Molecular characterization and antibiotic resistance of Streptococcus dysgalactiae subspecies equisimilis isolated from patients with streptococcal toxic shock syndrome

T Ikebe; R Okuno; M Sasaki; Y Kanda; H Otsuka; R Kawahara; H Ohya; M Suzuki; K Uchida; H Nihonmatsu; M Ohnishi; Working Group for Beta-Hemolytic Streptococci in Japan

doi:10.1016/j.jiac.2017.09.013

Molecular characterization and antibiotic resistance of Streptococcus dysgalactiae subspecies equisimilis isolated from patients with streptococcal toxic shock syndrome

J Infect Chemother. 2018 Feb;24(2):117-122. doi: 10.1016/j.jiac.2017.09.013. Epub 2017 Nov 6.

Authors

T Ikebe¹, R Okuno², M Sasaki³, Y Kanda³, H Otsuka⁴, R Kawahara⁵, H Ohya⁶, M Suzuki⁶, K Uchida⁷, H Nihonmatsu⁸, M Ohnishi⁹; Working Group for Beta-Hemolytic Streptococci in Japan

Collaborators

Working Group for Beta-Hemolytic Streptococci in Japan:
Y Morimoto¹⁰, Y Sakamoto¹¹, S Sato¹², M Musashi¹³, A Shirasawa¹⁴, T Konno¹⁵, T Kobayashi¹⁶, Y Watanabe¹⁷, J Seto¹⁸, Y Kobayashi¹⁹, K Sakai²⁰, Y Aihara²¹, R Kiritani²², S Kataoka²³, M Takayama²⁴, N Hamamoto²⁵, M Nakamura²⁶, Y Matsumoto²⁷, E Yuzawa²⁸, H Satoh²⁹, Y Igawa³⁰, H Nagaoka³¹, H Ehara³², Y Tsuchiya³³, K Tomari³⁴, K Takeuchi³⁵, Y Tsunomori³⁶, H Kawai³⁷, H Akita³⁸, C Kuribayashi³⁹, J Uchida⁴⁰, F Ichihara⁴¹, K Semba⁴², A Tokaji⁴³, Y Carle⁴⁴, M Honda⁴⁵, E Nakamura⁴⁶, M Ogata⁴⁷, N Tsuru⁴⁸, T Takara⁴⁹

