Penicillin Susceptibility and Macrolide-Lincosamide-Streptogramin B Resistance in Group B Streptococcus Isolates from a Canadian HospitalReport as inadecuate

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Canadian Journal of Infectious Diseases and Medical Microbiology - Volume 23 2012, Issue 4, Pages 196-198

Original Article

Department of Biological Science, Faculty of Science, Thompson Rivers University, Kamloops, Canada

Department of Pathology, Royal Inland Hospital, Kamloops, Canada

Department of Pathology & Laboratory Medicine, Kelowna General Hospital, Kelowna, British Columbia, Canada

Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Intrapartum antibiotic prophylaxis IAP is recommended for pregnant women who test positive for group B Streptococcus GBS in their genitourinary tract to prevent GBS-induced neonatal sepsis. Penicillin G is used as the primary antibiotic, and clindamycin or erythromycin as the secondary, if allergies exist. Decreased susceptibility to penicillin G has occasionally been reported; however, clindamycin and erythromycin resistance is on the rise and is causing concern over the use of clindamycin and erythromycin IAP.

METHODS: Antibiotic resistance was characterized phenotypically using a D-Test for erythromycin and clindamycin, while an E-Test E-strip was used for penicillin G. GBS was isolated from vaginal-rectal swabs and serologically confirmed using Prolex Pro-Lab Diagnostics, Canada streptococcal grouping reagents. Susceptibility testing of isolates was performed according to the Clinical Laboratory Standards Institute guidelines.

RESULTS: All 158 isolates were penicillin G sensitive. Inducible macrolide-lincosamide-streptogramin B MLSB resistance was observed in 13.9% of isolates. Constitutive MLSB resistance was observed in 12.7% of isolates. M phenotype resistance was observed in 6.3% of isolates. In total, erythromycin resistance was present in 32.9% of the GBS isolates, while clindamycin resistance was present in 26.6%.

DISCUSSION: The sampled GBS population showed no sign of reduced penicillin susceptibility, with all being well under susceptible minimum inhibitory concentration values. These data are congruent with the large body of evidence showing that penicillin G remains the most reliable clinical antibiotic for IAP. Clindamycin and erythromycin resistance was higher than expected, contributing to a growing body of evidence that suggests the re-evaluation of clindamycin and erythromycin IAP is warranted.

Author: Kevin Sherman, Sue Whitehead, Edith Blondel-Hill, Ken Wagner, and Naowarat Cheeptham



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