Cases Of Pyoderma Research Articles

Antimicrobial Prescribing Practices in Dogs and Cats by Colombian Veterinarians in the City of Medellin.

This study surveyed the prescribing behavior of Colombian companion animal veterinarians and compared the responses to the current guidelines of the International Society for Companion Animals on Infectious Diseases (ISCAID). A convenience sample of 100 primary-care veterinary practitioners was selected from the city of Medellin. A questionnaire was designed to present hypothetical clinical scenarios regarding prescription choices for systemic antimicrobials. The numbers of veterinarians empirically prescribing a course of systemic antimicrobials for each scenario were—perioperative elective surgeries (86%), superficial pyoderma (90%), lower urinary tract disease (52%), acute hemorrhagic diarrhea (50%), and kennel cough (46%). For urinary tract disease, cultures and susceptibility testing were only performed by half of the respondents, suggesting lower diagnostic standards. In superficial pyoderma cases, cytology was performed in the following percent of cases—0% (24), 20% (30), 40% (17), 60% (11), 80% (8), and 100% (10). Antimicrobials were over-prescribed relative to emerging standard for elective surgeries (86%), kennel cough (46%), and acute hemorrhagic diarrhea (50%). Critically important antimicrobials, such as fluoroquinolones, were applied commonly for superficial pyoderma (18%), kennel cough (12%), and lower urinary tract disease in dogs (20%) and cats (26%). In conclusion, antimicrobial prescribing behavior was inconsistent with current guidelines, and antimicrobial use could be improved by appropriate diagnostic steps allowing choice of an optimal antimicrobial drug. Overall, we documented the widespread use of antimicrobials for the treatment of these four common disease conditions.

MOLECULAR AND BIOCHEMICAL CHARACTERIZATION OF STAPHYLOCOCCUS PSEUDINTERMEDIUS FROM CANINE PYODERMA IN SHIVAMOGGA REGION OF KARNATAKA

Shivamogga. Exudate/pus/lesion swabs were collected from clinical cases of canine pyoderma (n=126) and subjected to isolation and identification of bacterial isolates by phenotypic methods. The bacteriological processing of the samples resulted in the recovery of 95 staphylococcal isolates and 18 other bacterial isolates. On culture, staphylococci were the most predominantly (n=95, 75.39%) isolated organisms. The PCR was employed as molecular method in this study for the detection of species of staphylococcal isolates by targeting nuc gene and it was also used for the detection of virulence gene and antibiotic resistance gene in staphylococcal isolates by targeting siet gene and mecA gene, respectively, by using primers published earlier. One of the S. pseudintermedius isolates which confirmed by PCR and sequencing of partial nuc gene was used as positive reference strain for further screening of isolates by PCR. Based on nuc gene-based PCR, out of 95 staphylococcal isolates obtained, 82 (86.1%)of the isolates were found belonging to S. pseudintermedius. And out of 82 S. pseudintermedius isolates, siet gene was detected in 69 (86.1%) isolates. S. pseudintermedius was found to be predominant bacterial pathogen responsible for pyoderma in dogs.

Bacteriological study of pyodermas with an emphasis on Methicillin Resistant Staphylococcus Aureus (MRSA) at a tertiary care centre in North Karnataka

Background: Pyoderma is quite common skin infection and constitutes a major portion of patients in dermatological clinics. Many cases nowadays do not respond to the antibiotics that were previously sensitive. In order to successfully treat cases of pyodermas, sound knowledge is necessary regarding the etiology and their sensitivity patterns.Aims: To study the causative organisms and their antimicrobial susceptibility pattern and prevalence of methicillin resistant Staphylococcus aureus (MRSA) among the patients.Materials and Methods: A total of 500 patients with pyoderma who attended dermatology outpatient Department at VIMS hospital during the study period January 2017 to December 2017. Statistical Analysis: Data was analyzed by SPSS Version 20.0 software. Results: Staphylococcus aureus was isolated from 260 (52%) samples followed by coagulase negative Staphylococci in 105 (21%) samples. MRSA was reported in 42 (16.2%) cases.Conclusion: This study gives an indication of the present pattern of bacteriological profile of Pyodermas in our tertiary care centre.

