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Journal of Clinical Microbiology, April 2004, p. 1559-1563, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1559-1563.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Detection of Multiple Macrolide- and Lincosamide-Resistant Strains of Streptococcus pyogenes from Patients in the Boston Area

Meredith E. Hasenbein,1 John E. Warner,2 Kathleen G. Lambert,1 Sarah E. Cole,1 Andrew B. Onderdonk,2 and Alexander J. McAdam1*

Department of Laboratory Medicine, Children's Hospital Boston and Harvard Medical School,1 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 021152

Received 29 August 2003/ Returned for modification 22 October 2003/ Accepted 17 December 2003

Macrolide (including erythromycin and azithromycin) and lincosamide (including clindamycin) antibiotics are recommended for treatment of penicillin-allergic patients with Streptococcus pyogenes pharyngitis. Resistance to erythromycin in S. pyogenes can be as high as 48% in specific populations in the United States. Macrolide and lincosamide resistance in S. pyogenes is mediated by several different genes. Expression of the erm(A) or erm(B) genes causes resistance to erythromycin and inducible or constitutive resistance to clindamycin, respectively, whereas expression of the mef(A) gene leads to resistance to erythromycin but not clindamycin. We studied the resistance of S. pyogenes to erythromycin and clindamycin at an urban tertiary-care hospital. Of 196 sequential isolates from throat cultures, 15 (7.7%) were resistant to erythromycin. Three of these were also constitutively resistant to clindamycin and had the erm(B) gene. Five of the erythromycin-resistant isolates were resistant to clindamycin upon induction with erythromycin and had the erm(A) gene. The remaining seven erythromycin-resistant isolates were susceptible to clindamycin even upon induction with erythromycin and had the mef(A) gene. Pulsed-field gel electrophoresis analysis and emm typing demonstrated that the erythromycin-resistant S. pyogenes comprised multiple strains. These results demonstrate that multiple mechanisms of resistance to macrolide and lincosamide antibiotics are present in S. pyogenes strains in the United States.

* Corresponding author. Mailing address: Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115. Phone: (617) 355-5754. Fax: (617) 713-4347. E-mail: alexander.mcadam{at}childrens.harvard.edu.

Journal of Clinical Microbiology, April 2004, p. 1559-1563, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1559-1563.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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