Incidence of macrolide\u2013lincosamide\u2013streptogramin B resistance amongst beta-haemolytic streptococci in The Gambia

Ebenezer Foster-Nyarko,Saffiatou Darboe,Brenda Kwambana,Sarah N Mulwa,Ousman O Secka,Martin Antonio,Kaddijatou Jawneh,Fatima Ceesay,Buntung Ceesay,Ifedayo Adetifa

doi:10.1186/s13104-017-2427-x

Ebenezer Foster-Nyarko, Saffiatou Darboe + Show 8 more

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https://doi.org/10.1186/s13104-017-2427-x

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Abstract

BackgroundIn West Africa, penicillin, macrolide and lincosamide resistance among beta-haemolytic streptococci (BHS) isolates has rarely been described. However, such data are critical to detect and track the emergence of antibiotic resistance.MethodsBeta-haemolytic streptococci were cultured from clinical specimens from patients attending the clinic at the Medical Research Council Unit The Gambia (n = 217) and kept at −70 °C. Of these, 186 were revived and tested for penicillin susceptibility by disc diffusion and E-test methods, and the D-test for determination of constitutive and inducible macrolide–lincosamide (MLSB) resistance phenotypes.ResultsThe majority of BHS isolates from infections were group A streptococci (GAS) (126/186, 67.7%). Of these, 16% were from invasive disease (30/186). Other BHS isolated included lancefield groups B (19, 10.2%); C (9/186, 4.8%), D (3/186, 1.6%), F (5/186, 2.7%), G (16/186, 8.6%) and non-typeable (8/186, 4.3%). Prevalence of BHS isolated from blood cultures ranges from 0% (2005) to 0.5% (2010). Most (85, 45.7%) of the isolates were from wound infections. Of the 186 BHS isolates, none was resistant to penicillin and 14 (6.1%) were resistant to erythromycin. Of these, 8 (4.3%) demonstrated constitutive MLSB resistance, and 5 (2.7%) were inducible MLSB resistant. All the inducible MLSB isolates were GAS, and majority of the constitutive MLSB isolates (6/8, 75.0%) were non-GAS.ConclusionsBeta-haemolytic streptococci, predominantly GAS are associated with a wide range of infections in The Gambia. It is reassuring that macrolide and lincosamide resistance is relatively low. However, monitoring of MLSB resistance is necessary with the global spread of resistant BHS strains.

Highlights

In West Africa, penicillin, macrolide and lincosamide resistance among beta-haemolytic streptococci (BHS) isolates has rarely been described
The occurrence of an erythromycin resistant, clindamycin susceptible isolate indicates the possibility of inducible clindamycin resistance, a phenomenon known as macrolide–lincosamide–streptogramin B (MLSB) resistance
Study area and population Beta-haemolytic streptococci were isolated from clinical specimens (blood, aspirates, cerebrospinal fluid (CSF), throat swabs, wound swabs, urine and other miscellaneous specimens) collected from patients of all ages who attended the Medical Research Council Unit The Gambia (MRCG) Clinic in Fajara, from 2004 to 2012

Summary

Introduction

In West Africa, penicillin, macrolide and lincosamide resistance among beta-haemolytic streptococci (BHS) isolates has rarely been described Such data are critical to detect and track the emergence of antibi‐ otic resistance. The WHO’s global surveillance of antibiotics in 2014 raised concerns that the management of even mild infections in both the community and hospitals is under serious threat as a result of antibiotic resistance [1, 2] This marks the beginning of what has been described as a Penicillin is the recommended first line of treatment for streptococcal infections that of GAS and GBS; macrolides and sometimes lincosamides. Similar to other Gram-positive organisms, macrolide and lincosamide resistance have been reported to be emerging amongst beta- haemolytic streptococcal isolates globally; including reports from Southern Africa [8,9,10,11,12] This highlights the need to probe resistance patterns to these antibiotic groups. This study reports the phenotypic patterns of macrolide–lincosamide-streptogramin B resistance in these pathogens

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