A rare case of malignant pyoderma associated with ulcerative colitis both treated effectively with adalimumab

A rare case of malignant pyoderma associated with ulcerative colitis both treated effectively with adalimumab

Pyoderma gangrenosum – interdisciplinary problem

A clinical case of gangrenous pyoderma is described, as well as the difficulty of differential diagnosis and treatment of this disease. We carried out a literature review of the materials of foreign and domestic authors describing the course of gangrenous pyoderma using search engines PubMed, Google Scholar, BioMed Central (55 articles).

Clindamycin resistance of skin derived Staphylococcus pseudintermedius is higher in dogs with a history of antimicrobial therapy.

BackgroundIn the Netherlands there is a lack of data regarding resistance of Staphylococcus pseudintermedius to the systemic antimicrobial drugs used for the treatment of superficial pyoderma.ObjectivesTo assess antimicrobial resistance, with emphasis on resistance to clindamycin and meticillin, in clinical isolates of S. pseudintermedius isolated from dogs with superficial pyoderma. Results were compared between dogs with and without a history of systemic antimicrobial therapy during the previous year.AnimalsA retrospective study of 237 referral cases presented to an academic teaching hospital between 2014 and 2019, with the clinical and microbiological diagnosis of superficial pyoderma.Methods and materialsAll clinical isolates were identified primarily by MALDI‐TOF mass spectrometry. Antimicrobial susceptibility was tested either by an agar diffusion method (2014–2016) or by broth microdilution. Antimicrobial history in the preceding year was obtained from medical records.ResultsMeticillin‐resistant S. pseudintermedius (MRSP) was isolated from 8% of superficial pyoderma cases. Within the meticillin‐susceptible S. pseudintermedius (MSSP) population, clindamycin resistance was significantly more common in isolates derived from dogs with histories of antimicrobial treatment (37.7%) compared to dogs with no histories of exposure (21.7%; P = 0.03).ConclusionsGiven the high prevalence of clindamycin resistance in MSSP isolated from dogs with prior antimicrobial exposure, it is recommended that bacterial culture and susceptibility testing be pursued before prescribing systemic antimicrobials. Clindamycin should be regarded as the preferred treatment option if susceptibility is confirmed, due to its narrow spectrum and reduced selective pressure for MRSP.

PARTICIPATION AND DRUG RESISTANCE OF COAGULASE-POSITIVE STAPHYLOCOCCI ISOLATED FROM CASES OF PYODERMA AND OTITIS EXTERNA IN DOGS

