Ann Lab Med.  2015 Mar;35(2):205-211. 10.3343/alm.2015.35.2.205.

Species-Specific Difference in Antimicrobial Susceptibility Among Viridans Group Streptococci

Affiliations
  • 1Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. micro.lee@samsung.com

Abstract

BACKGROUND
Viridans group streptococci (VGS) are both commensal microbes and potential pathogens. Increasing resistance to penicillin in VGS is an ongoing issue in the clinical environment. We investigated the difference in susceptibility and resistance to penicillin among various VGS species.
METHODS
In total 1,448 VGS isolated from various clinical specimens were analyzed over a two-yr period. Identification and antimicrobial susceptibility test was performed by the automated VITEK 2 system (bioMerieux, France) or the MicroScan MICroSTREP system (Siemens, Germany).
RESULTS
Among the 1,448 isolates, 412 were isolated from blood (28.4%). Streptococcus mitis group was the most frequently isolated (589 isolates, 40.7%), followed by the S. anginosus group (290 isolates, 20.0%), S. sanguinis group (179 isolates, 12.4%) and S. salivarius group (57 isolates, 3.9%). In total, 314 isolates could not be identified up to the species level. The overall non-susceptibility to penicillin was observed to be 40.0% (resistant, 11.2% and intermediately resistant, 28.8%) with uneven distribution among groups; 40.2% in S. sanguinis group (resistant, 5.0% and intermediately resistant, 35.2%), 60.3% in S. mitis group (resistant, 20.9% and intermediately resistant, 39.4%), 78.9% in S. salivarius group (resistant, 8.8% and intermediately resistant, 70.1%), and 6.2% in S. anginosus group (resistant, 1.7% and intermediately resistant, 4.5%).
CONCLUSIONS
Antimicrobial resistance patterns towards penicillin show differences among various VGS; this should be considered while devising an effective antimicrobial treatment against VGS.

Keyword

Viridans streptococci; Penicillin; Resistance; Microbial

MeSH Terms

Anti-Infective Agents/*pharmacology
Body Fluids/microbiology
Drug Resistance, Bacterial
Humans
Microbial Sensitivity Tests
Penicillins/pharmacology
Streptococcal Infections/microbiology/pathology
Viridans Streptococci/*drug effects/isolation & purification
Anti-Infective Agents
Penicillins

