Erythromycin-Susceptible but Clindamycin-Resistant Phenotype of Clinical ermB-PCR-Positive Group B Streptococci Isolates with IS1216E-Inserted ermB

Abstract

Streptococcus agalactiae (Group B Streptococcus, GBS) is a pathogen which causes neo natal sepsis, meningitis, and invasive infections in the elderly and people with medical conditions. Macrolide and lincosamide resistance rates of GBS strains have been increasing worldwide. A macrolide resistance gene, erythromycin ribosomal methylase (erm), typically confers macrolides, lincosamides, streptogramin B resistance phenotype. However, in the current study, we recovered and characterized 3 clinical ermB-PCR-positive isolates of GBS with L phenotype. The presence of ermB and lnuB (lincosamide nucleotidyltransferase) genes in all 3 clinical isolates was confirmed using PCR. The ermB gene of the clinical isolates harbored C222T (N74N), T224C (I75T), and A299G (N100S) nucleotide (amino acid) substitutions, and insertion of an IS1216E element at nucleotide position 643, resulted in the deletion of a segment spanning nucleotides 643–738 of ermB gene, which suggested the loss-of-function of ErmB protein in the 3 clinical isolates. Since these clinical isolates show positive PCR result for a drug resistance gene despite its partial deletion, these results contradict their drug resistance phenotype. These factors must be considered while performing PCR-based detection of antimicrobial drug resistance genes.