Korean J Lab Med.  2010 Oct;30(5):485-490. 10.3343/kjlm.2010.30.5.485.

Decline in Erythromycin Resistance in Group A Streptococci from Acute Pharyngitis due to Changes in the emm Genotypes Rather Than Restriction of Antibiotic Use

• Koh E
• Kim S

• KMID: 1022039
• DOI: http://doi.org/10.3343/kjlm.2010.30.5.485

Abstract

BACKGROUND
Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis in children. Antibiotic resistance rates and emm genotypes of GAS isolated from patients with acute pharyngitis were studied in 2009.
METHODS
Throat cultures were taken from 499 children with acute pharyngitis in Jinju, Korea, in 2008-2009. A total of 174 strains (34.9%) of GAS were isolated, and antimicrobial susceptibility testing was performed using the disk diffusion method. The phenotypes of macrolide resistance and macrolide resistance genes were determined. The emm genotypes were identified using PCR and sequencing. The data were compared with those acquired in 2002 in the same region. Data on the annual macrolide production were collected between 1999 and 2008.
RESULTS
The resistance rates of GAS to erythromycin, clindamycin, and tetracycline were 4.6%, 2.9%, and 2.3%, respectively. The constitutive resistance rate was 62.5% for the erm(B) gene and 37.5% for the M phenotype of the mef(A) gene. emm4 was most frequently detected (28.2%), followed by emm89 (20.1%). Most of the erythromycin resistant strains had the emm28 genotype. We noted a gradual increase in macrolide production during the study period.
CONCLUSIONS
The erythromycin resistance rate of GAS isolated from children with acute pharyngitis was significantly lower in 2009 (4.6%) than in 2002 (44.8%). We observed a remarkable change in the distribution of emm genotypes during the 7-yr period. The significant decline in erythromycin resistance in 2009 might be associated with a prominent decrease in the resistant genotype emm12 (3.4% in 2009 vs. 28.0% in 2002) rather than restriction of macrolide use.

Keyword

Group A Streptococci; Streptococcus pyogenes; Acute pharyngitis; Erythromycin resistance; emm genotype

MeSH Terms

Acute Disease
Adolescent
Anti-Bacterial Agents/*pharmacology
Child
Child, Preschool
Disk Diffusion Antimicrobial Tests
Drug Resistance, Bacterial/genetics
Erythromycin/*pharmacology
Female
Genotype
Humans
Male
Pharyngitis/drug therapy/*microbiology
Phenotype
Sequence Analysis, DNA
Streptococcus pyogenes/*drug effects/*genetics/isolation & purification

Figure

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  Fig. 1. Distribution of emm types of ERY-resistant and ERY-susceptible strains in 2002 and 2009. P<0.05. Abbreviations: 2002 ERY-S and 2002 ERY-R, erythromycin-susceptible and -resistant in 2002; 2009 ERY-S and 2009 ERY-R, erythromycin-susceptible and -resistant in 2009.

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