Erythromycin resistance in Group A Beta-hemolytic streptococci

Year 2022, , 421 - 425, 22.10.2022

Pervin Balcı

https://doi.org/10.38053/acmj.1166370

Abstract

Aim: Streptococcus pyogenes (Group A Beta-hemolytic streptococci, GABHS) is one of the important bacterial pathogens in clinical microbiology. It often causes upper respiratory tract infections such as tonsillitis, pharyngitis, and laryngitis. It also leads to complications such as acute rheumatic fever and post-streptococcal glomerulonephritis. Early diagnosis and treatment of these bacterial infections will prevent suppurative and non-suppurative complications, the transmission of infection to other people, and chronic carriage. Today, the treatment of streptococcal infections relies entirely on chemotherapy. Beta hemolytic group A streptococci and generally other beta-hemolytic streptococci in groups B (GBBHS), C, and G are generally sensitive to many chemotherapeutics, especially Penicillin and Erythromycin. In patients with penicillin allergy, erythromycin, amoxicillin-clavulanate, or oral cephalosporins are used instead of penicillin. However, it has recently been understood that there are strains resistant to Erythromycin in GABHS and are increasing. In this study, the situation in our region of Erythromycin resistance, which is used as an alternative for people allergic to Penicillin in the treatment of streptococcal infections, was investigated.
Material and Method: In our study, throat swab samples were taken from 150 pharyngitis patients and 94 GABHS were obtained by applying the Bacitracin-SXT test with the culture method, and antibiotic susceptibility tests were performed on these 94 GABHS by Kirby-Bauer agar disc diffusion method.
Result: GABHS was found susceptible to Bacitracin and resistant to SXT. GBBHS is resistant to Bacitracin and SXT. other beta-hemolytic streptococci were resistant to Bacitracin and susceptible to SXT.
Conclusion: In this study, Erythromycin’s resistance was found to be 19.1%. it is observed that Erythromycin resistance has increased over the years when compared to previous studies. Erythromycin should not be used empirically in treatment. An antibiotic susceptibility test should be performed and the antibiotic should be selected according to the results of the antibiogram test.

Keywords

Penicillin, erythromycin, Streptococcus pyogenes, tonsillitis, pharyngitis, laryngitis

Thanks

I would like to thank my late teacher Dr. Süheyla Öztürk for his support in my education and thesis work.

