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Betsy Foxman 2 Articles
Efflux-mediated resistance identified among norfloxacin resistant clinical strains of group B Streptococcus from South Korea
Trang Nguyen Doan Dang, Usha Srinivasan, Zachary Britt, Carl F. Marrs, Lixin Zhang, Moran Ki, Betsy Foxman
Epidemiol Health. 2014;36:e2014022.   Published online October 11, 2014
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  • 115 Download
  • 6 Citations
AbstractAbstract PDF
Group B Streptococcus (GBS), a common bowel commensal, is a major cause of neonatal sepsis and an emerging cause of infection in immune-compromised adult populations. Fluoroquinolones are used to treat GBS infections in those allergic to beta-lactams, but GBS are increasingly resistant to fluoroquinolones. Fluoroquinolone resistance has been previously attributed to quinolone resistance determining regions (QRDRs) mutations. We demonstrate that some of fluoroquinolone resistance is due to efflux-mediated resistance.
We tested 20 GBS strains resistant only to norfloxacin with no mutations in the QRDRs, for the efflux phenotype using norfloxacin and ethidium bromide as substrates in the presence of the efflux inhibitor reserpine. Also tested were 68 GBS strains resistant only to norfloxacin not screened for QRDRs, and 58 GBS strains resistant to ciprofloxacin, levofloxacin or moxifloxacin. Isolates were randomly selected from 221 pregnant women (35-37 weeks of gestation) asymptomatically carrying GBS, and 838 patients with GBS infection identified in South Korea between 2006 and 2008. The VITEK II automatic system (Biomerieux, Durham, NC, USA) was used to determine fluoroquinolone resistance.
The reserpine associated efflux phenotype was found in more than half of GBS strains resistant only to norfloxacin with no QRDR mutations, and half where QRDR mutations were unknown. No evidence of the efflux phenotype was detected in GBS strains that were resistant to moxifloxacin or levofloxacin or both. The reserpine sensitive efflux phenotype resulted in moderate increases in norfloxacin minimum inhibitory concentration (average=3.6 fold, range=>1-16 fold).
A substantial portion of GBS strains resistant to norfloxacin have an efflux phenotype.
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Citations to this article as recorded by  
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    Bryan D. Schindler, Glenn W. Kaatz
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  • Fluoroquinolone Resistance among Clonal Complex 1 Group BStreptococcusStrains
    Alefiya Neemuchwala, Sarah Teatero, Samir N. Patel, Nahuel Fittipaldi
    Canadian Journal of Infectious Diseases and Medical Microbiology.2016; 2016: 1.     CrossRef
  • Molecular Analysis of Rising Fluoroquinolone Resistance in Belgian Non-Invasive Streptococcus pneumoniae Isolates (1995-2014)
    Pieter-Jan Ceyssens, Françoise Van Bambeke, Wesley Mattheus, Sophie Bertrand, Frédéric Fux, Eddie Van Bossuyt, Sabrina Damée, Henry-Jean Nyssen, Stéphane De Craeye, Jan Verhaegen, Paul M. Tulkens, Raymond Vanhoof, Eliane Namie Miyaji
    PLOS ONE.2016; 11(5): e0154816.     CrossRef
Risk Factors for Group B Streptococcus Colonization Among Pregnant Women in Korea
Eun Ju Kim, Kwan Young Oh, Moon Young Kim, Yong Soo Seo, Jung-Hwan Shin, Young Rae Song, Jae-Hyug Yang, Betsy Foxman, Moran Ki
Epidemiol Health. 2011;33:e2011010.   Published online November 11, 2011
  • 13,107 View
  • 122 Download
  • 18 Citations
AbstractAbstract PDF

To identify obstetric and maternal factors related to Group B Streptococcus (GBS) colonization in pregnant women in Korea.


The study was conducted between the years 2006-2008 in four hospitals, Cheil and Eulji hospital in Seoul, and Motae and Eulji hospital in Daejeon. We recruited 2,644 pregnant women between 35 to 37 weeks of gestation who had visited for antenatal care. Participants completed a questionnaire, and urine, vaginal and rectal specimens were obtained and cultured using selective broth media. After delivery, medical records were reviewed.


GBS colonization was significantly associated with hospital, age group, education, frequency of pregnancy, and premature rupture of membranes (PROM, more than 18 hours). After adjustment for other variables, Cheil hospital (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.20-3.52), and the first pregnancy (OR, 2.32; 95% CI, 1.12-4.81) remained significant. History of vaginitis showed marginal significance (OR, 1.50; 95% CI, 0.98-2.29).


To prevent GBS infection of neonates, clinicians should be alert to the potentially higher risk of GBS colonization in pregnant women in their first pregnancy, and women with premature rupture of membranes (PROM) (18 hours+) or who have a history of vaginitis.

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