Staphylococcus pseudintermedius is considered as a major pathogen in dogs, typically involved in skin and ear infections. Other staphylococci, as well as β-hemolytic streptococci, Pseudomonas aeruginosa or yeast-like fungi of the genus Malassezia also play an important role in inflammation. Because of this diversity, an appropriate choice of antimicrobial agent(-s) can be difficult. A total of 474 tests were performed (including 255 pyoderma and 219 otitis externa cases). In the case of pyoderma, 82.4% of skin lesions were caused by staphylococci. Co-infections with β-hemolytic streptococci (17.3 %), Malassezia sp. (15.7 %) and P. aeruginosa (4.3 %) were also recorded. For external ear infections, the share of staphylococci in inflammation was lower (44.8 %) than that of Malassezia sp. (58 %). Relatively frequent co-infections with β-hemolytic streptococci (18.8 %) and P. aeruginosa (7.8 %) were also noted. A total of 308 susceptibility tests for coagulase-positive staphylococci were performed (210 and 98 for skin and otitis externa, respectively). In ≥ 86 % of cases, amoxicillin potentiated with clavulanic acid, cephalexin and fluoroquinolones effectively inhibited the growth of all bacteria in vitro. A total of 25 isolates (24 S. pseudintermedius and one S. aureus) were considered as methicillin-resistant. The mecA gene was identified in 100 % of those strains but only 44 % of the isolates additionally carried the blaZ gene. All mecA-positive staphylococci were multidrug-resistant, mainly to all β-lactams, fluoroquinolones, linkozamides, macrolides as well as sulfonamides but always susceptible to mupirocin. Overall, multidrug-resistance varied between 6 % (otitis externa) and 9 % (inflamed skin) and may become a significant problem in the future.Key words: pyoderma; otitis externa; dog; staphylococci; multidrug resistance; mecA, mupirocinPARTICIPATION AND DRUG RESISTANCE OF COAGULASE-POSITIVE STAPHYLOCOCCI ISOLATED FROM CASES OF PYODERMA AND OTITIS EXTERNA IN DOGSPovzetek: Staphylococcus pseudintermedius is considered as a major pathogen in dogs, typically involved in skin and ear infections. Other staphylococci, as well as β-hemolytic streptococci, Pseudomonas aeruginosa or yeast-like fungi of the genus Malassezia also play an important role in inflammation. Because of this diversity, an appropriate choice of antimicrobial agent(-s) can be difficult. A total of 474 tests were performed (including 255 pyoderma and 219 otitis externa cases). In the case of pyoderma, 82.4 % of skin lesions were caused by staphylococci. Co-infections with β-hemolytic streptococci (17.3 %), Malassezia sp. (15.7 %) and P. aeruginosa (4.3 %) were also recorded. For external ear infections, the share of staphylococci in inflammation was lower (44.8%) than that of Malassezia sp. (58 %). Relatively frequent co-infections with β-hemolytic streptococci (18.8 %) and P. aeruginosa (7.8 %) were also noted. A total of 308 susceptibility tests for coagulase-positive staphylococci were performed (210 and 98 for skin and otitis externa, respectively). In ≥ 86 % of cases, amoxicillin potentiated with clavulanic acid, cephalexin and fluoroquinolones effectively inhibited the growth of all bacteria in vitro. A total of 25 isolates (24 S. pseudintermedius and one S. aureus) were considered as methicillin-resistant. The mecA gene was identified in 100 % of those strains but only 44 % of the isolates additionally carried the blaZ gene. All mecA-positive staphylococci were multidrug-resistant, mainly to all β-lactams, fluoroquinolones, linkozamides, macrolides as well as sulfonamides but always susceptible to mupirocin. Overall, multidrug-resistance varied between 6 % (otitis externa) and 9 % (inflamed skin) and may become a significant problem in the future.Ključne besede: pyoderma; otitis externa; dog; staphylococci; multidrug resistance; mecA, mupirocin

In Vitro Efficiency of Antimicrobial Peptides against Staphylococcal Pathogens Associated with Canine Pyoderma.

Simple SummaryCoagulase-positive staphylococci (CoPS) are predominant pathogens in canine pyoderma, especially S. pseudintermedius and S. aureus. The antimicrobial resistance of CoPS has a key role in the management of canine skin infections. The vast majority of those diseases have a chronic character with a tendency to recur, which is reflected by recurrent systemic antibiotic therapy, associated with an alarming increase in the proportion of antibiotic-resistant staphylococci. Antimicrobial peptides (AMPs) seem to be a promising alternative to conventional antibiotics. The aim of this in vitro study was to evaluate the antimicrobial activity of selected AMPs against pathogenic staphylococcal strains, including multidrug- and methicillin-resistant strains isolated from canine pyoderma cases. The tested AMPs were shown to be equally efficient antimicrobial agents against resistant- and susceptible pathogenic staphylococcal strains associated with canine pyoderma. AMPs were more efficient against S. pseudintermedius than against S. aureus strains. Our findings seem to be particularly interesting from a clinical perspective, as a starting point from which to perform in vivo experiments to estimate the usefulness of these peptides as topical drug molecules for the treatment of canine pyoderma.The emergence of staphylococcal canine pathogens resistant to multiple antimicrobial agents is a growing and urgent problem in veterinary practice. Antimicrobial peptides (AMPs) seem to be a promising alternative to conventional antibiotics. The aim of this in vitro study was to evaluate the antimicrobial activity of selected AMPs against pathogenic staphylococcal strains, including multidrug- and methicillin-resistant strains isolated from canine pyoderma cases. Seven antimicrobial peptides (aurein 1.2, CAMEL, citropin 1.1, protegrin-1, pexiganan, temporin A and uperin 3.6) synthesized by the 9-fluorenylmethoxycarbonyl (Fmoc) solid-phase method were tested. The minimal inhibitory and minimal bactericidal concentrations (MIC and MBC) were determined by the broth microdilution method. The study showed that analyzed AMPs exerted an extensive effect against canine pathogens, with the most active peptide being uperin 3.6. The tested AMPs were equally efficient against both resistant- and susceptible staphylococcal strains and were more efficient against Staphylococcus pseudintermedius than against Staphylococcus aureus strains. Our findings are particularly interesting from a clinical perspective, as they point to AMPs as potential therapeutic topical agents in canine pyoderma cases associated with antimicrobial resistance of staphylococci.

