Clindamycin-resistant Streptococcus pyogenes in Chinese children

Abstract

The Correspondence by Bryan White and Emily Siegrist1White BP Siegrist EA Increasing clindamycin resistance in group A streptococcus.Lancet Infect Dis. 2021; 21: 1208-1209Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar about clindamycin-resistant group A streptococcal infection attracted much attention in the USA. White and Siegrist argued that although the findings from some studies suggest a decrease in mortality from group A streptococcal infections in the USA, serious infections caused by clindamycin non-susceptible invasive group A streptococcus are increasing due to expansion of several emm types.2Fay K Onukwube J Chochua S et al.Patterns of antibiotic nonsusceptibility among invasive group A streptococcus infections—United States, 2006–2017.Clin Infect Dis. 2021; (published online June 25.)https://doi.org/10.1093/cid/ciab575Crossref Scopus (3) Google Scholar Therefore, we hope to provide some information about clindamycin-resistant group A streptococcus in China to compare its prevalence in different areas. First, unlike in the USA and other countries and regions, the resurgence of group A streptococcal infection in China is mainly manifested in non-invasive group A streptococcal infections. Rheumatic fever rarely occurs. Next, in China, the resistance rate of group A streptococcus against clindamycin and macrolides in both adults and children has been very high since the 1990s but has varied by geographical location and time period (appendix). Chinese isolates mainly harbour the ermB resistance gene, with the constitutive macrolide, lincosamide, and streptogramin B (cMLSB) resistance phenotypes. In China, clindamycin was not thought to be an appropriate medical intervention. Finally, the high rate of resistance to clindamycin cannot be attributed to its clinical use because clindamycin was rarely used in paediatric patients in Western Pacific countries (including China).3Hsia Y Lee BR Versporten A et al.Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries.Lancet Glob Health. 2019; 7: e861-e871Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar Previous studies also suggested cross-resistance between clindamycin and erythromycin.4Jeong DW Lee B Heo S Oh Y Heo G Lee JH Two genes involved in clindamycin resistance of Bacillus licheniformis and Bacillus paralicheniformis identified by comparative genomic analysis.PLoS One. 2020; 15e0231274Crossref PubMed Scopus (4) Google Scholar Cross-resistance to cMLSB antibiotics is mainly mediated by the erm genes, and various mechanisms are involved in streptogramin B resistance.5Isogai N Urushibara N Kawaguchiya M et al.Characterization of Enterococcus faecium with macrolide resistance and reduced susceptibility to quinupristin/dalfopristin in a Japanese hospital: detection of extensive diversity in erm(B)-regulator regions.Microb Drug Resist. 2013; 19: 298-307Crossref PubMed Scopus (15) Google Scholar In view of the existing data, there is high resistance to clindamycin and macrolides such as erythromycin; therefore, these treatments should not be recommended as an adjuvant treatment for children with β-lactam antibiotic allergy and group A streptococcal infection in China. We declare no competing interests. This research was funded by the Shenzhen Key Medical Discipline Construction Fund (SZXK032), the Guangdong Medical Research Fund (A2021437), the Hospital Level Project of Shenzhen Children's Hospital (ynkt2020-zz19), and the Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (SZGSP012). DY and YL contributed equally. Download .pdf (.24 MB) Help with pdf files Supplementary appendix Increasing clindamycin resistance in group A streptococcusWe commend Ahmed Babiker and colleagues1 for their paper on adjunctive clindamycin for β-haemolytic streptococcal infections from 2000 to 2015, which showed a decrease in mortality for patients with severe group A streptococcal (GAS) infection and added to the literature regarding this disease state. We were concerned that increasing clindamycin resistance in GAS isolates was not discussed in the Article. Between 2011 and 2015, the US Centers for Disease Control and Prevention Active Bacterial Core surveillance programme reported an increase from 8·9% to 13·1% of GAS isolates that were non-susceptible to clindamycin (table). Full-Text PDF Remdesivir, on the road to DisCoVeRyDespite the availability of effective SARS-CoV-2 vaccines, improving care for patients with symptomatic infection remains relevant. Strategies to blunt the hyperinflammatory state that characterises severe COVID-19 include broad-spectrum immunosuppressive drugs such as corticosteroids, targeted immunomodulatory treatments such as tocilizumab or baricitinib, and direct-acting antivirals to reduce viral load. Full-Text PDF