization of group A streptococci recovered during 2004-2006, which is reported here, revealed that resistance was not stable during this period and that the decline in erythromycin resistance observed during 2004-2006 was due to a decrease in the prevalence of isolates presenting the M phenotype, while the proportion of isolates expressing the MLSB phenotype remained stable. Characterization by emm typing, T serotyping, pulsed-field gel electrophoresis (PFGE) profiling and multilocus sequence typing revealed a very diverse population. Several of the major PFGE clusters identified had already been found in the 1998-2003 study period, but others were found for the first time, e.g. T11/emm11/ST403, carrying the erm(B) gene, and T3/13/emm3/ST315, carrying the mef(A) gene. The clone defined as T12/emm12/ST36, previously found to be associated with mef(A), was now found to be predominantly associated with erm(B). The clonal dynamics of macrolide-resistant group A streptococci emphasizes the importance of considering factors other than antibiotic consumption in explaining the prevalence of resistant isolates.
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