Abstract
A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 1,281) were obtained between 2003 and 2013. All isolates were susceptible to penicillin, cefotaxime and vancomycin. Tetracycline showed the highest rate of resistant or intermediate resistant isolates with 9.8%, followed by macrolides (4.0%), trimethoprim/sulfamethoxazole (SXT) (1.9%), levofloxacin (1.3%), chloramphenicol (0.9%) and clindamycin (0.7%). The most prominent trends were the appearance of levofloxacin non-susceptible isolates since 2011, and an increase of SXT non-susceptibility since 2012.
Highlights
Streptococcus pyogenes (Lancefield group A streptococcus; GAS) is a major human pathogen and responsible for a wide range of both suppurative and non-suppurative diseases, e.g. pharyngitis, erysipelas, septicaemia, meningitis, pneumonia and the notably severe manifestations necrotising fasciitis (NF) and streptococcal toxic shock syndrome (STSS)
All isolates were susceptible to penicillin, cefotaxime and vancomycin
In this paper we present the results of 11 years of surveillance of iGAS disease in Germany
Summary
Streptococcus pyogenes (Lancefield group A streptococcus; GAS) is a major human pathogen and responsible for a wide range of both suppurative and non-suppurative diseases, e.g. pharyngitis, erysipelas, septicaemia, meningitis, pneumonia and the notably severe manifestations necrotising fasciitis (NF) and streptococcal toxic shock syndrome (STSS). Invasive infections caused by S. pyogenes (iGAS) have been increasingly reported since the mid- to late 1980s [2]. Recent upsurges in iGAS infections were reported from Sweden [3], Ireland [4, 5] and England [6]. The global burden of invasive S. pyogenes disease is estimated to be high, with at least 663,000 new cases and 163,000 deaths worldwide each year [7]. The resistance rates of S. pyogenes to several antibiotics vary considerably worldwide. Resistance rates from 2% to 98% have been reported for macrolides. While in several European countries, an increase of macrolide resistance has been described during the last 10–20 years, recently a decrease has been noted in some of these countries [8]. In case of penicillin allergy, a first-generation cephalosporin (for patients not anaphylactically sensitive), macrolides (clarithromycin or azithromycin) or PLOS ONE | DOI:10.1371/journal.pone.0137313 September 4, 2015
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