Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole?

Asha Bowen, Rachael Lilliebridge, Steven Tong, Robert Baird, Peter Ward, Malcolm McDonald, Bart Currie, Jonathan Carapetis

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter ?-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ?1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing. 
    Original languageEnglish
    Pages (from-to)4067-4072
    Number of pages6
    JournalJournal of Clinical Microbiology
    Volume50
    Issue number12
    DOIs
    Publication statusPublished - Dec 2012

    Fingerprint

    Streptococcus pyogenes
    Sulfamethoxazole Drug Combination Trimethoprim
    Agar
    Thymidine
    Horses
    Sulfur
    Impetigo
    Soft Tissue Infections
    Folic Acid
    NAD
    Sheep
    Clinical Trials
    Skin

    Cite this

    Bowen, A., Lilliebridge, R., Tong, S., Baird, R., Ward, P., McDonald, M., ... Carapetis, J. (2012). Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole? Journal of Clinical Microbiology, 50(12), 4067-4072. https://doi.org/10.1128/JCM.02195-12
    Bowen, Asha ; Lilliebridge, Rachael ; Tong, Steven ; Baird, Robert ; Ward, Peter ; McDonald, Malcolm ; Currie, Bart ; Carapetis, Jonathan. / Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole?. In: Journal of Clinical Microbiology. 2012 ; Vol. 50, No. 12. pp. 4067-4072.
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    title = "Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole?",
    abstract = "Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter ?-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ?1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99{\%} of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing. ",
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    author = "Asha Bowen and Rachael Lilliebridge and Steven Tong and Robert Baird and Peter Ward and Malcolm McDonald and Bart Currie and Jonathan Carapetis",
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    Bowen, A, Lilliebridge, R, Tong, S, Baird, R, Ward, P, McDonald, M, Currie, B & Carapetis, J 2012, 'Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole?', Journal of Clinical Microbiology, vol. 50, no. 12, pp. 4067-4072. https://doi.org/10.1128/JCM.02195-12

    Is Streptococcus pyogenes Resistant or Susceptible to Trimethoprim- Sulfamethoxazole? / Bowen, Asha; Lilliebridge, Rachael; Tong, Steven; Baird, Robert; Ward, Peter; McDonald, Malcolm; Currie, Bart; Carapetis, Jonathan.

    In: Journal of Clinical Microbiology, Vol. 50, No. 12, 12.2012, p. 4067-4072.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Bowen, Asha

    AU - Lilliebridge, Rachael

    AU - Tong, Steven

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    AU - Ward, Peter

    AU - McDonald, Malcolm

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    AU - Carapetis, Jonathan

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    N2 - Streptococcus pyogenes is commonly believed to be resistant to trimethoprim-sulfamethoxazole (SXT), resulting in reservations about using SXT for skin and soft tissue infections (SSTI) where S. pyogenes is involved. S. pyogenes' in vitro susceptibility to SXT depends on the medium's thymidine content. Thymidine allows S. pyogenes to bypass the sulfur-mediated inhibition of folate metabolism and, historically, has resulted in apparently reduced susceptibility of S. pyogenes to sulfur antibacterials. The low thymidine concentration in Mueller-Hinton agar (MHA) is now regulated. We explored S. pyogenes susceptibility to SXT on various media. Using two sets of 100 clinical S. pyogenes isolates, we tested for susceptibility using SXT Etests on MHA containing defibrinated horse blood and 20 mg/liter ?-NAD (MHF), MHA with sheep blood (MHS), MHA alone, MHA with horse blood (MHBA), and MHA with lysed horse blood (MHLHBA). European Committee on Antibacterial Susceptibility Testing (EUCAST) breakpoints defined susceptibility (MIC, ?1 mg/liter) and resistance (MIC, >2 mg/liter). In study 1, 99% of S. pyogenes isolates were susceptible to SXT on MHA, MHBA, and MHLHBA, with geometric mean MICs of 0.04, 0.04, and 0.05 mg/liter, respectively. In study 2, all 100 S. pyogenes isolates were susceptible to SXT on MHF, MHS, MHA, and MHLHBA with geometric mean MICs of 0.07, 0.16, 0.07, and 0.09 mg/liter, respectively. This study confirms the in vitro susceptibility of S. pyogenes to SXT, providing support for the use of SXT for SSTIs. A clinical trial using SXT for impetigo is ongoing. 

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