JAC Advance Access originally published online on September 12, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 636-644
© 2003 The British Society for Antimicrobial Chemotherapy
Antimicrobial susceptibility patterns and macrolide resistance genes of viridans group streptococci from normal flora
1 Antimicrobial Research Laboratory, National Public Health Institute, PO Box 57, 20521 Turku; 2 Department of Ophthalmology, Turku City Hospital, Turku; 3 Department of Ophthalmology, Turku University Central Hospital, Turku, Finland
Received 19 December 2002; returned 23 January 2003; revised 5 July 2003; accepted 9 July 2003
Objectives: Our aim was to study the antimicrobial susceptibilities and macrolide resistance mechanisms of viridans group streptococci isolated from the normal flora.
Methods: In vitro susceptibilities of 16 antimicrobials were studied for 161 viridans streptococci (on average 5.8 isolates per person) from the normal flora of 28 elderly persons. Resistance mechanisms of erythromycin-resistant isolates were studied by the double disc test and PCR.
Results: In all, 16.8% of the isolates were non-susceptible (MIC 
0.25 mg/L) to penicillin, but none showed high-level resistance (MIC 4 mg/L). Resistance to erythromycin, tetracycline, quinupristin/dalfopristin, levofloxacin and moxifloxacin was found in 22.4, 27.3, 13.0, 1.9 and 1.9% of the isolates, respectively. Combined resistance to erythromycin and tetracycline was found in 13.0% of the isolates. Erythromycin-resistant isolates were isolated from 57% of the study persons. Of the erythromycin-resistant isolates 80.6% were of the M phenotype and 19.4% were of the macrolide–lincosamide–streptogramin B (MLSB) phenotype (one isolate with constitutive and six with inducible expression). Isolates with the M phenotype were the least susceptible to telithromycin, a new ketolide. The mef(A) gene was found in the isolates with the M phenotype and the erm(B) gene in the isolates with the MLSB phenotype.
Conclusions: The distribution of phenotypes among the viridans streptococci resembles that found in Streptococcus pyogenes, with predominance of the M phenotype. However, the coding gene for the MLSB phenotype, erm(B), is the same in viridans streptococci as in Streptococcus pneumoniae. Viridans group streptococci carrying different resistance traits provide a pool of resistant bacteria that may transfer resistance determinants to more pathogenic organisms.
Keywords: 
-haemolytic streptococci, erythromycin resistance, commensal flora, elderly persons
* Corresponding author. Tel: +358-2-2519255; Fax: +358-2-2519254; E-mail: helena.seppala{at}utu.fi
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