Molecular characterization of Streptococcus pyogenes isolates to investigate an outbreak of puerperal sepsis.

OBJECTIVE: To describe microbiological characteristics and epidemiologic features of an outbreak of postpartum endometritis. METHODS: Various markers were investigated in five patients and three throat carriage isolates of Streptococcus pyogenes obtained during an outbreak of endometritis occurring in a 13-week period. Molecular characterization included biotyping, T-serotyping, emm gene sequence and restriction, pulsed-field gel electrophoresis (PFGE), and random amplified polymorphic DNA (RAPD) analysis. RESULTS: Biotype, T-serotype, and genotypic data (emm analysis, PFGE, and RAPD analysis) revealed a close relationship among the isolates from three patients, suggesting that cross-contamination had occurred. These isolates were biotype 1, T type 28, and emm type 28. The isolates from one patient and one carrier differed from those of the index patient by minor variations of the emm amplicon restriction pattern, PFGE pattern, or RAPD pattern. The remaining isolates were phenotypically and genetically different. CONCLUSION: Identification of different isolates demonstrated that different strains may circulate simultaneously during a true outbreak and that the predominant strain might persist for several months.

Impact of susceptibility to antibiotics of streptococci & enterococci isolated from patients with infective endocarditis on antibiotic treatment.

BACKGROUND & OBJECTIVES: Streptococci and enterococci are the most frequent pathogens causing infective endocarditis. In order to update the recommendations for both curative and prophylaxis treatment, the susceptibility to antibiotics of the most prevalent species of Streptococcaceae isolated from the patients with infective endocarditis was determined. METHODS: Streptococcal and enterococcal isolates (n=133) isolated from confirmed cases of infective endocarditis during a one-year prospective survey conducted in 1999 in France were studied. The identification of 106 streptococci and 27 enterococci to the species level was carried out by conventional methods. Their susceptibility to ten antibiotics used in curative or prophylactic treatment was measured. Minimal inhibitory concentrations were determined by agar dilution method. RESULTS: All the streptococcal and enterococcal isolates were susceptible to 4 mg/l or less of penicillin or amoxicillin. High levels of resistance to aminoglycosides were observed in two species, Streptococcus gallolyticus subsp. gallolyticus and Enterococcus faecalis. All isolates were susceptible to glycopeptides. Resistance to erythromycin, clindamycin, and pristinamycin was restricted to some species. INTERPRETATION & CONCLUSION: Curative treatments recommended for streptococcal or enterococcal endocarditis, including penicillin, amoxicillin or vancomycin in association with gentamicin were found to be appropriate for 98.5 per cent of cases. The emergence of erythromycin resistance in oral streptococci led to the use of pristinamycin in oral prophylactic treatment in patients allergic to beta-lactams.

New group D streptococcal species.

BACKGROUND & OBJECTIVES: The heterogeneity of group D streptococci led to the identification of various biotypes of Streptococcus equinus and Streptococcus bovis and to the description of new species. The objective of the present study was to improve the phenotypic delineation between species and to clarify their respective phylogenetic position. METHODS: Physiological and genomic analyses were carried out in 84 representative strains of the group D streptococci. Biotypes were determined with the API 20 strep and rapid ID 32 STREP systems of identification. Quantitative DNA-DNA hybridization under stringent conditions and values of the deltaT(m) allowed to delineate species and subspecies. The phylogenic position of the different genomic groups was determined by comparing the sequences of their 16S rDNA. RESULTS: Four DNA-clusters, including seven species or subspecies, were characterized. Differential associations of biochemical characters allowed their identification. S. equinus and the type strain of S. bovis belonged to a single species. S. gallolyticus, S. bovis biotype II.2, and S. macedonicus formed a single DNA-cluster including three different subspecies. These were designated as S. gallolyticus subsp. gallolyticus, S. gallolyticus subsp. pasteurianus, and S. gallolyticus subsp. macedonicus. The two other DNA-clusters corresponded to the two subspecies of S. infantarius, and to S. alactolyticus. INTERPRETATION & CONCLUSION: This study presented a new classification associated with an identification scheme of group D streptococci. The changes in this classification demonstrate the interest of a polyphagic approach of the bacterial identification.

Identification of major Streptococcal species by rrn-amplified ribosomal DNA restriction analysis.

Amplified ribosomal DNA restriction analysis (rrn-ARDRA) is based on PCR amplification and restriction of a fragment of rRNA genes including 16S and 23S genes and the intergenic spacer. rrn-ARDRA was evaluated for the identification of species within the genus Streptococcus: A total of 148 type and reference strains of pyogenic, oral, and group D streptococci were examined in order to construct a database for identification of streptococci. The amplified product was a single band approximately 4500 bp long. This amplicon was digested separately with three (HhaI, MboII, and Sau3A) restriction endonucleases. Respectively, 27, 26, and 28 major patterns were observed after HhaI, MboII, and Sau3A restrictions. Streptococcal strains belonging to different species had different patterns or different combination of patterns. An identification system based upon a combination of the three restriction patterns in a single database was then proposed. rrn-ARDRA was successfully applied to 11 clinical isolates whose identification to the species level was difficult to obtain by phenotypic analysis. Using a database of well-characterized strains, rrn-ARDRA is a powerful method for the identification of streptococcal isolates.

Reappraisal of the taxonomy of the Streptococcus bovis/Streptococcus equinus complex and related species: description of Streptococcus gallolyticus subsp. gallolyticus subsp. nov., S. gallolyticus subsp. macedonicus subsp. nov. and S. gallolyticus subsp. pasteurianus subsp. nov.

'Streptococcus bovis/Streptococcus equinus' is a large bacterial complex including different species frequently isolated from infections of humans (Streptococcus gallolyticus, Streptococcus infantarius) or animals (S. bovis, S. equinus, Streptococcus alactolyticus). The separation of S. bovis into three different biotypes has been partially correlated with genetic differentiation. In addition, recent advances in bacterial phylogeny have led to the inclusion of Streptococcus macedonicus and Streptococcus waius in this complex. The aim of this study was to improve physiological differentiation between species related to the complex and to clarify their respective phylogenetic positions. In this study, physiological, genetic and phylogenetic analyses of a set of 88 streptococcal strains were performed. The diversity of strains of S. bovis biotype II was analysed, and it was confirmed that they belong to different species, either S. equinus or S. infantarius. It was demonstrated that S. gallolyticus, S. bovis biotype II.2, S. macedonicus and S. waius form a single DNA cluster separated into three different subspecies. They are delineated by different biochemical traits, limited DNA-DNA relatedness and noticeable divergence in 16S rDNA sequences. According to the current definition of species, the names S. gallolyticus subsp. gallolyticus subsp. nov., S. gallolyticus subsp. pasteurianus subsp. nov. and S. gallolyticus subsp. macedonicus subsp. nov. are proposed for these three subspecies.