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Reports of Biochemistry & Molecular Biology Vol. 3, No. 2, Apr 2015
Short article
Pattern of Infection and Antibiotic Activity among
Streptococcus agalactiae Isolates from Adults
in Mashhad, Iran
Masoumeh Malek-Jafarian1, Fatemeh-Sadat Hosseini*1, Abodol-Reza Ahmadi1 Abstract
One of the main causes of sexually transmitted diseases is group B β- hemolytic
(GBS) multiplying in the genital tracts. Penicillin is the most common drug for the
treatment of infections caused by these bacteria, but in patients suffering from Penicillin allergy,
Erythromycin and Clindamycin are used as alternative therapeutic drugs against GBS. Recently,
resistance to these drugs has been reported more often. In this study, efforts have been made to
determine the prevalence and antibiotic resistance of GBS.
Methods: Modified Christie Atkins Munch-Petersen (CAMP) test was conducted on over 2400
samples of urine and discharge taken from vagina, urethra and prostate. The drug sensitivity was
performed by double disk sensitivity tests to Bacitracin, Trimethoprim, and Sulfamethoxazole and
then the resistant samples were investigated by E-test to determine the minimal inhibitory
concentrations (MICs) value.
Results: Twenty-three vaginal and 10 urethral discharge, 27urine and 6 prostatic secretion samples
were GBS positive. The most symbiotic microorganisms with GBS were strains of Enterococci
(90%), Staphylococcus saprophyticus (25%) and Candida albicans (6%). The disk diffusion
method showed 18 cases with Penicillin resistance (MIC: 1.5 mg/ml).
Conclusion: Taken together, GBS carriers' rate in this study was found 20.65% (8.24% men and
12.4% women). Furthermore, findings showed high-level resistance to Erythromycin and

Antibiotic resistance, Genitourinary system, Minimal inhibitory concentration (MIC),
Streptococcus agalactiae,

Group B β- hemolytic streptococci (GBS) is the main in adults. Especially people with background diseases cause of blood infection and Meningitis in infants (1, such as diabetes mellitus, malignant tumor, liver and 2). According to the statistics published by the World kidney failure, immune deficiency such as acquired Health Organization (WHO), about 15-45% of immunodeficiency syndrome (AIDS) are at the risk women are affected by GBS in their genitourinary for GBS (6-9). Moreover, GBS increases the risk for system (3, 4). Fifty percent of infants become infected sexual diseases; it can multiply in the male before birth or during delivery. In such cases, nearly reproductive organs, particularly the urethra and 1-2% of newborns will develop progressively severe prostate and then possibly lead to pneumonia and complications such as meningitis (5). In addition, bacteremia (9). Penicillin is the well-known drug in Streptococcus agalactiae may cause severe infections the treatment of infections caused by GBS. However, 1: Department of Laboratory Medicine, School of Paramedicine, Mashhad University of Medical Sciences, Mashhad, Iran
*Corresponding author: Fatemeh-Sadat Hosseini; Tel: +98 51- 38827029; Fax: +98- 51- 37684082; E-mail:
Received: Jun 21, 2014; Accepted: Oct 10, 2014
Malek-Jafarian M et al.
