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Six-Month Multicenter Study on Invasive Infections Due to Group B Streptococci in Argentina

Horacio A. Lopardo,^1* Patricia Vidal,¹ Paola Jeric,² Daniela Centron,² Hugo Paganini,³ Richard R. Facklam,⁴ The Argentinian Streptococcus Study Group, and John Elliott⁴

Servicio de Microbiología,¹ Servicio de Epidemiología, Infectología y Medicina Preventiva, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan",³ Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,² Division of Bacterial and Mycotic Diseases, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia⁴

Received 9 April 2003/ Returned for modification 9 June 2003/ Accepted 30 July 2003

There is little information about invasive infections by group B streptococci (GBS) and their antimicrobial susceptibilities in Latin America. We performed a prospective multicenter study to determine the serotype distribution and the antimicrobial susceptibility of GBS in Argentina. We identified 58 cases, but only 44 had sufficient data to be evaluated. Eight early-, four late-, and one fatal late, late-onset neonatal infections due to GBS were found. A total of 31 patients were adults with bacteremia, skin and soft tissue infections, osteomyelitis, arthritis, meningitis, abdominal infections, and renal abscess. Serotype III was prevalent in late-onset neonatal disease, and several serotypes (Ia/c, III, Ia, and II) were involved in early-onset neonatal infections. Serotypes II, Ia/c, III, and IV were commonly found in adults, with serotype II prevalent in younger adults (18 to 69 years old) and serotype Ia/c prevalent in elderly adults (>70 years old). The mortality rate attributable to GBS infections was 10.8%. All GBS were susceptible to penicillin and ceftriaxone. Resistance to clindamycin (1.7%), erythromycin (5.2%), azithromycin (5.2%), minocycline (69%), and tetracycline (72.4%), to high levels of kanamycin and amikacin (1.7%), and to intermediately high levels of gentamicin (1.7%) was observed. The bifunctional enzyme AAC6'-APH2" was detected in the isolate resistant to aminoglycosides, and other genetic determinants were identified in other resistant isolates: tetM and tetO in tetracycline-resistant streptococci and mefA and ermTR for efflux-mediated and inducible macrolide-lincosamide-streptogramin B-resistant streptococci, respectively. For clinical purposes and rapid and easy detection of high-level aminoglycoside-resistant GBS, a screening method that used 1,000-µg kanamycin disks is proposed.

The members of the Argentinian Streptococcus Study Group are listed in Acknowledgments.

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