Genetic commonality of macrolide-resistant group A beta hemolytic streptococcus pharyngeal strains
2009
Goering Richard V | Selvarangan Rangaraj | Jackson Mary | Myers Angela L | Harrison Christopher
<p>Abstract</p> <p>Background</p> <p>Group A beta hemolytic streptococcus (GABHS) pharyngitis is a common childhood illness. Penicillin remains the gold standard therapy, but macrolides are indicated for the penicillin allergic patient, and are often used for convenience.</p> <p>Methods</p> <p>We conducted a surveillance study of children with pharyngitis and positive streptococcal rapid antigen testing from 10/05 to 10/06 at 2 sites (A & B). Demographics, treatment, and resistance data was collected and compared to previous data from 2002. Erythromycin (EM) resistance was determined by disk diffusion and E-test on 500 isolates. Pulse field gel electrophoresis (PFGE) was performed to measure genetic relatedness of isolates. StatXact version 8 software (Cytel Inc., Cambridge, MA) was utilized to perform Fisher's exact test and exact confidence interval (CI) analysis.</p> <p>Results</p> <p>There were no differences in resistance rates or demographic features, with the exception of race, between sites A & B. EM resistance was 0 in 2002, 3.5% in 2005-06 at site A, and 4.5% in 2005-06 at site B. 3/7 and 3/9 had inducible resistance at A and B respectively. 8 isolates had relatedness ≥80%, 5 of which were 88% homologous on PFGE.</p> <p>Conclusion</p> <p>Community macrolide resistance has increased following increased macrolide use. These results may have treatment implications if use continues to be high.</p>
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