for people who have an allergic reaction to Penicillin, by antibiotic carriers were applied to each plate. After Erythromycin and Clindamycin are prescribed for overnight incubation, the MIC was reported at the patients with GBS infections. Recently, a developing intersection of growth inhibition zone with the strip. resistance to these drugs has been reported (10). The purpose of this study was to determine the prevalence of S. agalactiae in genitourinary system infections Table 1 shows the frequent GBS infections by gender and its resistance to Erythromycin and Clindamycin. representing 69.7% of women carrying GBS. Clinical isolates from different sites distributed Materials and Methods
among different age groups are summarized in table Samples were obtained from individuals with the 2. With routine identification tests, a total of 66 GBS genitourinary system infection (aged 15-40 and over) isolates were characterized (27 Urine, 23 Vagina, 9 referred to medical diagnostic laboratories in Urethra and 6 Prostate). The majority were from the Mashhad (Iran). Human specimens for testing collected samples of urine and vaginal discharge included urine (n=1687), discharge taken from the demonstrating 40.9% and 34.85%, respectively. vagina (n=208), urethra (n=200) and prostate Moreover, our findings indicated that specimens (n=205). At first, epithelial cells (ECs) and white taken from the vagina were more infected with GBS blood cells (WBCs) were counted for all samples. in 26-35 years old (48%). Highest rate of GBS Then, they were streaked over blood agar plates (5% presence in urinary tract was reported among sheep's blood) and incubated into a candle jar. The individuals over 40 years old (67%). For urethra and symbiotic relationship with Enterococcus, prostate secretion, this was ranged from 31 to 40 Staphylococcus saprophyticus and Candida albicans years old (40%). As shown in table 2, there was an (11), and the GBS identification from clinical abnormal increase in the number of WBCs and ECs specimens were analyzed using bacitracin, catalase, in about 34% of GBS isolates. CAMP and Gram stain tests (12, 13). Moreover, It was observed that the most symbiotic subsequent tests were performed to estimate different interactions were occurring between GBS and resistance levels of GBS to different antibiotics Enterococcus, 90%, followed by Staphylococcus (Ampicillin, Penicillin, Clindamycin, Erythromycin, saprophyticus, 25.7% (Table 3). Amoxiclav, Ceftriaxone, Vancomycin, Amikacin, Gentamicin, Nalidixic acid and Kanamycin). frequencies with Trimethoprim and Sulfamethoxazole. Clinical isolates of GBS on blood agar were About 27% of infectious samples were resistant to suspended in standard saline inoculating on Mueller- Penicillin at MIC of 1.5 µg/ml. The percentage of Hinton agar plates. Then, two prepared disks of GBS resistance to Clindamycin and Erythromycin Trimethoprim and Sulfamethoxazole (Masc Co, UK) were 20% and 24.5%, respectively, with the average were placed on the plates and incubated overnight MIC value of 0.01 µg/ml. Furthermore, the disk diffusion susceptibility to Amikacin, Gentamicin, In parallel, minimal inhibitory concentration (MIC) Nalidixic acid and Kanamycin resulted in 100% values were measured by E-test method and resistance for all clinical isolates of GBS fully interpreted as susceptible, intermediate or resistant (15). As described for disk diffusion, the inoculation was carried out in the plates, and then strips covered Table 1. The percentage of GBS carriers by gender.
Total patients
GBS carrier
90 Rep. Biochem. Mol. Biol, Vol. 3, No. 2, Apr 2015 Infection and Antibiotic Activity Among Streptococcus agalactiae Isolates
Table 2. Cell counts in obtained specimens and on site distributions among different age groups
White blood cells
Epithelial cells
Table 3. The culture positivity rate of Group β- hemolytic streptococci (GBS) and its coexistence organisms.
Enterococcus specie
Staphylococcus aureus
Candida species
Table 4. Sensitivity testing frequencies with Trimethoprim and Sulfamethoxazole.
Susceptible ( %)
Intermediate (%)
Resistant (%)
Nalidixic acid
Rep. Biochem. Mol. Biol, Vol. 3, No. 2, Apr 2015 Malek-Jafarian M et al.
