Macrolide Resistance Among Group B Streptococcus Isolated from Clinical Samples In and Around Kanchipuram
Abstract:
Streptococcus agalactiae (Group B
Streptococcus, GBS) remains a significant cause of invasive infections,
particularly in pregnant women, neonates, and immunocompromised individuals.
Rising resistance to macrolides and lincosamides, especially among penicillin-allergic
patients, is a growing concern. This study aimed to determine the prevalence
and patterns of macrolide resistance in clinical GBS isolates, evaluate
inducible clindamycin resistance, and assess associated demographic and
clinical variables in a tertiary care setting in South India. A cross-sectional
study was conducted at Meenakshi Medical College Hospital and Research
Institute, Kanchipuram, from January 2023 to June 2024. A total of 600 clinical
samples—including high vaginal swabs, urine, pus, blood, and cerebrospinal
fluid—were processed. GBS isolates were identified using standard
microbiological and automated methods. Antimicrobial susceptibility testing was
performed according to CLSI 2023 guidelines, and inducible clindamycin resistance
was detected using the D-zone test. GBS was isolated from 130 samples (21.7%),
predominantly from females (78.5%) and high vaginal swabs (32.4%). All isolates
were susceptible to penicillin, vancomycin, and linezolid. Resistance to
erythromycin and clindamycin was observed in 43.1% and 37.7% of isolates,
respectively. Among erythromycin-resistant strains, the M phenotype was most
prevalent (39.3%), followed by inducible MLSB (32.1%) and constitutive MLSB
(25.0%). No significant associations were found with age, sex, or specimen
type. These findings underscore the need for routine susceptibility testing and
support penicillin as the first-line therapy.
References:
[1]. Verani, J. R., McGee, L., Schrag, S. J., 2010,
Prevention of perinatal group B streptococcal disease: revised guidelines from
CDC. MMWR Recomm Rep, 59(RR-10):1–36.
[2]. Baker, C. J., 2013, The spectrum of perinatal group B
streptococcal disease. Vaccine, 31 Suppl4:D3–6.
[3]. Lin, F. Y., Weisman, L. E., Troendle, J., Adams, K.,
2000, Antibiotic susceptibility profiles for group B streptococci isolated from
neonates in the United States in 1995–1998. Antimicrob Agents Chemother,
44(4):1085–6.
[4]. Schrag, S. J., Zywicki, S., Farley, M. M., Reingold,
A. L., Harrison, L. H., Lefkowitz, L., et al., 2000, Group B streptococcal
disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med,
342(1):15–20.
[5]. Decheva, A., Kostyanev, T., Marinov, B., 2020,
Antimicrobial resistance and genetic diversity of Streptococcus agalactiae from
vaginal and rectal swabs of pregnant women. Diagn Microbiol Infect Dis,
97(4):115048.
[6]. Kimura, K., Wachino, J., Kurokawa, H., et al., 2008,
High prevalence of macrolide and clindamycin resistance among Streptococcus
agalactiae isolates in Japan. Antimicrob Agents Chemother, 52(1):282–4.
[7]. Praharaj, I., Sujatha, S., Parija, S. C., 2013,
Resistance to erythromycin and clindamycin in clinical isolates of
Streptococcus agalactiae from India. J Med Microbiol, 62(Pt 5):671–4.
[8]. Kaur, H., Rawat, S., Kaur, T., Sharma, P., Kaur, M.,
2022, Antibiotic resistance in clinical isolates of group B Streptococcus in
India. Indian J Med Res, 155(1):44–50.
[9]. Shrivastava, R., Srivastava, G. N., Mishra, P., et
al., 2021, Prevalence of antimicrobial resistance among Streptococcus
agalactiae isolates from a tertiary care center in North India. J Lab
Physicians, 13(2):137–42.
[10]. McGuire, E., Ready, D., Ellaby, N., Potterill, I.,
Pike, R., Hopkins, K. L., et al., 2025, A case of penicillin-resistant group B
Streptococcus isolated from a patient in the UK. J Antimicrob Chemother,
80(2):399–404.
[11]. Centers for Disease Control and Prevention (CDC),
2021, Group B Strep (GBS). [Internet]. Available from: https://www.cdc.gov/groupbstrep/index.html
[12]. Seppälä, H., Nissinen, A., Yu, Q., Huovinen, P., 1993,
Three different erythromycin resistance phenotypes in clinical isolates of
Streptococcus pyogenes and Streptococcus agalactiae. J Antimicrob Chemother.,
32(6):885–91.
[13]. Romero-Hernández, B., Baquero-Artigao, F.,
Aguilar-Luis, M. A., et al., 2020, Antimicrobial susceptibility of
Streptococcus agalactiae: trends and resistance mechanisms. Rev Esp
Quimioter, 33(3):179–85.
[14]. Kalapriya, B., Subramani, E., Thirunavukarasu, N.,
Muninathan, N., Baskaran, K., Suresh, A., 2024, Cross-sectional study of
antibiotic residues and antimicrobial-resistant pathogens from raw meat in and
around Kanchipuram Tamil Nadu. Pravara Med Rev., 16(04):83–95.
[15]. Rengaraj, R., Muninathan, N., Alagiri, S., Suresh, A.,
2024, A study of genotypic characterization of ESBL and MBL genes of
β-lactamase producing Pseudomonas aeruginosa in various clinical samples. J
Pure Appl Microbiol, Doi: 10.22207/JPAM.18.2.15.
[16]. Ali, M. M., Suresh, A., Muninathan, N., Baskaran, K.,
Gopikrishnan, V., Sarva, K., 2023, Navigating the landscape of Klebsiella
pneumoniae: virulence, pathogenicity and antibiotic resistance—a comprehensive
review. J Chem Health Risks., 13(4):671–86.
[17]. Gonçalves, B. P., Procter, S. R., Paul, P., et al.,
2022, Group B streptococcus infection during pregnancy and infancy: estimates
of regional and global burden. Lancet Glob Health, 10(6): e807–e819.
[18]. Wang, J., Zhang, Y., Lin, M., et al., 2023, Maternal
colonization with group B Streptococcus and antibiotic resistance in China:
systematic review and meta-analyses. Ann Clin Microbiol Antimicrob,
22(1):5.
[19]. Wadilo, F., Hailemeskel, E., Kedir, K., et al., 2023,
Prevalence of Group B Streptococcus maternal colonization, serotype
distribution, and antimicrobial resistance in Sub-Saharan Africa: a systematic
review and meta-analysis. J Glob Antimicrob Resist., 32:134–44.
[20]. van Kassel, M. N., Janssen, S. W. C. M., Kofman, S.,
et al., 2021, Prevalence of group B streptococcal colonization in the healthy
non-pregnant population: a systematic review and meta-analysis. Clin
Microbiol Infect., 27(7):968–80.
[21]. Bianchi-Jassir, F., Paul, P., To, K. N., et al., 2020, Systematic review of Group B Streptococcal capsular types, sequence types and surface proteins as potential vaccine candidates. Vaccine, 38(43):6682–94.
