Rate and Mechanism of Erythromycin Resistance in Streptococcus pyogenes in Beni-Suef University Hospital

2021 ◽  
Vol 30 (1) ◽  
pp. 153-160
Author(s):  
Mervat A. Tohamy ◽  
Mona A. Abdelmeseeh ◽  
Dina S. Abdelfatah ◽  
Mohamed A. Abdel Tawab ◽  
Mostafa S. Sheemy
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Macrolide Resistance ◽  
University Hospital ◽  
Upper Respiratory Tract Infections ◽  
P Value ◽  
Upper Respiratory Tract ◽  
Erythromycin Resistance ◽  
Upper Respiratory ◽  
Tract Infections

Background: Group A streptococci (GAS) is a major cause of morbidity and mortality. Erythromycin is an effective macrolide antibiotic for treating GAS infections. However, GAS macrolide resistance has been increased due to either an efflux mechanism (M phenotype), encoded by mef A gene, or by methylation of the ribosomal target resulting in resistance to macrolide, lincosamide, and streptogramin B (MLS) antibiotics. Methylase can be expressed either constitutively (cMLS phenotype) or inducibly (iMLS phenotype). Objectives: The present study aimed to find out frequency of S. pyogenes isolated from patients with upper respiratory tract infections at Beni-Suef University Hospital, determine rate and mechanism of macrolide resistance. Methodology: The present study was conducted on patients with upper respiratory tract infections attended to otorhinolaryngology clinic, Beni-Suef University Hospital, Egypt, in the period from February to December 2015. Detailed history taking was carried and clinical findings were obtained. Throat or ear swabs were taken and processed by conventional bacteriological methods. S. pyogenes isolates were further tested to determine erythromycin resistance phenotype by D- test, MIC of Erythromycin by tube broth dilution method and for mef A gene by PCR. Results: Forty two S. pyogenes isolates were identified from (100) swabs taken from either ear or throat specimens (42%), isolates resistance to erythromycin and clindamycin was 83.3% (35) and 31% (13) respectively. The pattern of macrolide resistance was 31% (13/ 42) cMLS phenotype, 52.3% (22/42) M phenotype and no isolate was iMLSB phenotype. Most strains with M phenotype expressed low-level macrolide resistance (MIC 1-4μg/ml), while cMLSB isolates showed a high level of erythromycin resistance (MIC ≥64 μg/ml) (highly significant: p-value 0.0001). The results confirmed a strong correlation between the M phenotype and the mef A gene in GAS (highly significant: p-value =0.001). Conclusion: Incidence of erythromycin resistance was evident among the isolates. To preserve the necessary efficacy, limited use of erythromycin is recommended.

scholarly journals 159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Anastasia Wasylyshyn ◽  
Keith S Kaye ◽  
Julia Chen ◽  
Haley Haddad ◽  
Jerod Nagel ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Upper Respiratory Tract Infections ◽  
P Value ◽  
Upper Respiratory Tract ◽  
Post Intervention ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs). Methods In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1). We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period. Results Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a). Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value < 0.001) in patients receiving guideline-concordant antibiotics. Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days Conclusion A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine. Disclosures Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose

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