References

• Bisno AL, Mandel GL, Douglas RG, Bennett JE. Classification Of Streptococci In (ed) : Principles and Practise of Infectious Diseaes, vol 2 New York, Churchill Livingstone 1990: 1518-28.
• Facklam RR. Serologic identification of streptococci: How useful is serologic grouping? Clin Microbiol Newsletter 1985; 7: 91-4.
• Hardie SM. Genus Streptococcus Rosenbah 1884 in Hat JG, Sneath PHA (ed) Bergey’s Manual of Systematic Bacteriology, vol 2 Baltimore, Williams & Willins 1984: 1043-71.
• Bilgehan H. “Streptococcacene”, Klinik Mikrobiyoloji, Özel Bakteriyolaji ve Bakteri Enfeksiyonları, 1.Baskı, İzmir Barış Yayınları. 1990: 210-3.
• Baron EJ, Finegad SM. Bailey and Scott’s Diagnostic Microbiology 8th ed. St. Louis, The CU Mospy Co 1990: 332-52.
• Hedges JR. Sore Throat, to culture or not to culture. Ann Emerg Med 1986; 15: 312-6.
• Peters G, Smith A. Group A streptococcal infections of the skin and pharynx. N Engl J Med 1977: 297-311.
• Jawetz E, Melnick JL, Adelburg EA. Rewiew of Medical Microbiology 7th ed. California, Appleton and Lange1987: 223-37.
• Onul B. Enfeksiyon Hastalıkları, 6.Baskı, Ankara Üniversitesi Tıp Takültesi Yayımı 1980 No: 391: 547-99.
• Özenci M. Temel Tedavi, Tedavi Ağırlıklı Klinik, Fidan Kitabevi, Ankara 1983: 521.
• Özdemir G, Saatçi Ü, Berkam E, Gür A. Okul çocuklarında a grubu beta hemolitik streptokok enfeksiyonu ve buna bağlı asemptomatik akut glomerulonefritin görülme sıklığı. Çocuk Sağlığı ve Hastalıkları Derg 1979; 22.
• Schachtel BP, Fillingin JM, Beiter DJ, et al. Subjective and objective features of sore throat. Arch Intern Med 1984; 144: 497-500.
• Shank JC, Poweli TA. A Five-year experience with throat cultures. J Fam Pract 1984; 18: 857-63.
• Bhattacharyya N, Shapiro J. Contemporary trends in microbiology and antibiotic resistance in otolaryngology. Auris Nasus Larynx 2022; 29: 59-63.
• Berkley SF, Ligau-Perez JG, Faclam R, Broome CU. Food borne streptococcal pharyngitis after a party. Public Health Rep 1986; 161: 211-5.
• Cimolai N, EHford RW-Bryan L, Anord C, et al. The beta-hemolitik non-group a streptococci cause pharyngitis? Rev Inf Dis 1988; 10: 587-601.
• Dobson SRM. Group A streptococci revisited Arch. Child 1988;64; 577-580.
• Alberti S, Garcia-Rey C, Dominguez MA, et al. “Survey of emm gene sequences from pharyngeal Streptococcus pyogenes isolates collected in spain and their relationship with erythromycin susceptibility” J Clin Microbiol 2003; 41: 2385-90.
• Li Y, Rivers J, Mathis S, et al. Continued Increase of Erythromycin-and Clindamycin-Nonsusceptibility among Invasive Group A Streptococci Driven by Genomic Clusters, USA 2018-2019. Clin Infect Dis 2022.
• Haenni, M, Lupo A, Madec JY. Antimicrobial resistance in Streptococcus spp. Microbiology spectrum 2018; 6: 6-2.
• Holmerg SD, Fainch GA. Streptococcal Phryngitis and acute rheumafic fever in Rhode island. JAMA 1983; 250: 2307-12.
• Lundberg C. Bacterial infections of the upper respiratory airways and beta-lactam antibiotics (suppl.). Second J infect Dis 1984; 42: 122-3.
• Tuncer AM, Kurak B, Kırsaç N, et al. Akut Farenjitte 4 Grubu Beta Hemolitik Streptokok Sıklığı, Penicillin Tedavisi ile Başarısız olgularda Sefadioksil, Klavulonik Asitte Kombine Amoksisilin ve Erythromycin’le alınan sonuçlar. Mikrobiyoloji Bülteni 1988; 21: 171-7.
• Stingemore N, Francis GR, Toohey M, McGechie DB. The emergence of erythromycin resistance in Streptococcus pyogenes in Fremantle, Western Australia. Med J Aust 1989; 150: 626-31.
• Hardie R, Hardie RA. Erythromycin-resistant Streptococcus pyogenes. Scott Med 1986; 31: 39.
• Seppala H, Nissinen A, Jarvinen H, et al. Resistance to Erythromycin in Group A Streptococci. New Engl J Med 1992; 326: 292-7.
• Kiraz N, Akşit F, Koçoğlu T. Boğaz sürüntülerinden izole edilen grup A streptokokların antibiyotik duyarlılık sonuçları.Mikrobiyol Bült 1990; 24: 237
• Sultan G, Demirsoy S, Olguntürk R, Türet S, Kurtar K. A grubu beta hemolitik streptokokların penicillin ve türevlerine karşı duyarlılığı ve beta laktamaz aktivitesi yönünden incelenmesi. GÜTF Derg 1987; 111: 57-62.
• Saniç A, Pirinçciler M, Leblebicioğlu H, Günaydın M. A grubu beta hemolitik streptokokların antimikrobiklere duyarlılıkları. Ankem 8. Türkiye Antibiyotik ve Kemoterapi Kongre Derg 1993; 7: 53.
• Gürsoy G, Çöplü N, Zarakolu P, Ulumlu G, Özkaya E, Güvener E. A grubu beta hemolitik sireptokokların erythromycin’e i̇nvitro duyarlılıkları. Anken 8. Türkiye Antibiyotik ve Kemoterapi Kongre Derg 1993; 7: 83.
• Berkiten R, Gürol SD. Solunum yolu infeksiyonlarından izole edilen beta-hemolitik streptokoklar ve eritromisin direnci, Türk Mikrobiyol Cem Derg 2000; 30: 20-2.
• Erdemoğlu A, Özcan fi, Diler M, et al. Boğaz kültürlerinden izole edilen Strepttococcus pyogenes suşlarının antibiyotik duyarlılıkları (Özet), ANKEM Derg 2000; 14: 130.
• Altun M, Meriçli Yapıcı B. Çanakkale’de tonsillofarenjitli hastaların boğaz kültürlerinden izole edilen beta hemolitik streptokokların grup dağılımlarının ve antibiyotik direnç profillerinin belirlenmesi, Turk Mikrobiyol Cemiy Derg 2021; 51: 180-8.
• Akalın HE; Antibiyotiklerde Direnç Mekanizmaları, Antibiyotikler, 1. Baskı, Türk Tabipleri Birliği Yayınları 1989; 27-30.
• Philips U, Parrot D, Orange GU, et al. Erythromycin-resistant Streptococcus pyogenes J. Anti Microhial Chemotheraphy Aprii 1990; 25: 723-4.
• Öngen B, Erdoğan H, Öksüz L, Gürler N, Töreci K. “A Grubu Beta Hemolitik Streptokoklarda Antibiyotik Direnci ve Makrolit Direnç Fenotipinin Saptanması” Ankem Derg 2000;14: 129.