Screening for β-lactam resistance by penicillin G in the Streptococcus anginosus group challenged by rare strains with altered PBPs

Author:

Chagneau Camille V12ORCID,Alcouffe Orancie1,Grare Marion1,Oswald Eric12,Massip Clémence12

Affiliation:

1. Department of Bacteriology and Hygiene, Toulouse University Hospital Centre , Toulouse , France

2. IRSD, INSERM, Toulouse University, INRAE, ENVT, UPS , Toulouse , France

Abstract

Abstract Background Streptococcus anginosus group (SAG) strains are common pathogens causing abscesses and bacteraemia. They are generally susceptible to β-lactams, which constitute first-line treatment. EUCAST recommends testing penicillin G susceptibility to screen for β-lactam resistance. Isolates categorized as susceptible (negative screening) can be reported as susceptible to aminopenicillins and third-generation cephalosporins. Objectives To assess the reliability of penicillin G resistance screening in predicting β-lactam resistance in SAG blood culture isolates, and to investigate isolates for which this test would be unreliable. Methods We determined the susceptibility to penicillin G, amoxicillin and ceftriaxone of 90 SAG blood culture isolates, all with negative penicillin G resistance screening. β-Lactam-resistant strains were sequenced and compared with susceptible reference SAG strains. Results We detected two isolates displaying β-lactam resistance, especially to third-generation cephalosporins, despite negative screening for penicillin G resistance. For these isolates, amino acid substitutions were identified next to the essential PBP motifs SxxK, SxN and/or KS/TGS/T. Changes in these motifs have been previously linked to β-lactam resistance in Streptococcus pneumoniae. Conclusions Our study suggests that aminopenicillin and third-generation cephalosporin susceptibility should be determined for SAG strains in the event of severe infection as screening for penicillin G resistance might not be sufficient to detect resistance mechanisms that predominantly affect cephalosporins. The PBP sequencing of resistant SAG strains allowed us to detect amino acid changes potentially linked to β-lactam resistance.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

Reference19 articles.

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3. Clinical features and outcomes of Streptococcus anginosus group infective endocarditis: a multicenter matched cohort study;Escrihuela-Vidal;Open Forum Infect Dis,2021

4. Serious infections due to penicillin-resistant strains of viridans streptococci with altered penicillin-binding proteins;Quinn;J Infect Dis,1988

5. Streptococcus anginosus group bacterial infections;Fazili;Am J Med Sci,2017

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