Draft Genome Sequence of Staphylococcus pseudintermedius Strain 13-13613, Isolated from a Case of Canine Pyoderma.

Here, we report the draft genome sequence of Staphylococcus pseudintermedius strain 13-13613, isolated from a case of canine pyoderma. The draft genome contains 2,533,486 bp in 570 contigs.

Bacteriological Profile of Pyoderma Cases Attending the Dermatology Department in a Tertiary Care Hospital

Introduction: Pyoderma, a commonly found skin disease among the general population in developing countries, is a challenge to the dermatologists due to its changing spectrum and antibiotic susceptibility pattern. Aim: To know the prevalence of different types of pyoderma, causative organisms, their antibiotic susceptibility with special reference to prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA). Materials and Methods: It was a prospective cross-sectional study which includes 402 clinically diagnosed cases of pyoderma who presented to the Department of Dermatology (both outdoor and indoor) from 15th May 2019-15th December 2019. Detailed history was taken and thorough clinical examination was done. Relevant investigations including bacterial culture and sensitivity were done. Descriptive statistics for both clinical and bacteriological characteristics were generated. Statistical comparison of categorical variables was undertaken using Chi-square test and a p-value of <0.05 was considered statistically significant. Results: The prevalence of pyoderma was 2.9%. Most of the pyoderma was observed in the 11-30 years of age group. Primary pyoderma (78.9%) was more common than secondary pyoderma, furuncle (45.1%) being the most common among primary pyodermas and infected eczema (43.5%) among secondary pyodermas. Staphylococcus aureus was the predominant organism isolated in 229 cases (out of 385 isolates, 59.5%). All the Staphylococcus aureus strains isolated were sensitive to vancomycin, 96.9% were sensitive to linezolid. Conclusion:Staphylococcus aureus was the primary pathogen causing pyodermas in this study. The antibiotic susceptibility pattern of the organisms isolated must be taken into account before starting therapeutic treatment.

Fluorescence biomodulation in the management of canine interdigital pyoderma cases: a prospective, single-blinded, randomized and controlled clinical study.

Interdigital pyoderma is a common multifactorial, inflammatory disease of the canine interdigital skin. Lesions commonly become infected secondarily. In addition to management of the underlying cause, management of the chronic inflammatory changes in the interdigital skin created by secondary infection and by the release of keratin into deep tissues is required. Fluorescence biomodulation appears to modulate the inflammatory process in dermatological disorders and has shown promise in preliminary studies evaluating its use in superficial and deep pyoderma in dogs. To evaluate the effect of a fluorescence biomodulation (FB) system used in conjunction with systemic antibiotic on clinical manifestations of canine interdigital pyoderma (CIP), compared to dogs treated with antibiotic alone. Thirty-six dogs diagnosed with CIP. Dogs were randomly allocated to treatment groups of either antibiotic alone (Group A) or antibiotic plus twice-weekly FB application (Group B). Dogs were scored over a 12 week period on the basis of two measured parameters: a global lesion score composed of four different lesions types and neutrophil engulfing bacterial scores. A statistically significant decrease was seen by Week 3 in both measured parameters for Group B compared to Group A. The mean time-to-resolution of lesions was 4.3weeks in Group B and 10.4weeks in Group A. The FB system shows promise as an adjunct therapy to systemic antibiotic use in the management of CIP.

