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Antimicrobial Agents and Chemotherapy, April 2007, p. 1228-1233, Vol. 51, No. 4
0066-4804/07/$08.00+0     doi:10.1128/AAC.01054-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Phenotypic and Genotypic Characterization of Streptococcus pyogenes Isolates Displaying the MLSB Phenotype of Macrolide Resistance in Spain, 1999 to 2005{triangledown}

Emilio Pérez-Trallero,1,3* Milagrosa Montes,1 Beatriz Orden,2 Esther Tamayo,1 José M. García-Arenzana,1 and José M. Marimón1

Servicio de Microbiología, Hospital Donostia, San Sebastián, Spain,1 Servicio de Microbiología, H.U. Puerta de Hierro (Centro de Especialidades Arguelles), Madrid, Spain,2 Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco, San Sebastián, Spain3

Received 22 August 2006/ Returned for modification 27 December 2006/ Accepted 13 January 2007

The aim of this study was to describe the genetic characteristics of Streptococcus pyogenes showing the MLSB phenotype of macrolide resistance from 1999 to 2005 in Spain and to highlight the substantial increase in these isolates in the last few years. The antimicrobial susceptibilities of 17,232 group A streptococci isolated from Madrid and Gipuzkoa from 1999 to 2005 were studied. The presence of the resistance genes ermA, ermB, mef, tetM, and tetO and the presence of the intTn and xis genes of the Tn916-Tn1545 transposon family were studied in a sample of 739 MLSB-resistant isolates. The epidemiological relationships among these isolates were analyzed by emm typing, T typing, and multilocus sequence typing. Erythromycin resistance was found in 21.3% of the isolates analyzed (annual variation of 14.3% to 28.9%). Until 2003, most erythromycin-resistant isolates showed the M phenotype, but in 2004 and 2005, about 50% of isolates showed the MLSB phenotype. Among the MLSB-resistant isolates studied, 16 clones were identified. The most prevalent clone was a strange emm11/T11/ST403 clone with a null yqiL allele. All but one of the 463 emm11/T11/ST403 isolates carried the ermB, tetM, intTn, and xis genes. The second most prevalent MLSB-resistant clone was emm28/T28/ST52, which comprised two subclones: one bacitracin-resistant, tetracycline-susceptible subclone carrying the ermB gene (n = 115) and another bacitracin-susceptible, tetracycline-resistant subclone carrying the ermB and tetM genes (n = 33). The rapid diffusion of these two clones, and especially of emm11/T11/ST403, caused the large increase in MLSB-resistant S. pyogenes isolates in Spain, suggesting a potential ability for international dissemination.

* Corresponding author. Mailing address: Servicio de Microbiología, Hospital Donostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain. Phone: 34 943007046. Fax: 34 943007470. E-mail: mikrobiol{at}terra.es

{triangledown} Published ahead of print on 22 January 2007.

Antimicrobial Agents and Chemotherapy, April 2007, p. 1228-1233, Vol. 51, No. 4
0066-4804/07/$08.00+0     doi:10.1128/AAC.01054-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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