Version 2: Group A Streptococcus isolated in Guyana with reduced susceptibility toβ-lactam antibiotics

Introduction: Streptococcus pyogenes (Group A streptococci [GAS]) is the causative agent of pharyngitis and various other syndromes involving cellulitis, streptococcal toxic shock syndrome (STSS) and necrotising fasciitis. Although the prevalence of GAS infections globally remains high, necessitating the widespread use of b-lactam antibiotics, GAS has remained largely susceptible to these agents. However, there have been several reports of GAS with reduced susceptibility harbouring mutations in genes for penicillin-binding proteins (PBPs). The objectives of this study were to examine the in vitro b-lactam susceptibility patterns of Group A streptococci, determine the prevalence of drug resistance and ascertain whether such resistance could be attributed to mutations in specific PBP genes. 

Methods: In this study, we sought to use Sanger sequencing to identify mutations in PBP genes of Streptococcus pyogenes isolated from patients that required inpatient and outpatient care that could confer reduced PBP affinity for penicillin and/or cephalosporin antibiotics. All isolates were screened for susceptibility to penicillin, amoxicillin, and cefazolin using E-test strips. 

Results: While there were no documented cases of reduced susceptibility to penicillin or amoxicillin. Thirteen isolates had reduced susceptibility against cefazolin. Examination of pbp1a by Sanger sequencing revealed several isolates with single amino acid substitutions, which could potentially reduce the affinity of PBP 1A for cefazolin and possibly other first-generation cephalosporins. 

Conclusion: Penicillin and penicillin-derived antibiotics remain effective treatment options for GAS infections, but active surveillance is needed to monitor for changes to susceptibility patterns against these and other antibiotics and understand the genetic mechanisms contributing to them.