Susceptibilidad antimicrobiana de estafilococos aislados en piodermas de caninos de Coro, Venezuela

Esta investigación retrospectiva estuvo enfocada en el estudio de la etiología de la pioderma en caninos de la ciudad de Coro (estado Falcón, Venezuela), entre 2010 y 2014, así como del perfil de susceptibilidad a antimicrobianos de las bacterias estafilocócicas. El microorganismo aislado en mayor frecuencia fue Staphylococcus (pseud)intermedius, seguido de Staphylococcus aureus y otras especies. Adicionalmente, se detectaron varios aislados multirresistentes para las dos especies mencionadas, los cuales no se correlacionaron con casos de pioderma recidivante. No se detectó asociación significativa entre la pioderma recurrente y factores de riesgo como el patrón racial, sexo, estrato etario y especie bacteriana infectante. En general, las especies estafilocócicas aisladas mostraron de manera significativa (p<0.05) susceptibilidad a carbapenémicos, aminoglucósidos y fluoroquinolonas, y resistencia a penicilinas, ciclinas, inhibidores de la síntesis de folatos y polipéptidos.

Topical treatment of canine pyodermas

Topical treatment in canine pyodermas helps to reduce or eliminate the surface bacterial population and to restore the epidermal and follicular integrity. In most superficial and deep pyodermas topical treatment rarely works when used alone; however, its judicious use can make the patient more comfortable and hasten the response to systemic antibiotics. Conversely, in surface pyodermas or pseudopyodermas topicals usually suffice. Among various antimicrobials, the most commonly used include benzoyl peroxide, ethyl lactate, povidone-iodine, triclozan and some antibiotics such as mupirocin, fucidic acid, neomycin and clindamycin. In addition, other topical medication like glucocorticoids, astrigents and dessicating powders are usually applied in dogs with surface pyodermas. Finally, hydrotherapy is very helpful in deep pyoderma cases in the form of wet dressings or baths. The effectiveness of topical treatment depends on the appropriate selection of the active ingredient and its delivery system (formulations), that should accommodate the kind, the distribution and the extension of skin lesions.

Ever-increasing emergence of multi-drug resistant Staphylococcus pseudintermedius in the dog and its zoonotic potentials

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) has emerged as an important pathogen in the dog over the past 10 years with an ever increasing incidence worldwide. This review focuses mainly on the epidemiology and detection of MRSP, emphasizing on the interpretation and pitfalls of screening laboratory tests and antimicrobial susceptibility tests. Risk factors for colonization and infection with MRSP and molecular analysis of the dominant clonal lineages are also described. The zoonotic potential and worldwide epidemiology of multidrug resistant Staphylococcus pseudintermedius (MDRSP) are presented. Finally, control options for the colonization of healthy dogs as well as infection by MRSP and MDRSP are described emphasizing on the indications for bacterial culture and susceptibility testing and the principles of topical therapy which may prove to be the sole effective treatment in several canine pyoderma cases.

