Antimicrobial resistance pattern of Streptococcus agalactiae strains: five years evaluation of single center’

Abstract

Aim: Streptococcus agalactiae is known to cause severe neonatal and postpartum infections. 
It also affects immunosuppressive patients. Penicillin is the first preferred antimicrobial agent in the treatment of these diseases. However, recent reports of penicillin tolerance and increased resistance to alternative antimicrobial agents in patients with penicillin allergies make treatment more difficult. In this study, we aimed to contribute to more effective treatment by determining antibiotic resistance profiles in GBS strains isolated from various clinical specimens. 

Material and Method: A total of 80 GBS strains isolated from various clinical specimens in clinical microbiology laboratory between 2012 and 2016 were evaluated retrospectively. 

Bacterial identification and antibiotic susceptibility tests were performed using conventional methods and an automated identification analyzer VITEK®-2 (BioMérieux, France).

Results: All GBS isolates were found as susceptible to penicillin, imipenem, meropenem, linezolid, trimethoprim sulfamethoxazole, tigecycline, teicoplanin and vancomycin.
The resistance rates of tetracycline, erythromycin, ciprofloxacin, clindamycin, moxifloxacin and ampicillin in isolates were 91.5%, 50.0%, 31.0%, 23.7%, 23.3% and 2.9% respectively.

Conclusion: In our study, penicillin resistance was not observed in GBS isolates. Penicillin has been using as the first preferred agent in the treatment of these infections. However, considering the increasing resistance rates in alternative drugs, antimicrobial susceptibility testing for the effective treatment and prophylaxis of GBS infections is suggested.

Keywords

• Group B streptococcus,penicillin,antimicrobial susceptibility

Streptococcus agalactiae suşlarının antimikrobiyal direnç paterni: beş yıllık tek merkez değerlendirmesi

Abstract

Amaç: Streptococcus agalactiae’nın ciddi neanatal ve postpartum enfeksiyonlara neden olduğu bilinmektedir. Ayrıca immünsupresif hastaları da etkilemektedir. Bu hastalıkların tedavisinde penisilin ilk tercih edilen antimikrobiyal ajandır. Ancak penisilin alerjisi olan hastalar, son zamanlarda bildirilen penisilin toleransı ve diğer alternatif antimikrobiyal ajanlara karşı artan direnç oranları tedaviyi zorlaştırmaktadır. Bu çalışmada çeşitli klinik örneklerden izole edilen GBS suşlarında antibiyotik direnç profillerini belirleyerek daha etkili tedaviye katkıda bulunmayı amaçladık.

Gereç ve Yöntem:  2012 - 2016 yılları arasında klinik mikrobiyoloji laboratuvarında çeşitli klinik örneklerden izole edilen toplam 80 GBS suşu retrospektif olarak değerlendirilmiştir. Bakteri identifikasyonu ve antibiyotik duyarlılık testleri konvansiyonel metodlar ve VITEK^®-2 (BioMérieux, Fransa) otomatize identifkasyon cihazı kullanılarak yapılmıştır.

Bulgular: Tüm GBS izolatları penisilin, imipenem, meropenem, linezolid,  trimetoprim sulfametoksazol, tigesiklin, teikoplanin ve vankomisine duyarlı bulunmuştur. İzolatların tetraksiklin, eritromisin, siprofloksasin, klindamisin, moksifloksasin ve ampisilin direnç oranları ise sırasıyla %91,5, %50,0, %31,0, %23,7, %23,3 ve %2,9’dur.

Sonuç: Çalışmamızda bölgemizde GBS izolatlarında penisiline direnç görülmemiştir.
Penisilin, bu enfeksiyonların tedavisinde ilk tercih edilen ajan olarak kullanılmaktadır. Ancak alternatif ilaçlarda artan direnç oranları göz önüne alındığında GBS enfeksiyonlarının etkin tedavi ve profilaksisi için antimikrobiyal duyarlılık testlerinin yapılması önerilir.

