Macrolide resistance among Streptococcus agalactiae during COVID-19 public health emergency in Brazil.
Braz J Microbiol
; 55(2): 1445-1449, 2024 Jun.
Article
in En
| MEDLINE
| ID: mdl-38687418
ABSTRACT
During COVID-19 public health emergence, azithromycin was excessively used in Brazil, as part of a controversial "early treatment", recommended by former national health authorities. Excessive usage of macrolides may increase resistance rates among beta-hemolytic streptococci. Therefore, this study aimed to investigate the occurrence of resistance to erythromycin and clindamycin among Streptococcus agalactiae recovered from February 2020 to May 2023. Bacterial isolates (n = 116) were obtained from pregnant women and submitted to antimicrobial susceptibility testing, investigation of macrolide resistance phenotypes and genotypes, and identification of capsular type. The overall rate of erythromycin not susceptible (NS) isolates was 25.9%, while resistance to clindamycin was 5.2%. Drug efflux, associated with the M phenotype and mef(A) gene, was the prevalent mechanism of resistance (80%). Capsular type Ia was predominant (39.8%), followed by II, III, and V (17.7% each). A higher diversity of types was observed in the last years of the study. Type IV has had an increasing trend over time, being the fourth most common in 2023. The majority of the isolates that expressed the M phenotype presented capsular type Ia, while those with iMLS phenotype presented capsular type V. Despite no causal relationship can be established, azithromycin excessive usage may be a possible factor associated with this higher rate of erythromycin NS isolates, compared with most previous national studies. On the other hand, resistance to clindamycin has not changed significantly. Therefore, in the studied clinical setting, clindamycin remains a useful alternative to intrapartum prophylaxis among penicillin-allergic pregnant women.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Streptococcal Infections
/
Streptococcus agalactiae
/
Microbial Sensitivity Tests
/
Macrolides
/
Drug Resistance, Bacterial
/
SARS-CoV-2
/
COVID-19
/
Anti-Bacterial Agents
Limits:
Female
/
Humans
/
Pregnancy
Country/Region as subject:
America do sul
/
Brasil
Language:
En
Journal:
Braz J Microbiol
Year:
2024
Document type:
Article
Affiliation country:
Brasil