Journal Article

Community-Based Surveillance in the United States of Macrolide-Resistant Pediatric Pharyngeal Group A Streptococci during 3 Respiratory Disease Seasons

Robert R. Tanz, Stanford T. Shulman, Virginia D. Shortridge, William Kabat, Kathy Kabat, Emily Cederlund, Jason Rippe, Jill Beyer, Stella Doktor and Bernard W. Beall

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 12, pages 1794-1801
Published in print December 2004 | ISSN: 1058-4838
Published online December 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/426025
Community-Based Surveillance in the United States of Macrolide-Resistant Pediatric Pharyngeal Group A Streptococci during 3 Respiratory Disease Seasons

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Background. In 2001, a total of 48% of pharyngeal group A streptococci (GAS) from Pittsburgh children were macrolide resistant. We assessed macrolide resistance, resistance genes, and emm types among GAS in the United States.

Methods. In prospective, multicenter, community-based surveillance of pharyngeal GAS recovered from children 3–18 years old during 3 respiratory seasons (the 2000–2001 season, the 2001–2002 season, and the 2002–2003 season), GAS were tested for macrolide resistance and underwent emm gene sequencing. Macrolide-resistant GAS were tested for resistance to clindamycin, and resistance genes were determined.

Results. Erythromycin resistance was observed in 4.4% of isolates from the 2000–2001 season, 4.3% from the 2001–2002 season, and 3.8% from the 2002–2003 season (P = .80). Clindamycin resistance was found in 1.04% of isolates; annual rates of clindamycin resistance were stable (P = .75). The predominant resistance genotype each year was mef A (65%–76.9%; overall, 70.3%). Resistant isolates included strains representing 8–11 different emm types each year. Heterogeneity of emm subtypes, resistance genes, and clindamycin resistance was evident among resistant isolates within some emm types. Geographic variability in resistance rates was present each year.

Conclusions. The macrolide resistance rate among pharyngeal GAS was <5% and was stable over the 3 seasons. However, rates varied among sites each year. There was no evidence of spread of a specific resistant clone, increasing clindamycin resistance, or escalation in median erythromycin MICs.

Journal Article.  4933 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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