JAC Advance Access originally published online on December 12, 2002
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Journal of Antimicrobial Chemotherapy (2003) 51, 53-57
© 2003 The British Society for Antimicrobial Chemotherapy
Phenotypes of macrolide resistance of group A streptococci isolated from outpatients in Bavaria and susceptibility to 16 antibiotics
1 Department of Internal Medicine I, Division of Infectious Diseases and Chemotherapy, and 2 Department of Internal Medicine IV, Division of Pulmology, University of Vienna, Vienna General Hospital, Waehringer Guertel 18–20, 1090 Vienna, Austria
Received 7 August 2002; returned 21 August 2002; revised 7 October 2002; accepted 8 October 2002
The purpose of the present study was to determine the antimicrobial resistance among Streptococcus pyogenes in Bavaria, Germany. Five hundred and forty isolates of S. pyogenes were collected from patients with tonsillopharyngitis. Of these, 425 isolates were obtained from children and 115 from adult patients. All isolates were tested for susceptibility to macrolides, clindamycin, penicillin and 10 other commonly prescribed antimicrobial agents, using broth microdilution tests. All isolates were fully susceptible to penicillin, amoxicillin and cephalosporins; 16.1% of the isolates were resistant to tetracycline. MIC90 values of erythromycin, clarithromycin, azithromycin and josamycin were 16, 4, 16 and 0.5 mg/L. The overall resistance rate of S. pyogenes to erythromycin, clarithromycin and azithromycin was 13.3%. All isolates resistant to erythromycin were also resistant to clarithromycin and azithromycin, and vice versa. Erythromycin resistance rates were higher in adult patients (19.1%) than in children (11.8%). The resistance rate to josamycin was only 1.5%, a value similar to that of clindamycin (1.1%). Among the 72 erythromycin-resistant isolates the M phenotype of macrolide resistance predominated (78%), while percentages of cMLSB (8%) and iMLSB (14%) phenotypes were low. Of the iMLSB strains (n = 10), the majority were of the subtype C (n = 8). The M phenotype was associated with a low, and the iMLSB-C phenotype with a high, rate of resistance to tetracycline. Conclusively, present data point to rising macrolide resistance among S. pyogenes in Bavaria.
Keywords: S. pyogenes, Bavaria, susceptibility, macrolide resistance, phenotypes
* Corresponding author. Tel: +43-1-40400-5139; Fax: +43-1-40400-5167; E-mail: apostolos.georgopoulos{at}akh-wien.ac.at
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