Keywords

• Grup B streptokok,penisilin,antimikrobiyal duyarlılık

References

1. 1. Da Cunha, Violette, et al. "Streptococcus agalactiae clones infecting humans were selected and fixed through the extensive use of tetracycline." Nature communications 5 (2014): ncomms5544.2. Topkaya AE, Çıragil P, Sezer O, Karateke A, Küçükercan M. The serotype distrubition of group B streptococci isolated from pregnant women. Türk Mikrobiyol Cem Derg 2005; 35(2): 81-4.3. Murray PR, Baron EJ, Jorgensen JH. Manual of Clinical Microbiology. Başustaoğlu A, Kubar A, Yıldıran ŞT ve ark. (çeviren). 9. Baskı, İstanbul: Atlas 2007;8: 1721-92.4. Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. Morb Mortal Wkly Rep 2002; 51 (No. RR-11): 1-22.5. Yenişehirli G, Bulut Y, Demirtürk F, Çalışkan AC. Gebe Kadınlardan İzole Edilen Streptococcus Agalactiae Suşlarının Antimikrobiyal Duyarlılıkları Ve Serotip Dağılımı. Mikrobiyol Bült 2006; 40: 155-160.6. Karakuş M, Karaca Derici Y, Günçiner Ş. "Gebelerde grup B streptokok kolonizasyonu ve antimikrobiyal direnç paterni." Ege Tıp Dergisi 2007; 46.3.7. Longtin J, et al. Novel mutations in a patient isolate of Streptococcus agalactiae with reduced penicillin susceptibility emerging after long-term oral suppressive therapy. Antimicrobial agents and chemotherapy 2011; 55(6): 2983-5.8. CLSI. 2010. Performance standards for antimicrobial susceptibility testing; 20th informational supplement M100-S20. Clinical and Laboratory Standards Institute, Wayne, PA.9. Betriu C, et al. Antibiotic resistance and penicillin tolerance in clinical isolates of group B streptococci. Antimicrob Agents Chemother 1994; 38: 2183–6.10. Dahesh S, et al. Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to beta-lactam antibiotics. Antimicrob Agents Chemother 2008; 52: 2915–8. 11. de Azavedo JC, M McGavin, C Duncan, D E Low, A McGeer. Prevalence and mechanisms of macrolide resistance in invasive and noninvasive group B streptococcus isolates from Ontario, Canada. Antimicrob Agents Chemother 2001; 45: 3504–812. Gaudreau C, et al. Prosthetic hip joint infection with a Streptococcus agalactiae isolate not susceptible to penicillin G and ceftriaxone. J. Antimicrob. Chemother 2010; 65: 594–5.13. Kimura, K, et al. First molecular characterization of group B streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother 2008; 52: 2890–7.14. Nagano, N, K Kimura, Y Nagano, H Yakumaru, Y. Arakawa. Molecular characterization of group B streptococci with reduced penicillin susceptibility recurrently isolated from a sacral decubitus ulcer. J Antimicro Chemother 2009; 64:1326–8.15. Nagano, N, et al. Genetic heterogeneity in pbp genes among clinically isolated group B streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother 2008; 52: 4258–67.16. Ko WC, Lee HC Wang LR, et al. Serotyping and antimicrobial susceptibility of group B streptococcus over an eight-year period in Southern Taiwan. Eur J Clin Microbiol Infect Dis 2001; 20: 334-8.17. Motlova J, Strakova L, Urbaskova P, et al. Vaginal and rectal carriage of Streptococcus agalactiae in the Czech Republic: incidence, serotypes distribution and susceptibility to antibiotics. Indian J Med Res 2004; 119 : 84-7.18. Bland MB, Vermillion ST, Soper DE, et al. Antibiotic resistance patterns of group B streptococci in late third-trimester rectovaginal cultures. Am J Obstet Gynecol 2001; 184: 1125-6.19. Tsolia M, Psoma M, Gavrili S, et al. Group B streptococcus colonization of Greek pregnant women and neonates: prevalence, risk factors and serotypes. Clin Microbiol Infect 2003; 9: 832-8.20. Andrews JI, Diekema DJ, Hunter SK, et al. Group B streptococci causing neonatal bloodstream infection: antimicrobial susceptibility and serotyping results from SENTRY centers in the Western Hemisphere. Am J Obstet Gynecol 2000; 183: 859-62.21. Wu JJ, Lin KY, Hsueh PR, et al. High incidences of erythromycin-resistant streptococci in Taiwan. Antimicrob Agents Chemother 1997; 41: 844-6.