Molecular Epidemiology and Antibacterial Susceptibility of Streptococci Isolated from Healthy Children Attending Day Care Units

Abstract

Objective: The aims of the study were to investigate antibacterial susceptibility and resistance mechanisms of streptococci isolated from healthy children attending day care units and to evaluate clonal relatedness of the strains. Material and Methods: Antimicrobial susceptibilities of streptococci isolated from 212 children attending 3 different day care units were evaluated using the agar dilution method. Polymerase chain reaction and sequencing were used to investigate resistance mechanisms. Clonal relatedness was evaluated using pulsed field gel electrophoresis. Results: Of 212 children, 11 (5.2%) carried Streptococcus pneumoniae, 17 (8.0%) S. pyogenes, and 42 (19.8%) erythromycin resistant viridans group streptococci. All S. pyogenes were susceptible to penicillin G and macrolides. Ten of 11 clonally unique S. pneumoniae were resistant to penicillin G. Three of 11 S. pneumoniae were macrolide resistant and carried erm(B). Among clonally unique 42 erythromycin resistant viridans group streptococci, 2 (4.8%) had erm(B), 33 (78.6%) had mef(A) and 7 (16.6%) had both erm(B) and mef(A) genes. All S. pyogenes from the first centre and three strains from the second centre were pulse-type A. Conclusion: Among healthy children, colonization with penicillin resistant pneumococci and erythromycin resistant viridans group streptococci is quite high. Clonal spread of S. pyogenes is important for day care units.

Keywords

• Streptococcus pneumoniae, Streptococcus pyogenes, viridans group streptococci, day care units, colonization, antimicrobial resistance

Molecular Epidemiology and Antibacterial Susceptibility of Streptococci Isolated from Healthy Children Attending Day Care Units

Öz

References

1. Gallis HA. Viridans and β-hemolytic (non-group A, B, and D) streptococci. In: Mandell GL, Douglas RG & Bennett JE, editors. Principles and Practice of Infectious Diseases. 3rd edn. New York, Chuchill Livingstone; 1990. p. 1563-72.
2. Dowson CG, Coffey TJ, Kell C, Whiley RA. Evolution of penicillin resistance in Streptococcus pneumoniae: the role of Streptococ- cus mitis in the formation of a low-affinity PBP 2b in Streptococ- cus pneumoniae. Molecular Microbiol 1993;9:635-43. [CrossRef]
3. Ono T, Shiota S, Hirota K, Nemoto K, Tsuchiya T, Miyake Y. Sus- ceptibilities of oral and nasal isolates of Streptococcus mitis and Streptococcus oralis to macrolides and PCR detection of resis- tance genes. Antimicrob Agents Chemother 2000;44:1078-80. [CrossRef]
4. Pérez-Trallero E, Vicente D, Montes M, Marimon JM, Piñeiro L. High proportion of pharyngeal carriers of commensal strepto- cocci resistant to erythromycin in Spanish adults. J Antimicrob Chemother 2001;48:225-9. [CrossRef]
5. Gür D, Güçiz B, Hasçelik G, Esel D, Sümerkan B, Over U, et al. Streptococcus pneumoniae penicillin resistance in Turkey. J Che- mother 2001;13:541-5.
6. Appelbaum PC, Bhamjee A, Scragg JN, Hallett AF, Bowen AJ, Cooper RC. Streptococcus pneumoniae resistant to penicillin and chloramphenicol. Lancet 1977;2:995-7. [CrossRef]
7. Esel D, Sumerkan B, Kocagoz S. Epidemiology of penicillin resis- tance in Streptococcus pneumoniae isolates in Kayseri, Turkey. Clin Microbiol Infect 2001;7:548-52. [CrossRef]
8. Palavecino EL, Riedel I, Duran C, Bajaksouzian S, Joloba M, Davies T, et al. Macrolide resistance phenotypes in Streptococ- cus pneumoniae in Santiago, Chile. Int J Antimicrob Agents 2002;20:108-12. [CrossRef]

