Serious infections due to penicillin-resistant strains of viridans streptococci with altered penicillin-binding proteins.

We investigated the mechanism of resistance to penicillin in two penicillin-resistant clinical isolates of viridans streptococci that caused life-threatening infections in two patients not receiving chronic penicillin therapy. The first was a strain of Streptococcus intermedius that was isolated from the cerebrospinal fluid of a patient with post-neurosurgical meningitis. The second was a strain of Streptococcus mitis recovered from the bloodstream of a leukemic patient with neutropenia. Both patients failed to respond to penicillin. The mechanism of resistance in these strains was associated with diminished affinity for penicillin of their penicillin-binding proteins, as compared with those of penicillin-susceptible control strains. We conclude that penicillin-resistant viridans streptococci may cause serious infections even in patients not receiving chronic penicillin therapy, that this resistance is clinically significant and may result in failure of penicillin therapy, and that the mechanism of resistance in these strains is associated with diminished affinity of the penicillin-binding proteins for penicillin.

[1]  A. Tomasz,et al.  Increased amounts of a novel penicillin-binding protein in a strain of methicillin-resistant Staphylococcus aureus exposed to nafcillin. , 1985, The Journal of clinical investigation.

[2]  G. Wormser,et al.  Meningitis caused by multiply antibiotic-resistant viridans streptococci. , 1984, The Journal of pediatrics.

[3]  L. Bryan,et al.  Mechanism of resistance of an ampicillin-resistant, beta-lactamase-negative clinical isolate of Haemophilus influenzae type b to beta-lactam antibiotics , 1984, Antimicrobial Agents and Chemotherapy.

[4]  D. Catovsky,et al.  SEPTICAEMIA CAUSED BY VIRIDANS STREPTOCOCCI IN NEUTROPENIC PATIENTS WITH LEUKAEMIA , 1983, The Lancet.

[5]  G. Eliopoulos,et al.  Resistance to penicillin-streptomycin synergy among clinical isolates of viridans streptococci , 1983, Antimicrobial Agents and Chemotherapy.

[6]  G. Eliopoulos,et al.  Multiply resistant viridans streptococci: susceptibility to beta-lactam antibiotics and comparison of penicillin-binding protein patterns , 1983, Antimicrobial Agents and Chemotherapy.

[7]  J. Dankert,et al.  Penicillin prophylaxis in children with cardiac disease: postextraction bacteremia and penicillin-resistant strains of viridans streptococci. , 1983, The Journal of infectious diseases.

[8]  A. Tomasz,et al.  Penicillin-resistant and penicillin-tolerant mutants of group A Streptococci , 1982, Antimicrobial Agents and Chemotherapy.

[9]  M. Rahman,et al.  Penicillin resistance in viridans streptococci. , 1982, The Journal of infection.

[10]  A. Tomasz,et al.  Penicillin-binding proteins of penicillin-susceptible and intrinsically resistant Neisseria gonorrhoeae , 1980, Antimicrobial Agents and Chemotherapy.

[11]  N. Georgopapadakou,et al.  Binding of beta-lactam antibiotics to penicillin-binding proteins of Staphylococcus aureus and Streptococcus faecalis: relation to antibacterial activity , 1980, Antimicrobial Agents and Chemotherapy.

[12]  A. Tomasz,et al.  Multiple changes of penicillin-binding proteins in penicillin-resistant clinical isolates of Streptococcus pneumoniae , 1980, Antimicrobial Agents and Chemotherapy.

[13]  A. Tomasz,et al.  Penicillin-binding proteins of multiply antibiotic-resistant South African strains of Streptococcus pneumoniae , 1980, Antimicrobial Agents and Chemotherapy.

[14]  B. Ramsey,et al.  Bacterial Endocarditis due to Penicillin-Resistant Streptococcus viridans , 1979, Clinical pediatrics.

[15]  J. Parrillo,et al.  Endocarditis due to resistant viridans streptococci during oral penicillin chemoprophylaxis. , 1979, The New England journal of medicine.

[16]  P. Lerner.  Meningitis caused by Streptococcus in adults. , 1975, The Journal of infectious diseases.

[17]  W. Bonner,et al.  A film detection method for tritium-labelled proteins and nucleic acids in polyacrylamide gels. , 1974, European journal of biochemistry.

[18]  C. O'callaghan,et al.  Novel Method for Detection of β-Lactamases by Using a Chromogenic Cephalosporin Substrate , 1972, Antimicrobial Agents and Chemotherapy.

[19]  N. Wenger,et al.  Rheumatic fever chemoprophylaxis and penicillin-resistant gingival organisms. , 1970, Annals of internal medicine.

[20]  U. K. Laemmli,et al.  Cleavage of Structural Proteins during the Assembly of the Head of Bacteriophage T4 , 1970, Nature.

[21]  R. Duma,et al.  STREPTOCOCCAL INFECTIONS: A Bacteriologic and Clinical Study of Streptococcal Bacteremia , 1969 .

[22]  K. Sprunt,et al.  Penicillin resistant alpha Streptococci in pharynx of patients given oral penicillin. , 1968, Pediatrics.

[23]  M. Markowitz,et al.  The risk of bacterial endocarditis during antirheumatic prophylaxis. , 1967, JAMA.

[24]  N. Shotts,et al.  Antibiotic-resistant streptococci in the mouths of children treated with penicillin. , 1967, Lancet.

[25]  J. Barrow,et al.  Pencillin-resistant bacteria in the mouths and throats of children receiving continuous prophylaxis against rheumatic fever. , 1963, Annals of internal medicine.

[26]  L. Garrod,et al.  THE RISKS OF DENTAL EXTRACTION DURING PENICILLIN TREATMENT , 1962, British heart journal.

[27]  O. H. Lowry,et al.  Protein measurement with the Folin phenol reagent. , 1951, The Journal of biological chemistry.