GAS surveillance. emm12 emm28 emm89 GAS GAS. A GAS Streptococcus pyogenes GAS GAS PSAGN GAS GAS. emm. Vol. 26 No GAS surveillance study group
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1 014 Vol. 6No. 11 A 1 1 GAS surveillance study group A GAS GAS surveillance study group01 GAS 44 PCR 60 GAS emm emm8emm8 GAS emm GAS A GASStreptococcus pyogenes GAS GAS 1, GAS GAS GAS PSAGN GAS Key wordsa emm
2 014 1GAS surveillance study group JA GAS surveillance study groupgas GAS PCR 1 GAS surveillance study group GAS WHO B emm 4 Streptococcus dysgalactiae subsp. equisimilis SDSE SDSE H l Todd HewittTHbroth l emm 4 TH broth DNA,000 rpm 0l EXTRA- GEN DNA DNase DW 40l DNA
3 014 Vol. 6No. 1 1 A DNA realtime PCR GAS SDSE slo DNA emm emm CDC web penicillingpcgampicillinabpcamoxicillinapccefdinircdn cefpodoximecpdxcefditorencdtrclarithromycincaazithromycinaz 8 PCR 1 GAS 60 SDSE 4 6 GAS 1 PCR SDSE GAS O slo PCR GAS emm emm emm 18 emm 6.1.6emm8 16.emm8 1. GAS
4 4 014 A emm n6 G IC gml 0.01gml 0.01gml 0.016gml gml 0.016gml gml mefa1.1 ermb 6. mefa mefa ermb emm8 ermb GAS emm emm emm8 emm8 4 1 mgkg emm GAS 4..8 GAS 1 GAS 1 GAS
5 014 Vol. 6No. 1 emm mgkg mgkg p emm GAS emm GAS 40 mgkg mgkg emm PCR slo DNA GAS 1 GAS GAS GAS T 1
6 6 014 GAS emm type mgkg W041 W1 W0 W W086 W ND emm emm8 emm8 W0 W4 W W01 W44 W6 W18 W ND emm4 1 emm emm4 emm emm4 1 emm emm4 emm8 W emm W06 W01 W08 W emm8 emm emm8 emm8 W1 6 1 emm emm8 W emm4 GAS GAS SDSE 8 emm emm 4,6, T N GAS emm 10 GAS GAS GAS GAS GAS GAS GAS PCR GAS 8. GAS,, GAS.. emm4. 4 emm8 emm8 emm emm4 emm6 6 GAS
7 014 Vol. 6No. 1 emm8 80 GAS 11 B 1 1 GAS 14 Seppälä 1 GAS emm GAS emm8 01 IDSA V 0 mgkg mgkg mgkg GAS IDSA GAS PKPD GAS time above ICTA IC 0 TA 114 mgkg 18 1
8 GAS IC 0 kg mg mg mg mg gml AUC 01 IC 0 ghrml gml BRL000Cravuranic acidamoxicillin Jap J Antibiotics mgjap J Antibiotics mg GAS GAS GAS GAS GAS GAS A 1 LucaHarari B, et alclinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin icrobiol , 00 H0101 4Wajima T, et aldistribution of emm type and antibiotic susceptibility of group A streptococci causing invasive and noninvasive disease. J ed icrobiol 18188, 008 orozumi, et alsimultaneous detection of
9 014 Vol. 6No. 1 pathogens in clinical samples from patients with communityacquired pneumonia by realtime PCR with pathogenspecific molecular beacon probes. J Clin icrobiol , 006 6Centers for Disease Control and PreventionCDC S. pyogenes emm sequence databasehttp:www. cdc.govncidodbiotechstrepstrepblast.htm to determine the emm type. Ubukata K, et alin vitro activities of new ketolide, telithromycin, and eight other macrolide antibiotics against Streptococcus pneumoniae having mefa and ermb genes that mediate macrolide resistance. J Infect Chemother 16, 00 8Shimomura Y, et alcomplete genome sequencing and analysis of a Lancefield group G Streptococcus dysgalactiae subsp. equisimilis strain causing streptococcal toxic shock syndromestss. BC genomics 11, 011 Wajima T, et alassociations of macrolide and fluoroquinolone resistance with molecular typing in Streptococcus pyogenes from invasive infections, 001. Int J Antimicrob Agents 44444, 01 Plainvert C, et alinvasive group A streptococcal infections in adults, rance Clin icrobiol Infect 180, 01 11orozumi, et alantibiotic susceptibility in relation to genotype of Streptococcus pneumoniae, Haemophilus influenzae, and ycoplasma pneumoniae responsible for communityacquired pneumonia in children. J Infect Chemother 14440, 01 1orozumi, et alassociations between capsular serotype, multilocus sequence type, and macrolide resistance in Streptococcus agalactiae isolates from Japanese infants with invasive infections. Epidemiol Infect 1818, 01 1Richter SS, et alacrolideresistant Streptococcus pyogenes in the United States, Clin Infect Dis 41608, 00 14Liu X, et alhigh macrolide resistance in Streptococcus pyogenes strains isolated from children with pharyngitis in China. Pediatr Pulmonol , 00 1Seppälä H, et althe effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in inland. innish study group for antimicrobial resistance. N Engl J ed , 1 16Shulman ST, et alclinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis01 update by the infectious diseases society of America. Clin Infectious Dis 118, A A
10 ulticenter analysis of pharyngotonsillitis caused by group A hemolytic streptococcitherapeutic effect of oral lactam antibiotics and features of the agents Takeshi TAJIA 1, Takeaki WAJIA, Satoshi KOYAA 1, Satoshi IWATA, Kimiko UBUKATA, GAS surveillance study group 1 Department of Pediatrics, Hakujikai emorial Hospital Department of icrobiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences Department of Infectious Diseases, Keio University School of edicine In order to clarify the therapeutic effects of oral lactam antibiotics for pharyngotonsillitis caused by group A hemolytic streptococcigasand the epidemiological features of the agents, thegas surveillance study groupwas organized by the active participation of pediatricians at the clinic of this study. Pharyngeal swab samples before and after administration of the therapeutic agent were collected from 44 patients with pharyngotonsillitis between April and October, 01. GAS strains were isolated from a total of 608.of them by combining culture and PCR. olecular emm typing showed that the most frequent type was 6.1, followed by.6, emm816., and emm81.. GAS isolates, as the causative agent, have had significant changes epidemiologically in recent years. No strains with lactam resistance have been identified in contrast to macrolideresistant strains at a high percentage among prevalent emm type strains. Amoxicillin, cefdinir, and cefditoren of the representative oral lactams have been used for all cases as the therapeutic agent. There were no significant differences in clinical efficacy by type of antibiotics and dosing conditionstwice or three times daily. However, the effectiveness of oral cephalosporins was slightly lower with administration twice daily than with administration three times a day. Based on the above findings, surveillance based on molecular epidemiology and antimicrobial susceptibility of GAS is necessary for selecting the best therapeutical agent, in addition to giving further consideration to the dosing conditions during the treatment of pharyngotonsillitis
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