Macrolide resistance is pervasive in oral streptococci in the Belgian general population: a cross-sectional survey

<b>Background.</b> Commensal streptococci are common inhabitants of the oral microbiome and regulate its structure and function in beneficial ways for human health. They can, however, also be opportunistic pathogens and act as a reservoir of resistance genes that can be passed on to other bacteria, including pathogens. Little is known about the prevalence of these commensals in parents and their children and their antimicrobial susceptibilities in the Belgian general population.<b>Gap Statement.</b> The macrolide susceptibility of commensal oral Streptococci in Belgium is unknown.<b>Methods.</b> We assessed the prevalence and azithromycin susceptibility of commensal streptococcal species in the parents (<i>n</i>=38) and children (<i>n</i>=50) of 35 families in Belgium.<b>Results.</b> The most frequently detected taxonomic grouping was <i>Streptococcus mitis/oralis</i>, which was detected in 78/181 (43.1%) of the children's isolates and 66/128 (51.6%) of the parents' isolates. Of the 311 isolates collected in this study, 282 isolates (90.7%) had an azithromycin MIC value greater than the breakpoint of 0.25 mg l^-1 and 146 isolates (46.9%) had azithromycin MICs greater than 2 mg l^-1. There was no difference in the azithromycin MIC distribution of all streptococcal isolates between children and parents. All individuals were colonized by streptococci with azithromycin MICs greater than 0.25 mg l^-1, and 87.5% of individuals had streptococci with MICs greater than 2 mg l^-1.<b>Interpretation.</b> The most prevalent species identified in both age groups was <i>S. mitis/oralis</i>. All individuals harboured streptococci with macrolide resistance. This highlights the need for additional antimicrobial stewardship initiatives to reduce the consumption of macrolides in the general population.