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Antimicrobial Agents and Chemotherapy, January 2006, p. 256-261, Vol. 50, No. 1
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.1.256-261.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Resistance to Erythromycin and Telithromycin in Streptococcus pyogenes Isolates Obtained between 1999 and 2002 from Greek Children with Tonsillopharyngitis: Phenotypic and Genotypic Analysis

Ioanna N. Grivea,1 Adnan Al-Lahham,2 George D. Katopodis,1 George A. Syrogiannopoulos,1* and Ralf René Reinert2

University of Patras, School of Medicine, Patras, Greece,1 Institute for Medical Microbiology and National Reference Center for Streptococci, University Hospital, Aachen, Germany2

Received 24 August 2005/ Returned for modification 21 September 2005/ Accepted 20 October 2005

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, ≥2 µg/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.

* Corresponding author. Present address: Department of Pediatrics, University of Thessaly, School of Medicine, 22 Papakyriazi Street, 412 22 Larissa, Greece. Phone: 30-2410-681136. Fax: 30-2410-611097. E-mail: syrogian{at}otenet.gr.

Antimicrobial Agents and Chemotherapy, January 2006, p. 256-261, Vol. 50, No. 1
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.1.256-261.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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