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Macrolide resistance in Streptococcus spp

2019; Elsevier BV; Volume: 19; Issue: 3 Linguagem: Inglês

10.1016/s1473-3099(19)30039-8

1474-4457

Shinya Tsuzuki,

Neonatal and Maternal Infections

In their Review in The Lancet Infectious Diseases, Kieran O'Brien and colleagues1O'Brien KS Emerson P Hooper PJ et al.Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic review.Lancet Infect Dis. 2019; 19: e14-e25Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar extensively examined antimicrobial resistance following mass azithromycin distribution for trachoma. Their results were of great interest, particularly with regards to macrolide resistance in Streptococcus pneumoniae, the main target organism of the studies included in the Review. As they discussed, the use of azithromycin might induce macrolide resistance in other organisms. They mentioned Escherichia coli and Staphylococcus aureus as examples of macrolide-resistant organisms other than S pneumoniae. However, several other organisms might be appropriate candidates for continued surveillance of antimicrobial resistance. According to a report from the Japan Nosocomial Infections Surveillance,2Ministry of Health Labour and Welfare JapanJapan Nosocomial Infections Surveillance (JANIS). Ministry of Health Labour and Welfare Japan, 2017https://janis.mhlw.go.jp/report/open_report/2017/3/1/ken_Open_Report_201700.pdfDate accessed: January 14, 2019Google Scholar 34·4% of Streptococcus pyogenes and 33·5% of Streptococcus agalactiae showed macrolide resistance. S pyogenes is a major cause of bacterial pharyngitis and rheumatic fever in children and sometimes causes severe infection such as necrotising fasciitis. S agalactiae is the most important causative organism of neonatal sepsis. Both are sensitive to penicillin, so usually treatment selection is not difficult. Nevertheless, macrolides are a useful option for patients with penicillin allergy.3Randel A IDSA updates guideline for managing group A streptococcal pharyngitis.Am Fam Physician. 2013; 88: 338-340PubMed Google Scholar This alternative has unfortunately been lost in clinical settings in Japan, and the same thing might happen in other countries in the near future. Japan Antimicrobial Consumption Surveillance and the AMR Clinical Reference Center provide statistical information about antimicrobial consumption.4AMR Clinical Reference CenterTrends in parenteral antimicrobial consumption calculated from the sales data, Japan [Antimicrobials for humans]. Nippon AMR One Health Report (NAOR).https://amr-onehealth.ncgm.go.jp/en/statistics/5787/Date: 2017Date accessed: January 14, 2019Google Scholar They reported that larger amounts of macrolide are consumed in Japan than in EU and European Economic Area member states (4·84 defined daily doses per 1000 inhabitants per day [DID] in 2013 in Japan and 3·1 DID in 2013–14 in the EU and European Economic Area).4AMR Clinical Reference CenterTrends in parenteral antimicrobial consumption calculated from the sales data, Japan [Antimicrobials for humans]. Nippon AMR One Health Report (NAOR).https://amr-onehealth.ncgm.go.jp/en/statistics/5787/Date: 2017Date accessed: January 14, 2019Google Scholar, 5European Center for Disease Prevention and ControlSurveillance of antimicrobial consumption in Europe, 2013–2014. European Center for Disease Prevention and Control, Stockholm2014Google Scholar Although further research is required to understand the factors that contribute to this high proportion of macrolide resistance, the association between larger amounts of consumption and high proportions of resistance is difficult to deny. We intend to continue longitudinal antimicrobial resistance surveillance, including Streptococcus spp other than S pneumoniae, to fully understand the effects of antimicrobial use. We hope our activities will generate interest from other countries. I declare no competing interests. Antimicrobial resistance following mass azithromycin distribution for trachoma: a systematic reviewMass azithromycin distribution is a core component of trachoma control programmes and could reduce mortality in children younger than 5 years in some settings. In this systematic review we synthesise evidence on the emergence of antimicrobial resistance after mass azithromycin distribution. We searched electronic databases for publications up to June 14, 2018. We included studies of any type (excluding modelling studies, surveillance reports, and review articles) on community-wide distribution of oral azithromycin for the prevention and treatment of trachoma that assessed macrolide resistance, without restrictions to the type of organism. Full-Text PDF