Resistance patterns and mechanism of group B Streptococcus isolated from infants with invasive disease

doi:10.3877/cma.j.issn.1674-1358.2018.01.005

Abstract

Abstract:

Objective

To investigate the antibiotics resistance rates and the resistance mechanisms of erythromycin and tetracycline among group B Streptococcus (GBS)-positive isolates cultured from infants with invasive infection, and to provide a reliable evidence for the prevention and treatment of infants with invasive GBS infection.

Methods

From January 2013 to June 2016, the GBS strains isolated from infants with invasive diseases of < 90 days from four teaching hospitals were collected to investigate the current antimicrobial resistance status and resistance genes of these strains. The GBS isolates were identified and the minimum inhibitory concentration (MIC) of the antibiotics was determined by VITEK-2 Compact automatic bacterial identification system. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) were investigated using PCR amplification and DNA sequencing.

Results

Total of 93 non-duplicate colonizing GBS isolates were collected from infants with invasive GBS infection, among whom, 34 cases with early-onset infection and 59 cases with late-onset infection were diagnosed. All the isolates were susceptible to penicillins, cephalosporins, linezolid and vancomycin. The resistance of the isolates to levofloxacin, ofloxacin and azithromycin were 8.6 %, 2.2% and 1.1%, respectively. The resistance of isolates to erythromycin, clindamycin and tetracycline were significantly high, which were 60.2%, 78.5% and 93.5%, respectively. The most predominant phenotype was cMLSB (53.9%), followed by L phenotype (26.3%), iMLSB (15.8%) and M phenotype (3.9%). Among the resistance genes investigated, tetM (46%) and tetO (74.7%) were detected among tetracycline-resistant isolates and ermB (85.7%) and mefA (3.6%) were found among macrolide-resistant isolates. But ermA was not detected.

Conclusions

For neonates and young infants, empirical treatment with penicillins and ampicillin at birth for all high-risk neonates were recommended. Ribosomal modification by ermB gene play major role in erythromycin resistance of GBS, and the tetracycline resistance mediated by tetO and tetM genes were dominated.

Key words: Infant, Group B Streptococcus, Antimicrobial sensitivity test, Resistance gene

Juan Li, Kankan Gao, Lili Rong, Xiaoshan Guan, Qiulian Deng, Huamin Zhong, Yan Long, Xiurong Gao, Lihua Zhang, Xiaoping Mu, Chunlei Yuan, Wenjing Ji, Haiying Liu. Resistance patterns and mechanism of group B Streptococcus isolated from infants with invasive disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(01): 20-27.

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Figures/Tables 7

References 21

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引物	核酸序列（5'→3'）	产物长度（bp）
ermA-F	TCT AAA AAG CAT GTA AAA GAA	645
ermA-R	CTT CGA TAG TTT ATT AAT ATT AGT
ermB-F	GAA AAG GTA CTC AAC CAA ATA	639
ermB-R	AGT AAC GGT ACT TAA ATT GTT TAC
mefA-F	CGTAGCATTGGAACAGC	316
mefA-R	TGCCGTAGTACAGCCAT
tetL-F	TGAACGTCTCATTACCTG	993
tetL-R	ACGAAAGCCCACCTAAAA
tetO-F	AAC TT AGGCAT TC TGGC TCAC	515
tetO-R	TCCC AC TGT TCCA TAT CG TCA
tetK-F	TCCTGGAACCATGAGTGT	189
tetK-R	AGATAATCCGCCCATAAC
tetM-F	TTATCAACGGTTTATCAGG	397
tetM-R	CGTATATATGCAAGACG

引物	核酸序列（5'→3'）	产物长度（bp）
ermA-F	TCT AAA AAG CAT GTA AAA GAA	645
ermA-R	CTT CGA TAG TTT ATT AAT ATT AGT
ermB-F	GAA AAG GTA CTC AAC CAA ATA	639
ermB-R	AGT AAC GGT ACT TAA ATT GTT TAC
mefA-F	CGTAGCATTGGAACAGC	316
mefA-R	TGCCGTAGTACAGCCAT
tetL-F	TGAACGTCTCATTACCTG	993
tetL-R	ACGAAAGCCCACCTAAAA
tetO-F	AAC TT AGGCAT TC TGGC TCAC	515
tetO-R	TCCC AC TGT TCCA TAT CG TCA
tetK-F	TCCTGGAACCATGAGTGT	189
tetK-R	AGATAATCCGCCCATAAC
tetM-F	TTATCAACGGTTTATCAGG	397
tetM-R	CGTATATATGCAAGACG

疾病类型	血液	脑脊液	血液+脑脊液	关节腔积液
GBS-EOD	28（30.1）	1（1.1）	5（5.4）	0（0.0）
GBS-LOD	34（36.6）	16（17.2）	8（8.6）	1（1.1）
合计	62（66.7）	17（18.3）	13（14.0）	1（1.1）

疾病类型	血液	脑脊液	血液+脑脊液	关节腔积液
GBS-EOD	28（30.1）	1（1.1）	5（5.4）	0（0.0）
GBS-LOD	34（36.6）	16（17.2）	8（8.6）	1（1.1）
合计	62（66.7）	17（18.3）	13（14.0）	1（1.1）

抗菌药物	耐药		中介		敏感
抗菌药物	株数	耐药率	株数	中介率	株数	敏感率
青霉素G	0	0.0	0	0.0	93	100.0
氨苄西林	0	0.0	0	0.0	93	100.0
头孢曲松	0	0.0	0	0.0	93	100.0
万古霉素	0	0.0	0	0.0	93	100.0
利奈唑胺	0	0.0	0	0.0	93	100.0
四环素	87	93.5	0	0.0	6	6.5
克林霉素	73	78.5	0	0.0	20	22.6
红霉素	56	60.2	17	18.3	20	21.5
左氧氟沙星	8	8.6	1	1.1	84	90.3
氧氟沙星	2	2.2	0	0.0	91	97.8
阿奇霉素	1	1.1	0	0.0	92	98.9

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