PMID:16377695

Citation	Grivea, IN, Al-Lahham, A, Katopodis, GD, Syrogiannopoulos, GA and Reinert, RR (2006) Resistance to erythromycin and telithromycin in Streptococcus pyogenes isolates obtained between 1999 and 2002 from Greek children with tonsillopharyngitis: phenotypic and genotypic analysis. Antimicrob. Agents Chemother. 50:256-61
Abstract	Since the late 1990s, the prevalence of erythromycin-resistant Streptococcus pyogenes has significantly increased in several European countries. Between January 1999 and December 2002, 1,577 isolates of S. pyogenes were recovered from children with tonsillopharyngitis living in various areas of Western Greece. Erythromycin resistance was observed in 379 (24%) of the 1,577 isolates. All erythromycin-resistant strains along with 153 randomly selected erythromycin-susceptible S. pyogenes isolates were tested for their antimicrobial susceptibility, resistance phenotypes, and genotypes. Representative isolates underwent emm gene sequence typing. Isolates with reduced susceptibility to telithromycin (MIC, > or = 2 microg/ml) were studied for multilocus sequence type, L22, L4, and 23S rRNA mutations. Of the total 379 erythromycin-resistant isolates, 193 (50.9%) harbored the mef(A) gene, 163 (43%) erm(A), 1 (0.3%) mef(A) plus erm(A), and 22 (5.8%) the erm(B) gene. Among the erythromycin-susceptible isolates, emm 1 (25%), emm 2 (12.5%), and emm 77 (12.5%) predominated. Furthermore, among the erythromycin-resistant isolates, emm 4 (30.6%), emm 28 (22.2%), and emm 77 (12.5%) prevailed. Resistance to telithromycin was observed in 22 (5.8%) of the erythromycin-resistant isolates. Sixteen (72.7%) of the 22 isolates appeared to be clonally related, since all of them belonged to emm type 28 and multilocus sequence type 52. One of the well-known mutations (T2166C) in 23S rRNA, as well as a new one (T2136C), was detected in erythromycin- and telithromycin-resistant isolates. High incidence of macrolide resistance and clonal spread of telithromycin resistance were the characteristics of the Greek S. pyogenes isolates obtained from 1999 to 2002.
Links	PubMed PMC1346824 Online version:10.1128/AAC.50.1.256-261.2006
Keywords	Acute Disease; Child; Child, Preschool; Drug Resistance, Bacterial; Erythromycin/pharmacology; Genotype; Greece/epidemiology; Humans; Ketolides/pharmacology; Pharyngitis/epidemiology; Pharyngitis/microbiology; Phenotype; Streptococcal Infections/diagnosis; Streptococcal Infections/epidemiology; Streptococcus pyogenes/drug effects; Streptococcus pyogenes/isolation & purification; Tonsillitis/epidemiology; Tonsillitis/microbiology
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Annotations

Gene product	Qualifier	GO Term	Evidence Code	with/from	Aspect	Extension	Notes	Status
STRPY:Q2XU33		GO:0010467: gene expression	ECO:0000315:		P		Table 2 shows how many resistance phenotypes of the 379 erythromycin-resistant isolates. Within that chart it shows the ermA gene.	complete CACAO 11352

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