Reference

1. Doern CD. It's not easy being green: the viridans group streptococci, with a focus on pediatric clinical manifestations. J Clin Microbiol. 2010; 48:3829–3835. PMID: 20810781.
Article
2. Facklam R. What happened to the streptococci: overview of taxonomic and nomenclature changes. Clin Microbiol Rev. 2002; 15:613–630. PMID: 12364372.
Article
3. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. 1995; 274:1706–1713. PMID: 7474277.
Article
4. Tunkel AR. Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis. 2002; 34:1524–1529. PMID: 12015700.
Article
5. Bryskier A. Viridans group streptococci: a reservoir of resistant bacteria in oral cavities. Clin Microbiol Infect. 2002; 8:65–69. PMID: 11952717.
Article
6. Cho EH. Clinical significance of viridans streptococcal bacteremia. Korean J Lab Med. 2003; 23:246–250.
7. Naiman RA. Pencillin-resistant bacteria in the mouths and throats of children receiving continuous prophylaxis against rheumatic fever. Ann Intern Med. 1963; 58:768–772. PMID: 13937270.
8. Gossling J. Occurrence and pathogenicity of the Streptococcus milleri group. Rev Infect Dis. 1988; 10:257–285. PMID: 3287560.
Article
9. Farber BF, Eliopoulos GM, Ward JI, Ruoff KL, Syriopoulou V, Moellering RC Jr. Multiply resistant viridans streptococci: susceptibility to beta-lactam antibiotics and comparison of penicillin-binding protein patterns. Antimicrob Agents Chemother. 1983; 24:702–705. PMID: 6607030.
Article
10. Quinn JP, DiVincenzo CA, Lucks DA, Luskin RL, Shatzer KL, Lerner SA. Serious infections due to penicillin-resistant strains of viridans streptococci with altered penicillin-binding proteins. J Infect Dis. 1988; 157:764–769. PMID: 3346567.
Article
11. Goldfarb J, Wormser GP, Glaser JH. Meningitis caused by multiply antibiotic-resistant viridans streptococci. J Pediatr. 1984; 105:891–895. PMID: 6502338.
Article
12. Diekema DJ, Beach ML, Pfaller MA, Jones RN. SENTRY Participants Group. Antimicrobial resistance in viridans group streptococci among patients with and without the diagnosis of cancer in the USA, Canada and Latin America. Clin Microbiol Infect. 2001; 7:152–157. PMID: 11318814.
Article
13. Doern GV, Brueggemann AB, Huynh H, Wingert E. Antimicrobial resistance with Streptococcus pneumoniae in the United States, 1997-98. Emerg Infect Dis. 1999; 5:757–765. PMID: 10603208.
14. Dowson CG, Coffey TJ, Kell C, Whiley RA. Evolution of penicillin resistance in Streptococcus pneumoniae; the role of Streptococcus mitis in the formation of a low affinity PBP2B in S. pneumoniae. Mol Microbiol. 1993; 9:635–643. PMID: 8412708.
15. Alcaide F, Liñares J, Pallares R, Carratala J, Benitez MA, Gudiol F, et al. In vitro activities of 22 beta-lactam antibiotics against penicillin-resistant and penicillin-susceptible viridans group streptococci isolated from blood. Antimicrob Agents Chemother. 1995; 39:2243–2247. PMID: 8619576.
Article
16. Han SB, Bae EY, Lee JW, Lee DG, Chung NG, Jeong DC, et al. Clinical characteristics and antibiotic susceptibility of viridans streptococcal bacteremia in children with febrile neutropenia. Infection. 2013; 41:917–924. PMID: 23640200.
Article
17. Husain E, Whitehead S, Castell A, Thomas EE, Speert DP. Viridans streptococci bacteremia in children with malignancy: relevance of species identification and penicillin susceptibility. Pediatr Infect Dis J. 2005; 24:563–566. PMID: 15933573.
18. Marron A, Carratalà J, González-Barca E, Fernández-Sevilla A, Alcaide F, Gudiol F. Serious complications of bacteremia caused by Viridans streptococci in neutropenic patients with cancer. Clin Infect Dis. 2000; 31:1126–1130. PMID: 11073739.
Article
19. Reinert RR, von Eiff C, Kresken M, Brauers J, Hafner D, Al-Lahham A, et al. Nationwide German multicenter study on the prevalence of antibiotic resistance in streptococcal blood isolates from neutropenic patients and comparative in vitro activities of quinupristin-dalfopristin and eight other antimicrobials. J Clin Microbiol. 2001; 39:1928–1931. PMID: 11326015.
Article
20. Bronzwaer SL, Cars O, Buchholz U, Mölstad S, Goettsch W, Veldhuijzen IK, et al. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002; 8:278–282. PMID: 11927025.
21. Jorgensen JH, Barry AL, Traczewski MM, Sahm DF, McElmeel ML, Crawford SA. Rapid automated antimicrobial susceptibility testing of Streptococcus pneumoniae by use of the bioMerieux VITEK 2. J Clin Microbiol. 2000; 38:2814–2818. PMID: 10921932.
22. Kim SJ, Uh Y, Jang IH, Lee KS, Park SD, Yoon KJ. Evaluation of the MicroScan MICroSTREP plus antimicrobial panel for testing β-hemolytic streptococci and viridans group streptococci. Korean J Lab Med. 2011; 31:185–190. PMID: 21779193.
Article
23. Haanperä M, Jalava J, Huovinen P, Meurman O, Rantakokko-Jalava K. Identification of alpha-hemolytic streptococci by pyrosequencing the 16S rRNA gene and by use of VITEK 2. J Clin Microbiol. 2007; 45:762–770. PMID: 17215341.
Article
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