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JAC Advance Access published online on February 12, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh118
© 2004 by The British Society for Antimicrobial Chemotherapy
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© 2004 The British Society for Antimicrobial Chemotherapy

Original article

Macrolide resistance and genotypic characterization of Streptococcus pneumoniae in Asian countries: a study of the Asian Network for Surveillance of Resistant Pathogens (ANSORP)

Jae-Hoon Song 1 *, Hyun-Ha Chang 2 , Ji Yoeun Suh 3 , Kwan Soo Ko 3 , Sook-In Jung 4 , Won Sup Oh 5 , Kyong Ran Peck 5 , Nam Yong Lee 6 , Yonghong Yang 7 , Anan Chongthaleong 8 , Nalinee Aswapokee 9 , Cheng-Hsun Chiu 10 , M. K. Lalitha 11 , Jennifer Perera 12 , Ti Teow Yee 13 , Gamini Kumararasinghe 13 , Farida Jamal 14 , Adeeba Kamarulazaman 15 , Navaratnam Parasakthi 15 , Pham Hung Van 16 , Thomas So 17 , Tak Keung Ng 17 , and on behalf of the ANSORP Study Group

1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Il-won dong, Kangnam-ku, Seoul 135-710;
2 Department of Medicine, Kyunghee University Medical Center, Seoul;
3 Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Seoul;
4 Chonnam National University Hospital, Kwangju, Korea;
5 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Il-won dong, Kangnam-ku, Seoul 135-710;
6 Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Il-won dong, Kangnam-ku, Seoul 135-710;
7 Beijing Children’s Hospital, Beijing, China;
8 Chulalongkorn University, Bangkok;
9 Siriraj Hospital, Bangkok, Thailand;
10 Chang Gung Children’s Hospital, Taipei, Taiwan;
11 Christian Medical College, Vellore, India;
12 University of Colombo, Colombo, Sri Lanka;
13 National University of Singapore, Singapore;
14 Universiti Putra Malaysia, Kuala Lumpur;
15 University Malaya, Kuala Lumpur, Malaysia;
16 University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam;
17 Princess Margaret Hospital, Hong Kong

* Corresponding author. E-mail: jhsong{at}ansorp.org.

Received 15 August 2003 ; revised 17 December 2003 ; accepted 17 December 2003

Abstract

Objectives: To characterize mechanisms of macrolide resistance among Streptococcus pneumoniae from 10 Asian countries during 1998-2001.

Methods: Phenotypic and genotypic characterization of the isolates and their resistance mechanisms.

Results: Of 555 isolates studied, 216 (38.9%) were susceptible, 10 (1.8%) were intermediate and 329 (59.3%) were resistant to erythromycin. Vietnam had the highest prevalence of erythromycin resistance (88.3%), followed by Taiwan (87.2%), Korea (85.1%), Hong Kong (76.5%) and China (75.6%). Ribosomal methylation encoded by erm(B) was the most common mechanism of erythromycin resistance in China, Taiwan, Sri Lanka and Korea. In Hong Kong, Singapore, Thailand and Malaysia, efflux encoded by mef(A) was the more common in erythromycin-resistant isolates. In most Asian countries except Hong Kong, Malaysia and Singapore, erm(B) was found in >50% of pneumococcal isolates either alone or in combination with mef(A). The level of erythromycin resistance among pneumococcal isolates in most Asian countries except Thailand and India was very high with MIC90s of >128 mg/L. Molecular epidemiological studies suggest the horizontal transfer of the erm(B) gene and clonal dissemination of resistant strains in the Asian region.

Conclusion: Data confirm that macrolide resistance in pneumococci is a serious problem in many Asian countries.

Keywords: erythromycin, erm(B), mef(A), pneumococci
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