Lopardo Horacio A, Vidal Patricia, Jeric Paola, Centron Daniela, Paganini Hugo, Facklam Richard R, Elliott John
Servicio de Microbiología, Hospital de Pediatría, Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
J Clin Microbiol. 2003 Oct;41(10):4688-94. doi: 10.1128/JCM.41.10.4688-4694.2003.
There is little information about invasive infections by group B streptococci (GBS) and their antimicrobial susceptibilities in Latin America. We performed a prospective multicenter study to determine the serotype distribution and the antimicrobial susceptibility of GBS in Argentina. We identified 58 cases, but only 44 had sufficient data to be evaluated. Eight early-, four late-, and one fatal late, late-onset neonatal infections due to GBS were found. A total of 31 patients were adults with bacteremia, skin and soft tissue infections, osteomyelitis, arthritis, meningitis, abdominal infections, and renal abscess. Serotype III was prevalent in late-onset neonatal disease, and several serotypes (Ia/c, III, Ia, and II) were involved in early-onset neonatal infections. Serotypes II, Ia/c, III, and IV were commonly found in adults, with serotype II prevalent in younger adults (18 to 69 years old) and serotype Ia/c prevalent in elderly adults (>70 years old). The mortality rate attributable to GBS infections was 10.8%. All GBS were susceptible to penicillin and ceftriaxone. Resistance to clindamycin (1.7%), erythromycin (5.2%), azithromycin (5.2%), minocycline (69%), and tetracycline (72.4%), to high levels of kanamycin and amikacin (1.7%), and to intermediately high levels of gentamicin (1.7%) was observed. The bifunctional enzyme AAC6'-APH2" was detected in the isolate resistant to aminoglycosides, and other genetic determinants were identified in other resistant isolates: tetM and tetO in tetracycline-resistant streptococci and mefA and ermTR for efflux-mediated and inducible macrolide-lincosamide-streptogramin B-resistant streptococci, respectively. For clinical purposes and rapid and easy detection of high-level aminoglycoside-resistant GBS, a screening method that used 1,000- micro g kanamycin disks is proposed.
关于拉丁美洲B族链球菌（GBS）侵袭性感染及其抗菌药物敏感性的信息很少。我们进行了一项前瞻性多中心研究，以确定阿根廷GBS的血清型分布和抗菌药物敏感性。我们共识别出58例病例，但只有44例有足够的数据可供评估。发现了8例早发型、4例晚发型和1例致命性晚发型新生儿GBS感染。共有31例成年患者患有菌血症、皮肤和软组织感染、骨髓炎、关节炎、脑膜炎、腹部感染和肾脓肿。血清型III在晚发型新生儿疾病中占主导地位，几种血清型（Ia/c、III、Ia和II）与早发型新生儿感染有关。血清型II、Ia/c、III和IV在成人中常见，血清型II在年轻成人（18至69岁）中占主导地位，血清型Ia/c在老年成人（>70岁）中占主导地位。GBS感染导致的死亡率为10.8%。所有GBS对青霉素和头孢曲松敏感。观察到对克林霉素（1.7%）、红霉素（5.2%）、阿奇霉素（5.2%）、米诺环素（69%）和四环素（72.4%）、对高水平卡那霉素和阿米卡星（1.7%）以及对中等高水平庆大霉素（1.7%）的耐药情况。在对氨基糖苷类耐药的分离株中检测到双功能酶AAC6'-APH2"，在其他耐药分离株中鉴定出其他遗传决定因素：四环素耐药链球菌中的tetM和tetO，以及分别介导外排和诱导型大环内酯-林可酰胺-链阳菌素B耐药链球菌中的mefA和ermTR。为了临床目的以及快速简便地检测高水平氨基糖苷类耐药GBS，提出了一种使用1000μg卡那霉素纸片的筛选方法。
