Mechanisms of Antibiotic Resistance

Vincent Cattoir, Joseph J. Ferretti, Dennis L. Stevens, Vincent A. Fischetti, Vincent Cattoir, Joseph J. Ferretti, Dennis L. Stevens, Vincent A. Fischetti

Excerpt

Streptococcus pyogenes, or group A streptococcus, is a major human pathogen that causes over 600 million infections annually (Lynskey, Lawrenson, & Sriskandan, 2011). This species is able to colonize the upper respiratory tract and skin of asymptomatic people, but is also responsible for a wide range of diseases, including suppurative infections and non-suppurative complications, which may occur either endemically or as outbreaks (Cunningham, 2000; Efstratiou, 2000). The types of infections can be divided into three groups: superficial infections (such as pharyngotonsillitis, impetigo, erysipelas, vaginitis, or post-partum infections), deep infections (such as bacteremia, cellulitis, myositis, necrotizing fasciitis, puerperal sepsis, pericarditis, meningitis, pneumonia, or septic arthritis), and toxin-mediated diseases (such as scarlet fever or streptococcal toxic shock syndrome [STSS]) (Efstratiou, 2000). These infections also play a significant role in the development of post-infection immune sequelae, including rheumatic fever, acute glomerulonephritis, and reactive arthritis (Cunningham, 2000). Clinical isolates of S. pyogenes were classically differentiated into M serotypes, based on structural differences of the M protein (encoded by the emm gene), which is a fibrillar cell-wall protein involved in adherence to human cells and prevention of opsonophagocytosis (Lynskey, Lawrenson, & Sriskandan, 2011; Cunningham, 2000). This method was replaced in the late 1990s by the typing system based on sequencing of the 5’ end of the emm gene, and is referred to as emm typing (Facklam, et al., 1999). Even though there were significant differences in the emm-type distribution that depended on geographical area or clinical disease state, the most common emm types found in a large systematic review were emm1 (18.3%), emm12 (11.1%), emm28 (8.5%), emm3 (6.9%), and emm4 (6.9%) (Steer, Law, Matatolu, Beall, & Carapetis, 2009). As far as antimicrobial resistance, S. pyogenes has remained highly susceptible to almost all classes of antibiotics [Table 1] (Bourbeau & Campos, 1982; Kayser, 1994; Chin, Gu, Yu, Zhang, & Neu, 1991; Cohen, et al., 1991; Bouanchaud, 1997; Blondeau, Church, Yaschuk, & Bjarnason, 1999). Among S. pyogenes clinical isolates in some geographic regions, only resistance to macrolides (and related compounds) and tetracyclines are commonly found.

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Source: PubMed

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