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Article in Japanese

Clinical presentation of children with isolated group A streptococcus in 2017 and antimicrobial susceptibility of the isolate

Kazunori HARUTA1), Takao OZAKI1), Takuya AKANO1), Hiroki TAKAO1), Yuto FUKUDA1), Ayami YOSHIKANE1), Shuta KITO1), Tomoyasu NOGUCHI1), Kensei GOTOH1), Koji TAKEMOTO1), Naoko NISHIMURA1)

During a 1-year period from April 2017, 187 strains of group A streptococcus were isolated from the pharyngeal swabs from 187 patients attending the pediatric department of this hospital. The minimal inhibitory concentration (MIC) values of 17 antimicrobials were measured in all of the isolates, and the S, I, and R categories were determined. Data on antimicrobial susceptibility were compared with the results of five previous surveys (1996: n=431, 2001: n=317, 2003: n=295, 2006: n=438, and 2013: n=215).
The median age of the patients was 4 years and 9 months (20 days-15 years and 9 months). The incidence rate was 88%, 79%, 18%, and 16% for fever (≥ 37.5ºC), pharyngeal pain or redness, rash, and lymphadenopathy, respectively. Three patients also had impetigo, and each one developed acute glomerulonephritis and IgA vasculitis. Antimicrobial therapy was performed in 175 patients, of whom 4 showed relapse at 6-41 days after completing the treatment. It was found that 43.9%, 27.3%, and 1.1% of the isolates showed resistance (I or R) to clarithromycin (CAM), clindamycin (CLDM), and levofloxacin (LVFX) respectively. Among a total of 1,883 strains (including those from the past five surveys), none showed resistance to β-lactam antimicrobials or vancomycin (VCM). The CAM resistance rate was 13.2% in 2001, 19.7% in 2003, 19.6% in 2006, 58.1% in 2013, and 43.9% in the present survey. Therefore, approximately half of the strains isolated in recent years showed CAM resistance.

1) Department of Pediatrics, Konan Kosei Hospital

Key words group A streptococcus, antimicrobial susceptibility, β-lactam antimicrobials, CAM resistance
Received February 18, 2019
Accepted July 4, 2019

31 (4):313─320,2019