Affiliations

¹ Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Electronic address: [email protected].
² Department of Microbiology, Tokyo Metropolitan Institute of Public Health, 3-24-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.
³ Laboratory of Microbiology, Oita Prefectural Institute of Health and Environment, 2-8 Takae-Nishi, Oita 870-1117, Japan.
⁴ Department of Public Health Sciences, Yamaguchi Prefectural Institute of Public Health and Environment, 2-5-67 Aoi, Yamaguchi 753-0821, Japan.
⁵ Division of Bacteriology, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan.
⁶ Division of Microbiology, Kanagawa Prefectural Institute of Public Health, 1-3-1 Shimomachiya, Chigasaki, Kanagawa 253-0087, Japan.
⁷ Department of Bacteriology, Toyama Institute of Health, 17-1 Naka-Taikouyama, Imizu, Toyama 939-0363, Japan.
⁸ Department of Microbiology, Fukushima Institute of Public Health, 16-6 Mitouchi, Katakida, Fukushima 960-8560, Japan.
⁹ Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
¹⁰ Hokkaido Institute of Public Health, Japan.
¹¹ Sapporo City Institute of Public Health, Japan.
¹² Hakodate City Institute of Public Health, Japan.
¹³ Aomori Prefectural Institute of Public Health and Environment, Japan.
¹⁴ Research Institute for Environmental Sciences and Public Health of Iwate Prefecture, Japan.
¹⁵ Akita Prefectural Research Centre for Public Health and Environment, Japan.
¹⁶ Miyagi Prefectural Institute of Public Health and Environment, Japan.
¹⁷ Sendai City Institute of Public Health, Japan.
¹⁸ Yamagata Prefectural Institute of Public Health, Japan.
¹⁹ Niigata Prefectural Institute of Public Health and Environmental Sciences, Japan.
²⁰ Niigata City Institute of Public Health and the Environment, Japan.
²¹ Ibaraki Prefectural Institute of Public Health, Japan.
²² Tochigi prefectural Institute of Public Health and Environmental Science, Japan.
²³ Utsunomiya City Institute of Public Health and Environment Laboratory, Japan.
²⁴ Gunma Prefectural Institute of Public Health and Environmental Sciences, Japan.
²⁵ Saitama Prefectural Institute of Public Health, Japan.
²⁶ Prefectural Institute of Public Health, Chiba, Japan.
²⁷ Yokohama City Institute of Public Health, Japan.
²⁸ Kawasaki City Institute for Public Health, Japan.
²⁹ Sagamihara City Institute of Public Health, Japan.
³⁰ Nagano Environmental Conservation Research Institute, Japan.
³¹ Shizuoka Institute of Environment and Hygiene, Japan.
³² Shizuoka City Institute of Environmental Sciences and Public Health, Japan.
³³ Hamamatsu City Health Environment Research Center, Japan.
³⁴ Saitama City Institute of Health Science and Research, Japan.
³⁵ Tottori Prefectural Institute of Public Health and Environment, Japan.
³⁶ Shimane Prefectural Institute of Public Health and Environmental Science, Japan.
³⁷ Okayama Prefectural Institute for Environmental Science and Public Health, Japan.
³⁸ Hiroshima Prefectural Technology Research Institute, Public Health and Environment Center, Japan.
³⁹ Hiroshima City Institute of Public Health, Japan.
⁴⁰ Kagawa Prefectural Research Institute for Environmental Science and Public Health, Japan.
⁴¹ Tokushima Prefectural Public Health Pharmaceutical and Environmental Sciences Centre, Japan.
⁴² Ehime Prefectural Institute of Public Health and Environmental Science, Japan.
⁴³ Public Health Institute of Kochi Prefecture, Japan.
⁴⁴ Fukuoka Institute of Health and Environmental Sciences, Japan.
⁴⁵ Fukuoka City Institute of Health and Environment, Japan.
⁴⁶ Kitakyushu City Institute of Health and Environmental Sciences, Japan.
⁴⁷ Saga Prefectural Institute of Public Health and Pharmaceutical Research, Japan.
⁴⁸ Miyazaki Prefectural Institute for Public Health and Environment, Japan.
⁴⁹ Okinawa Prefectural Institute of Health and Environment, Japan.

PMID: 29107650
DOI: 10.1016/j.jiac.2017.09.013

Abstract

Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multiorgan failure, and high mortality. Although STSS is mainly caused by Streptococcus pyogenes, group G streptococcus identified as S. dysgalactiae subsp. equisimilis (SDSE) causing STSS has also been reported; however, no study has analyzed >100 isolates of SDSE causing STSS. Therefore, we characterized the emm genotype of 173 SDSE isolates obtained from STSS patients in Japan during 2014-2016 and performed antimicrobial susceptibility testing using the broth microdilution method and emm gene typing. The predominant emm genotype was found to be stG6792, followed by stG485, stG245, stG10, stG6, and stG2078. These six genotypes constituted more than 75% of the STSS isolates. The proportion of each emm genotype in STSS isolates correlated with that in invasive isolates previously reported. We found that 16.2% of the isolates showed clindamycin resistance. The proportion of clindamycin-resistant SDSE isolates was significantly higher than that of S. pyogenes isolates. Thus, while treating STSS caused by SDSE, it is necessary to consider the possibility of clindamycin resistance and to ensure judicious use of the drug.

Keywords: Antibiotic resistance; Streptococcal toxic shock syndrome; Streptococcus dysgalactiae subspecies equisimilis; emm genotype.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use
Antigens, Bacterial / genetics
Bacterial Outer Membrane Proteins / genetics
Carrier Proteins / genetics
Clindamycin / therapeutic use
Drug Resistance, Bacterial*
Female
Genotyping Techniques
Humans
Japan / epidemiology
Male
Microbial Sensitivity Tests
Middle Aged
Shock, Septic / drug therapy
Shock, Septic / epidemiology
Shock, Septic / microbiology*
Streptococcal Infections / drug therapy
Streptococcal Infections / epidemiology
Streptococcal Infections / microbiology*
Streptococcus pyogenes* / classification
Streptococcus pyogenes* / drug effects
Streptococcus pyogenes* / genetics
Streptococcus pyogenes* / isolation & purification

Substances

Anti-Bacterial Agents
Antigens, Bacterial
Bacterial Outer Membrane Proteins
Carrier Proteins
streptococcal M protein
Clindamycin