Antibiotic resistance of Staphylococcus intermedius strains isolated from 53 natural cases of canine pyoderma

Samples for bacterial cultures on blood agar were obtained from the skin lesions of 53 dogs demonstrating the typical clinical and cytological features of superficial (n=17) or deep (n=36) pyoderma. None of them had received any kind of antimicrobial therapy within the previous month. The Staphylococcus looking colonies were recultured on blood and Chapman agar for staphylococcal species identification and biotyping. All 53 coagulasepositive staphylococcal isolates were eventually identified as S. intermedius. The susceptibility for each of these isolates was tested against 12 different antibiotics with the disc diffusion method. Resistance rates were found to be 0% for amoxicillin/clavulanate, 11.3% for oxacillin, 7.5% for cefalexin, 5.7% for enrofloxacin, 32.1% for erythromycin, 11.3% for tylosin, 20.8% for lincomycin, 18.9% for clindamycin, 32.1% for doxycycline, 5.7% for amicacin, 7.5% for chloramphenicol and 92.5% for trimethoprim/sulfamethoxazole. No correlation between the resistance pattern and either the age, breed, sex, and the animals' lifestyle, or the depth of skin infection, the presence or not of underlying diseases and any past treatment with antibiotics was identified.

A clinico-bacteriological study of pyodermas in pediatric population

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Pyodermas are frequently confronted skin infections by dermatologists in pediatric population. While treating them recurrence and resistance to commonly used antibiotics are the major concerns.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">456 cases of pyodermas in pediatric population attending dermatology outpatient department of Sri Guru Ram Das Medical College over the period of 8 months from February 2016- October 2016 were evaluated. Samples were collected with sterile swab and sent for gram staining, culture and sensitivity</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of cases of pyodermas in pediatric population were due to impetigo and secondarily infected scabies. Most cases were seen in the age group of 4-7 years. <em>Staphylococcus aureus</em> (49.5%) was the most frequently isolated organism from these cases followed by streptococcus (29.8%). Majority of these gram positive organisms were sensitive to antibiotics like amoxiclav, ampicillin and linezolid. <em>E. coli</em> and <em>enterococcus</em> were predominantly encountered gram negative isolates with high susceptibility to aminoglycosides and ceftriaxone. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Bacteriological study of pyodermas and knowledge of their susceptibility pattern is imperative for appropriate management. It also helps in prevention of emergence of resistant strains.</span></p>

A Case of Superficial Pyoderma Improved by Shampoo Therapy Containing 1% of Isopropylmethylphenol in Dog

A Case of Superficial Pyoderma Improved by Shampoo Therapy Containing 1% of Isopropylmethylphenol in Dog

Effectiveness of topical green tea against multidrug-resistant Staphylococcus aureus in cases of primary pyoderma: An open controlled trial.

Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1-5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.

Clinical Manifestations Enticed in Clinical Cases of Canine Pyoderma

Canine pyoderma is one of the most common causes of dermatitis with worldwide occurrence in small animal practice. The condition is diagnosed on the basis of clinical manifestations, isolation and identification of causative organisms by bacteriological cultural examination. A study was conducted on 130 dogs diagnosed with canine pyoderma presented at the Veterinary Clinical Complex (VCC), Veterinary College, Anand. These included cases of surface pyoderma (15), superficial pyoderma (50), deep pyoderma (32) and secondary pyoderma (33). The common clinical manifestations observed were exudation of pus, pruritus, erythema, pustules, papules, crusts, epidermal collarettes and alopecia. Canine pyoderma found secondary to other dermatological afflictions illustrated manifestations associated with the underlying cause. Hence, the condition should be differentially diagnosed and treated accordingly.

Drug-resistant Streptococcus pyogenes: a case report of pyoderma and cellulitis

In the last years there has been worldwide an increase in the incidence of <em>Streptococcus</em> <em>pyogenes</em> infections and its sequelae. The purpose of the present study is to describe a clinical case of pyoderma and cellulitis by <em>S. pyogenes</em> with a pattern of resistance to penicillin, erythromycin and levofloxacin. Antimicrobial susceptibility was analysed by automated method of disk diffusion while E-test method was used to verify the minimum inhibitory concentration to penicillin, erythromycin and levofloxacin. Although penicillin remains the first-choice treatment for <em>S. pyogenes</em> infection, worldwide antibiotic resistance and the associated phenotypes are highly variable across countries. This case report strengthens the need for continued surveillance to obtain further insights into the forces governing resistance in <em>S. pyogenes.</em>