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Antimicrobial Agents and Chemotherapy, July 2003, p. 2152-2157, Vol. 47, No. 7
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.7.2152-2157.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Telithromycin and Quinupristin-Dalfopristin Resistance in Clinical Isolates of Streptococcus pyogenes: SMART Program 2001 Data

Po-Ren Hsueh,^1* Lee-Jene Teng,¹ Chun-Ming Lee,² Wen-Kuei Huang,³ Tsu-Lan Wu,⁴ Jen-Hsien Wan,⁵ Dine Yang,² Jainn-Ming Shyr,⁶ Yin-Ching Chuang,⁷ Jing-Jou Yan,⁸ Jang-Jih Lu,⁹ Jiunn-Jong Wu,⁸ Wen-Chien Ko,⁸ Feng-Yee Chang,⁹ Yi-Chueh Yang,⁷ Yeu-Jun Lau,⁶ Yung-Ching Liu,³ Hsieh-Shong Leu,⁴ Cheng-Yi Liu,¹⁰ and Kwen-Tay Luh¹

Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine,¹ Mackay Memorial Hospital,² Tri-service General Hospital,⁹ Taipei Veterans General Hospital, Taipei,¹⁰ Kaohsiung Veterans General Hospital, Kaohsiung,³ Chang-Gung Memorial Hospital, LinKou,⁴ China Medical College Hospital,⁵ Taichung Veterans General Hospital, Taichung,⁶ Chi-Mei Medical Center,⁷ National Cheng-Kung University Hospital, Tainan, Taiwan⁸

Received 24 January 2003/ Returned for modification 27 March 2003/ Accepted 28 April 2003

This study evaluated the current status of antimicrobial resistance in clinical isolates of Streptococcus pyogenes in Taiwan as part of the SMART (Surveillance from Multicenter Antimicrobial Resistance in Taiwan) program. In 2001, 419 different isolates of S. pyogenes, including 275 from respiratory secretions, 87 from wound pus, and 31 from blood, were collected from nine hospitals in different parts of Taiwan. MICs of 23 antimicrobial agents were determined at a central location by the agar dilution method. All of the isolates were susceptible to penicillin (MIC at which 90% of the isolates were inhibited [MIC₉₀], ≤0.03 µg/ml), cefotaxime (MIC₉₀, ≤0.03 µg/ml), cefepime (MIC₉₀, 0.06 µg/ml), meropenem (MIC₉₀, ≤0.03 µg/ml), moxifloxacin (MIC₉₀, 0.25 µg/ml), vancomycin (MIC₉₀, 0.5 µg/ml), and linezolid (MIC₉₀, 1 µg/ml). Overall, 78% of isolates were not susceptible to erythromycin (54% were intermediate, and 24% were resistant), and 5% were not susceptible to clindamycin. Of the 101 erythromycin-resistant isolates, 80.2% exhibited the M phenotype (mefA gene positive), 18.9% exhibited the cMLS (constitutive resistance to macrolides-lincosamides-streptogramin B [MLS]) phenotype (ermB gene positive), and 1% exhibited the iMLS (inducible resistance to MLS) phenotype (ermB gene positive). Fluoroquinolones (sitafloxacin > moxifloxacin > ciprofloxacin = levofloxacin = gatifloxacin > gemifloxacin) demonstrated potent activity against nearly all of the isolates of S. pyogenes tested. Thirty-two isolates (8%) were not susceptible to quinupristin-dalfopristin. Seventeen percent of isolates had telithromycin MICs of ≥1 µg/ml, and all of these isolates exhibited erythromycin MICs of ≥32 µg/ml. The high prevalence of resistance to telithromycin (which is not available in Taiwan) limits its potential use in the treatment of S. pyogenes infections, particularly in areas with high rates of macrolide resistance.

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* Corresponding author. Mailing address: Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei, Taiwan. Phone: 886-23123456, ext. 5363. Fax: 886-2-23224263. E-mail: hsporen{at}ha.mc.ntu.edu.tw.

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Antimicrobial Agents and Chemotherapy, July 2003, p. 2152-2157, Vol. 47, No. 7
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.7.2152-2157.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

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