The aim of this study was to investigate the frequency, mechanism, and epidemiological association of FQ non susceptibility in S.pyogenes during 2011 and 2016 from Shanghai, China.

2. Streptococcus pyogenes
 One of the top 10 infectious causes of death worldwide
 More than 517,000 deaths annually
 Known as GAS (group A streptococcus)
 Can cause pharyngitis, impetigo, scarlet fever, necrotizing fasciitis, streptococcal
toxic shock syndrome, acute rheumatic fever and rheumatic heart disease.
 Gram-positive

3. Resistance
 Inherited chromosomal-mediated resistance or by acquired chromosomal- or
extrachromosomal (plasmid)-mediated resistance.
 Has increased because of:
 Microbial characteristics,
 bacterial selection pressure caused by antimicrobial use
 and societal and technologic changes that enhance the transmission
 Types:
 Modifications of the Antibiotic Molecule, Decreased Antibiotic Penetration and
Efflux, Changes in Target Sites, and more.

4. Objective
 The aim of this study was to investigate the frequency, mechanism, and
epidemiological association of FQ non susceptibility in S.pyogenes during 2011
and 2016 from Shanghai, China.

5. Methods
 isolated database
 clinical isolates were collected from Shanghai, between June 2011 to June 2016.
 A total of 2,258 isolates were collected, of which 2,230 were from children ≤15
years
 patients with scarlet fever (n = 1,717), tonsillitis (n = 355), invasive infections (n =
1), or Henoch-Schonlein purpura (n = 1).

6. PFGE
 a pulse field gel electrophoresis is a technique used to make the genetic
characterization of a given population.
 Genetic characterization of the streptococcal strains
 Restriction enzymes are used to generate cuts in the genetic material and it gives
a specific electrophoretic patterns for each of the strains that are being studied
 It was used to examine the genomic relationships of the FQ-resistant population ,
genome fingerprinting of the 30 FQ-non-susceptible isolates was performed

7. PCR
 the objective is the amplification of genes or DNA fragment or by RNA.
 Is based in enzymatic in vitro amplification, by the geometrical increase in the
number of copies.
 In this study it was used to detect genes associated with macrolide resistance
(ermB, ermA, and mef) and tetracycline resistance (tetM and tetO)

8.  Mic
 is lowest concentration of an antimicrobial that will inhibit the visible growth of a
microorganism
 It is used to monitor resistance to antimicrobial agents
 Secuencing for determining the sequence of nucleotides (As, Ts, Cs, and Gs) in a
piece of DNA.

9. Resultados
figura 1. Frecuencia y distribución tipo emm de la no susceptibilidad a
la fluoroquinolona en cepas de S. pyogenes aisladas entre 2011 y 2016
en Shanghai, China.

10. Tabla 1. susceptibilidad antimicrobiana
de cultivos con diferentes tipos emm

11. Figura 2
Patrones de PFGE de 30 cepas de S. pyogenes no fluoradas de
fluoroquinolonas aisladas entre 2011 y 2016 en Shanghai, China

12. Figure
3.
Análisis
filogenético de la
región del parC
determinante de
la resistencia a
la quinolona de
diferentes
especies de
estreptococos

13. Discussion
Author concept Yes or no
Stahlmann et al., 1990
This may in part be attributable to
clinical practice where
administration of fluoroquinolones
is largely restricted to adults due
to cartilage toxicity observed in
children
Laponogov et al., 2007
The most common alterations
occurred in the amino acid site
Ser79, a potential site to bind
FQs
Jing et al., 2006; Chen et al.,
2012; Yang
et al., 2013
Since 2006, very high
frequencies (>90%) of resistance
to macrolide and tetracycline in
GAS isolates have been reported
in mainland China

14. Conclussion
The high consumption of antibiotics and the
bad regulation that is made to them has lead
to resistant strains
The worst thing that can happen in the next
years is the imposiblity to treat the diseases
because of the high proliferation of the multi
drug resistance microorganisms

15. Conceptual map