9. Nagai K, Appelbaum PC, Davies TA, Kelly LM, Hoellman DB, An- drasevic AT, et al. Susceptibilities to telithromycin and six other agents and prevalence of macrolide resistance due to L4 ribo- somal protein mutation among 992 pneumococci from 10 central and eastern European countries. Antimicrob Agents Chemother 2002;46:371-7. [CrossRef]
10. Akata F, Oztürk D, Tansel O, Tatman-Otkun M, Otkun M, Fitoussi F, et al. Resistance to macrolides in Group A streptococci from the European section of Turkey: genetic and phenotypic charac- terization. Int J Antimicrob Agents 2002;20:461-3. [CrossRef]
11. Farrell DJ, Douthwaite S, Morrissey I, Bakker S, Poehlsgaard J, Jakobsen L, et al. Macrolide resistance by ribosomal mutation in clinical isolates of Streptococcus pneumoniae from the PROTECT 1999-2000 study. Antimicrob Agents Chemother 2003;47:1777-83. [CrossRef]
12. Mulazimoglu L, Erdem I, Taser B, et al. (1995). Nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae at day- care centers in Istanbul. In Program and Abstracts of the Seventh European Congress of Clinical Microbiology and Infectious Dis- eases, Vienna. Abstract 320. Blackwell Science, UK, 1995: p. 62.
13. Tetik H, Otkun M, Eskiocak M, et al. Trakya bolgesindeki hu- zurevleri ve yetistirme yurtlarinda penisiline direncli pnomokok tasiyiciligi (Carriage of penicillin-resistant pnemococci in day-care centers in Trakya region). In: XI. Türk Klinik Mikrobiyoloji ve In- feksiyon Hastaliklari Kongresi Pogram ve Ozet Kitabi, Istanbul. Abstract P-12/14. Klinik Mikrobiyoloji ve Infeksiyon Hastaliklari Dernegi, Istanbul, Turkey, 2003: p. 338.
14. Clinical Laboratory Standards Institute. Methods for Dilution An- timicrobial Susceptibility Tests for Bacteria that Grow Aerobical- ly-Seventh Edition: Approved Standard M7-A7. CLSI, Wayne, PA, USA, 2006.
15. Clinical Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement M100-S19. CLSI, Wayne, PA, USA, 2009.
16. Sutcliffe J, Grebe T, Tait-Kamradt A, Wondrack L. Detection of erythromycin-resistant determinants by PCR. Antimicrob Agents
17. Trzcinski K, Cooper BS, Hryniewicz W, Dowson CG. Expression of resistance to tetracyclines in strains of methicillin-resistant Staphylococcus aureus. J Antimicrobial Chemother 2000;5:763- 70. [CrossRef]
18. González I, Georgiou M, Alcaide F, Balas D, Linares J, de la Cam- pa AG. Fluoroquinolone resistance mutations in the parC, parE, and gyrA genes of clinical isolates of viridans group streptococci. Antimicrob Agents Chemother 1998;44:2118-25.
19. Soares S, Kristinsson KG, Musser JM, Tomasz A. Evidence for the introduction of a multiresistant cloneof serotype 6B Streptococ- cus pneumoniae from Spain to Iceland in the late 1980s. J Infect Dis 1993;168:158-63. [CrossRef]
20. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction pat- terns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233-9.
21. Baquero F. Epidemiology and management of penicillin-resistant pneumococci. Curr Opin Infect Dis 1996;9:372-9. [CrossRef]
22. Takala AK, Santosham M, Almeido-Hill J, Wolff M, Newcomer W, Reid R, et al. Vaccination with Haemophilus influenzae type b meningecoccal protein conjugate vaccine reduces oropharyn- geal carriage of Haemophilus influenzae type b among American Indian children. Ped Infect Dis J 1993;12:593-9. [CrossRef]
23. Dagan R, Melamed R, Muallem M, Piglansky L, Greenberg D, Abramson O, et al. Reduction of nazopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine. J Infect Dis 1996;174:1271-8. [CrossRef]
24. Gulay Z, Bicmen M, Gur D. Resistance mechanisms to macrolide antibiotics in erythromycin-resistant S. pneumoniae in Turkey. In: Program and Abstracts of the 13th European Congress of Clini- cal Microbiology and Infectious Diseases, Glasgow. Poster no. P-1544. Blackwell Science, UK, 2003: p. 376.
25. Pihlajamäki M, Kaijalainen T, Huovinen P, Jalava J; Finnish Study Group for Antimicrobial Resistance. Rapid increase in macrolide resistance among penicillin non-susceptible pneumococci in Finland, 1996-2000. J Antimicrob Chemother 2002;49:785-92. [CrossRef]
26. Petrosillo N, Pantosti A, Bordi E, Spanó A, Del Grosso M, Tal- larida B, et al. Prevalence, determinants, and molecular epide- miology of Streptococcus pneumoniae isolates colonizing the nasopharynx of healthy children in Rome. Eur J Clin Microbiol Infect Dis 2002;21:181-8. [CrossRef]
27. Melo-Cristino J, Ramirez M, Serrano N, Hanscheid T; Portuguese Surveillance Group for the Study of Respiratory Pathogens. Mac- rolide resistance in Streptococcus pneumoniae isolated from pa- tients with community-acquired lower respiratory tract infections in Portugal: results of a 3-year (1999-2001) multicenter surveil- lance study. Microb Drug Resist 2003;9:73-80. [CrossRef]
28. Ioannidou S, Tassios PT, Kotsovili-Tseleni A, Foustoukou M, Lega- kis NJ, Vatopoulos A. Antibiotic resistance rates and macrolide resistance phenotypes of viridans group streptococci from the oropharynx of healthy Greek children. International J Antimicrob Agents 2001;17:195-201. [CrossRef]
29. Poyart-Salmeron C, Trieu-Cuot P, Carlier C, Courvalin P. Nucleo- tide sequences specific for Tn1545-like conjugative transposons in pneumococci and staphylococci resistant to tetracycline. Anti- microb Agents Chemother 1991;35:1657-60.
30. Seral C, Castillo FJ, Rubio-Calvo MC, Fenoll A, García C, Gomez- Lus R. Distribution of resistance genes tet(M), aph3’-III, catpC194 and the integrase gene of Tn1545 in clinical Streptococcus pneu- moniae harbouring erm(B) and mef(A) genes in Spain. J Antimi- crob Chemother 2001;47:863-6. [CrossRef]
31. Rodriguez-Avial I, Rodriguez-Avial C, Culebras E, Picazo JJ. Dis- tribution of tetracycline resistance genes tet(M), tet(O), tet(L) and tet(K) in blood isolates of viridans group streptococci harbouring erm(B) and mef(A) genes. Susceptibility to quinupristin/dalfopristin and linezolid. Int J Antimicrob Agents 2003;21:536-41. [CrossRef]
32. Doern GV, Ferraro MJ, Brueggemann AB, Ruoff KL. Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States. Antimicrob Agents Chemother 1996;40:891-4.
33. Ferrandiz MJ, Oteo J, Aracil B, Gomez-Garces JL, De La Campa AG. Drug efflux and parC mutations are involved in fluoroquino- lone resistance in viridans group streptococci. Antimicrob Agents