Dissemination of emm28 Erythromycin-, Clindamycin- and Bacitracin-Resistant Streptococcus pyogenes in Spain

  • E. Perez-TralleroEmail author
  • C. Garcia
  • B. Orden
  • J. M. Marimon
  • M. Montes
Concise Article


Reported here is an unusual cluster of non-invasive infections caused by an emm28 Streptococcus pyogenes strain resistant to bacitracin, erythromycin and clindamycin detected in Santander, Spain. Since one of the characteristics of group A streptococci is their almost uniform susceptibility to bacitracin, this finding was unusual, and a search for bacitracin-resistant Streptococcus pyogenes strains was conducted in two other distant cities of Spain (Madrid and San Sebastián) where their presence was confirmed. These strains were frequently associated with erythromycin- and clindamycin-resistance, and most of them belonged to a unique emm28 T28, ST52 clone.


Clindamycin Bacitracin Multilocus Sequence Typing PFGE Pattern Clonal Dissemination 
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  1. 1.
    Kilian M (1998) Streptococcus and Lactobacillus. In: Collier L, Ballows A, Sussman M (eds) Topley and Wilson’s microbiology and microbial infections, 9th edn. Arnold, Hodder Headline group, London, pp 633–667Google Scholar
  2. 2.
    Ruoff KL, Whiley RA, Beighton D (1999) Streptococcus. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (eds) Manual of clinical microbiology, 7th edn. American Society for Microbiology, Washington, DC, pp 283–296Google Scholar
  3. 3.
    Shigei J (1998) Laboratory diagnosis of streptococcal pharyngitis. In: Isenberg HD (ed.) Essential procedures for clinical microbiology. American Society for Microbiology, Washington, DC, pp 73–74Google Scholar
  4. 4.
    Seppala H, Skurnik M, Soini H, Roberts MC, Huovinen P (1998) A novel erythromycin resistance methylase gene (ermTR) in Streptococcus pyogenes. Antimicrob Agents Chemother 42:257–262PubMedGoogle Scholar
  5. 5.
    National Committee for Clinical Laboratory Standards (2002) Performance standards for antimicrobial susceptibility testing. Twelfth informational supplement. M100-S12. NCCLS, Wayne, PAGoogle Scholar
  6. 6.
    Perez-Trallero E, Marimon JM, Montes M, Orden B, Pablos M de (1999) Clonal differences among erythromycin-resistant Streptococcus pyogenes in Spain. Emerg Infect Dis 5:235–240PubMedGoogle Scholar
  7. 7.
    Enright MC, Spratt BG, Kalia A, Cross JH, Bessen DE (2001) Multilocus sequence typing of Streptococcus pyogenes and the relationships between emm type and clone. Infect Immun 69:2416–2427CrossRefPubMedGoogle Scholar
  8. 8.
    Maruyama S, Yoshioka H, Fujita K, Takimoto M, Satake Y (1979) Sensitivity of group A streptococci to antibiotics. Prevalence of resistance to erythromycin in Japan. Am J Dis Child 133:1143–1145PubMedGoogle Scholar
  9. 9.
    Kataja J, Huovinen P, Muotiala A, Vuopio-Varkila J, Efstratiou A, Hallas G, Seppala H (1998) Clonal spread of group A streptococcus with the new type of erythromycin resistance. Finnish Study Group for Antimicrobial Resistance. J Infect Dis 177:786–789PubMedGoogle Scholar
  10. 10.
    Jasir A, Schalen C (1998) Survey of macrolide resistance phenotypes in Swedish clinical isolates of Streptococcus pyogenes. J Antimicrob Chemother 41:135–137CrossRefPubMedGoogle Scholar
  11. 11.
    Yan JJ, Wu HM, Huang AH, Fu HM, Lee CT, Wu JJ (2000) Prevalence of polyclonal mefA-containing isolates among erythromycin-resistant group A streptococci in Southern Taiwan. J Clin Microbiol 38:2475–2479PubMedGoogle Scholar
  12. 12.
    Perez-Trallero E, Fernandez-Mazarrasa C, Garcia-Rey C, Bouza E, Aguilar L, Garcia-de-Lomas J, Baquero F (2001) Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998–1999) multicenter surveillance study in Spain. Antimicrob Agents Chemother 45:3334–3340CrossRefPubMedGoogle Scholar
  13. 13.
    Perez-Trallero E, Urbieta M, Montes M, Ayestaran I, Marimon JM (1998) Emergence of Streptococcus pyogenes strains resistant to erythromycin in Gipuzkoa, Spain. Eur J Clin Microbiol Infect Dis 17:25–31PubMedGoogle Scholar
  14. 14.
    Ngui-Yen JH, Walker M (1992) Detection of cross infection with Streptococcus pyogenes in a hospital. Can J Infect Control 7:30Google Scholar
  15. 15.
    York MK, Gibbs L, Perdreau-Remington F, Brooks GF (1999) Characterization of antimicrobial resistance in Streptococcus pyogenes isolates from the San Francisco Bay area of northern California. J Clin Microbiol 37:1727–1731PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • E. Perez-Trallero
    • 1
    Email author
  • C. Garcia
    • 2
  • B. Orden
    • 3
  • J. M. Marimon
    • 1
  • M. Montes
    • 1
  1. 1.Microbiology DepartmentHospital DonostiaSan SebastiánSpain
  2. 2.Microbiology DepartmentHospital “Marques de Valdecilla”SantanderSpain
  3. 3.Microbiology LaboratoryCentro Especialidades ArguellesMadridSpain

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