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Journal of Clinical Microbiology, May 2000, p. 1731-1734, Vol. 38, No. 5
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Use of Clindamycin Disks To Detect Macrolide Resistance Mediated by ermB and mefE in Streptococcus pneumoniae Isolates from Adults and Children

Ken Waites,1,2,* Crystal Johnson,2 Barry Gray,3 Kathryn Edwards,4 Marilyn Crain,5 and William Benjamin Jr.1,2

Departments of Pathology,1 Microbiology,2 and Pediatrics,5 University of Alabama at Birmingham, Birmingham, Alabama; Spartanburg Regional Healthcare Center, Spartanburg, South Carolina3; and Department of Pediatrics, Vanderbilt University, Nashville, Tennessee4

Received 1 November 1999/Returned for modification 10 January 2000/Accepted 26 January 2000

We studied 198 macrolide-resistant S. pneumoniae isolates obtained from adults and children to evaluate whether 2-µg clindamycin disks can distinguish between isolates manifesting ermB- versus mefE-mediated resistance to clarithromycin and to determine the relative frequency with which each resistance mechanism occurred in these populations. The mefE gene was predominant among 109 isolates from children, occurring in 73.4% versus 50.6% of 89 isolates from adults. Three isolates (1.5%) did not amplify either gene. Among 125 mefE+ isolates, the MIC of clarithromycin at which 90% of the isolates tested were inhibited, determined by Etest, was 32 µg/ml versus >256 µg/ml in 70 ermB+ isolates. All ermB+ isolates were highly resistant to clindamycin (MICs >256 µg/ml), whereas all mefE+ isolates were susceptible to clindamycin using the 2-µg disk. Testing S. pneumoniae from the respiratory tract for susceptibility to clindamycin by agar disk diffusion is an easy and inexpensive method to estimate the frequency of resistance mediated by ermB in specific patient populations. Macrolide resistance mediated by ermB is usually of greater magnitude than that due to mefE. Clinical studies are needed to determine the significance of high- versus low-level macrolide resistance in S. pneumoniae.

* Corresponding author. Mailing address: Department of Pathology, WP 230, University of Alabama at Birmingham, 618 South 18th St., Birmingham, AL 35233-7331. Phone: (205) 934-0578. Fax: (205) 975-4468. E-mail: waites{at}path.uab.edu.

Journal of Clinical Microbiology, May 2000, p. 1731-1734, Vol. 38, No. 5
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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