Susceptibilities of Streptococcus pyogenes and Streptococcus pneumoniae to Macrolides and Telithromycin: Data from an Italian Multicenter Study

Abstract

687 isolates of Streptococcus pyogenes and 600 isolates of Streptococcus pneumoniae, isolated over the period 2002-2003 from specimens of different human origin obtained in 16 different Italian centres, were assayed for their susceptibilities to different macrolides and to telithromycin, and were investigated by PCR to detect their different erythromycin resistance genes. 25.5% of the S. pyogenes isolates proved resistant to erythromycin, as well as to clarithromycin and azithromycin. 6.6% of the isolates proved non-susceptible to clindamycin. 4.9% of the isolates were non-susceptible to telithromycin. 22.3% of all erythromycin-resistant isolates exhibited cMLS_B resistance, 50.3% iMLS_B resistance, and 27.4% Mtype resistance. All cMLS_B strains had the erm(B) gene, all M strains had the mef(A) gene, and no resistance genes were found in the erythromycin-susceptible strains. Roughly one quarter of the iMLS_B strains had erm(A) and roughly three quarters erm(B). 35.2% of the S. pneumoniae isolates proved resistant to erythromycin, and virtually all of them also proved resistant to clarithromycin and azithromycin, too. Only 6.0% of the pneumococcal isolates were resistant to penicillin and a further 11.0% were intermediate. Only 0.2% of the isolates were nonsusceptible to telithromycin. 65.9% of all erythromycin-resistant S. pneumoniae isolates had cMLS_B resistance, 18.0% had iMLS_B resistance, and 16.1% had M-type resistance. All the MLS_B-resistant isolates had an erm(B) gene, and all the M-type isolates had a mef gene.

We conclude that macrolide resistance of streptococci still persists in Italy with incidences as high as 40%, more often than not being characterised by the MLS_B phenotype.

The ketolide telithromycin, structurally related to macrolides and most likely to substitute for them in a number of clinical uses, is confirmed as being extremely active even against recent clinical streptococcal isolates.

Keywords:

• Telithromycin
• macrolides
• clarithromycin
• azithromycin
• erythromycin
• penicillin
• resistance to macrolides
• Streptococcus pneumoniae
• Streptococcus pyogenes