A growing body of literature reported that the resistance rate of GBS to Clindamycin and infection rate and the frequency of antibiotic Erythromycin were among ranges (4-43% for resistance of GBS have increased in adults (16). Clindamycin and 1.7-46% for Erythromycin) so far Taking into account all studies to date, these different recorded (16). We detected lower resistant rate to incidence rates well correlated with geography, age, Clindamycin than those to Penicillin and gender and collection sites reveal serious reservations Erythromycin. Besides, GBS isolates showed full about performing the susceptibility test before susceptibility against Ceftriaxone providing another prescribing any antibiotic therapy (17). alternative option for treating patients especially To elucidate the frequent sites in various age and women with a penicillin allergy in our environment gender groups and resistance rate of GBS, 2400 samples from clinical laboratories in Mashhad, Iran, Our results highlight a rapid screening method were studied and patterns of the antibiotic activity for diagnosing GBS in women. In addition, were carried out by the disk diffusion susceptibility. Clindamycin and Ceftriaxone are suggested as Of the 2400 specimens, vagina indicated a alternative antibacterial against GBS. higher proportion of GBS infection (11.05%) among the rest of isolates. In previous studies the frequency of GBS collection from different sites has The authors would like to thank Ms. Motahare Sadat also predominated in vaginal swabs (15, 18, 19). Hosseini at Varastegan Institute for Medical Sciences Surprisingly comparison of our findings with (Mashhad, Iran) for her kind help improving the those from Iran or other countries disclosed that the
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Información de apoyo a Profesionales Agosto 2006 Revisado Enero 2010 Comentario Si bien la prevalencia de la epilepsia activa puede situarse entre el 5 – 10 / 1.000, en nuestra población de personas con P.C.I., especialmente en los cuadros más severos, esta proporción es muy superior. Las crisis aparecen, por regla general, en el primer año de vida y es habitual que mantengan una frecuencia mayor o menor de episodios críticos a lo largo de su vida y que, por tanto, estén medicados de manera permanente. No podemos olvidar que estamos hablando de personas con muchos trastornos asociados y con deterioro progresivo de su estado de salud. Por tanto, si tenemos que emplear medicación antiepiléptica, debemos considerar, muy especialmente en estos casos, la conveniencia de:

Clinical summary

Clinical Summary Name: Justine D'Italia Date of Birth: 01/12/1964 Chief Complaint/Identifying Information: Ms. D'Italia is a 45-50 year-old woman with frequent falls with stiffening of her body, easy startling, and gait disturbance since her 20's. She is seeking Best Doctors opinion re the etiology of her symptoms and recommendations for treatment options. History of Present Illness: Ms. D'Italia is a 45-50 year old woman with seropositive rheumatoid arthritis diagnosed in 2005. She was treated with steroids initially. She is currently on Hydroxychloroquine and Methotrexate. She was diagnosed with right peroneal tenosynovitis in 2009 and underwent debridement in November 2010. She has been using a walker since the surgery. She was found to have left peroneal tendonitis in 2012. She recently started Isoniazid therapy for latent tuberculosis (equivocal PPD and positive Quantiferon gold testing). She reports she has multiple family members, including aunts and cousins, with similar symptoms to the ones she describes below. One aunt has been diagnosed with hyperekplexia. Evidently some of her family members have been treated with anti-seizure medications, but these have not been helpful. (Of note, the available neurology notes do not include this family history.) Ms. D'Italia reports the following history re her falls and gait disturbance: (There are no records available until 2006.) She reports in her 20's, she began to fall frequently. There was no prodrome before falls. She always wore high heels, and she assumed the falls were due to clumsiness. An MRI (NOS) performed in her 20's was a normal study. She was treated with Valproic Acid and then Carbamazepine. She continued to fall. At times, the falls would results in lacerations and concussions. Imaging continued to be negative. She developed a panic disorder because she never knew when she was about to fall. She became afraid to walk. She also reports that she became quite sensitive to environmental stimuli and was easily startled. Whenever she became startled, she would start to fall. She was admitted to the hospital for 4 days for continuous EEG monitoring. She was told that she did not have epilepsy, but ant-epileptic drugs were not discontinued at that time. She was seen at a different neurology clinic in approximately 2006. 48-hour ambulatory EEG monitoring was within normal limits. There were four events on the log which had no EEG correlate. She was started on Lamotrigine to treat a possible seizure disorder at some point with some benefit for a few years. In July 2009, Ms. D'Italia fell after tripping over some clutter on the floor. She hit her head against the arm of a chair and on the tile floor. She did not lose consciousness. She developed nausea and a severe headache at that time. She presented to 3 ED's over the