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JAC Advance Access originally published online on March 23, 2006
Journal of Antimicrobial Chemotherapy 2006 57(6):1240-1243; doi:10.1093/jac/dkl101
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Multicentre surveillance of the prevalence and molecular epidemiology of macrolide resistance among pharyngeal isolates of group A streptococci in the USA

Michael D. Green1,*, Bernard Beall2, Mario J. Marcon3, Coburn H. Allen4, John S. Bradley5, Barry Dashefsky6, Janet R. Gilsdorf7, Gordon E. Schutze8, Clay Smith9, Emmanuel B. Walter10, Judith M. Martin1, Kathryn M. Edwards9, Karen A. Barbadora1 and Ellen R. Wald1

1 Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine Pittsburgh, PA, USA 2 Respiratory Diseases Branch, Centres for Disease Control and Prevention Atlanta, GA, USA 3 Children's Hospital of Columbus Columbus, OH, USA 4 Texas Children's Hospital Houston, TX, USA 5 Children's Hospital of San Diego San Diego, CA, USA 6 New Jersey Medical School—UMDNJ Newark, NJ, USA 7 Mott's Children's Hospital Ann Arbor, MI, USA 8 Arkansas Children's Hospital Littlerock, AR, USA 9 Vanderbilt University Medical Centre Nashville, TN, USA 10 Duke University Medical Centre Durham, NC, USA

Received 13 December 2005; returned 3 February 2006; revised 2 March 2006; accepted 3 March 2006

*Corresponding author. Tel: +1-412-692-7438; Fax: +1-412-692-8499; E-mail: Michael.Green{at}chp.edu

Objectives: Rates of macrolide resistance in group A streptococci (GAS) were reported to be low in the US in the 1990s. However, we documented an unexpectedly high rate of macrolide resistance among GAS in Pittsburgh, PA, in 2001 and 2002. In an effort to define the current prevalence of macrolide-resistant GAS in the US, a multicentre surveillance project was initiated.

Methods: Between October 2002 and May 2003, 50 pharyngeal GAS isolates per month were requested from each of the nine participating sites representing a wide geographical distribution. Standard susceptibility testing was performed and the macrolide resistance phenotype was assessed using double-disc diffusion testing. Monthly and annual rates of macrolide resistance were calculated for each site. An adjusted overall rate of macrolide resistance was determined to account for differences in the numbers of GAS isolates sent from each centre.

Results: Overall, 171 of the 2797 collected isolates of GAS (6.1%) were resistant to erythromycin. The adjusted overall resistance rate was 5.2%. Rates of macrolide resistance varied by site (range 3.0–8.7%) and also by month (<2% to >10%). The M phenotype of macrolide resistance accounted for >60% of all macrolide-resistant isolates recovered in this study.

Conclusions: These data suggest an increasing prevalence and broad geographical distribution of macrolide-resistant GAS in the US, indicating the need for ongoing local and national longitudinal surveillance to define the extent of this problem.

Keywords: antibiotic resistance , Streptococcus pyogenes , mef(A)


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