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Kim L, McGee L, Tomczyk S, Beall B. Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective. Clin Microbiol Rev 2016; 29:525-52. [PMID: 27076637 PMCID: PMC4861989 DOI: 10.1128/cmr.00058-15] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Streptococcus pneumoniae inflicts a huge disease burden as the leading cause of community-acquired pneumonia and meningitis. Soon after mainstream antibiotic usage, multiresistant pneumococcal clones emerged and disseminated worldwide. Resistant clones are generated through adaptation to antibiotic pressures imposed while naturally residing within the human upper respiratory tract. Here, a huge array of related commensal streptococcal strains transfers core genomic and accessory resistance determinants to the highly transformable pneumococcus. β-Lactam resistance is the hallmark of pneumococcal adaptability, requiring multiple independent recombination events that are traceable to nonpneumococcal origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal strains with elevated MICs of β-lactams are most often resistant to additional antibiotics. Basic underlying mechanisms of most pneumococcal resistances have been identified, although new insights that increase our understanding are continually provided. Although all pneumococcal infections can be successfully treated with antibiotics, the available choices are limited for some strains. Invasive pneumococcal disease data compiled during 1998 to 2013 through the population-based Active Bacterial Core surveillance program (U.S. population base of 30,600,000) demonstrate that targeting prevalent capsular serotypes with conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010, respectively) is extremely effective in reducing resistant infections. Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand.
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Affiliation(s)
- Lindsay Kim
- Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara Tomczyk
- Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard Beall
- Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wyres KL, Lambertsen LM, Croucher NJ, McGee L, von Gottberg A, Liñares J, Jacobs MR, Kristinsson KG, Beall BW, Klugman KP, Parkhill J, Hakenbeck R, Bentley SD, Brueggemann AB. The multidrug-resistant PMEN1 pneumococcus is a paradigm for genetic success. Genome Biol 2012; 13:R103. [PMID: 23158461 PMCID: PMC3580495 DOI: 10.1186/gb-2012-13-11-r103] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/16/2012] [Accepted: 11/16/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae, also called the pneumococcus, is a major bacterial pathogen. Since its introduction in the 1940s, penicillin has been the primary treatment for pneumococcal diseases. Penicillin resistance rapidly increased among pneumococci over the past 30 years, and one particular multidrug-resistant clone, PMEN1, became highly prevalent globally. We studied a collection of 426 pneumococci isolated between 1937 and 2007 to better understand the evolution of penicillin resistance within this species. RESULTS We discovered that one of the earliest known penicillin-nonsusceptible pneumococci, recovered in 1967 from Australia, was the likely ancestor of PMEN1, since approximately 95% of coding sequences identified within its genome were highly similar to those of PMEN1. The regions of the PMEN1 genome that differed from the ancestor contained genes associated with antibiotic resistance, transmission and virulence. We also revealed that PMEN1 was uniquely promiscuous with its DNA, donating penicillin-resistance genes and sometimes many other genes associated with antibiotic resistance, virulence and cell adherence to many genotypically diverse pneumococci. In particular, we describe two strains in which up to 10% of the PMEN1 genome was acquired in multiple fragments, some as long as 32 kb, distributed around the recipient genomes. This type of directional genetic promiscuity from a single clone to numerous unrelated clones has, to our knowledge, never before been described. CONCLUSIONS These findings suggest that PMEN1 is a paradigm of genetic success both through its epidemiology and promiscuity. These findings also challenge the existing views about horizontal gene transfer among pneumococci.
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Affiliation(s)
- Kelly L Wyres
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Lotte M Lambertsen
- Department of Microbiology Surveillance and Research, Statens Serum Institut, 5 Artillerivej, DK 2300 Copenhagen S, Denmark
| | - Nicholas J Croucher
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Lesley McGee
- Streptococcus Laboratory, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia, 30333, USA
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, Johannesburg 2131, South Africa
| | - Josefina Liñares
- Department of Microbiology, Bellvitge Hospital-CIBERes-IDIBELL-UB, Feixa Llarga s/n, 08907 Barcelona, Spain
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Karl G Kristinsson
- Clinical Microbiology Department, Landspitali University Hospital and University of Iceland, 101 Reykjavik, Iceland
| | - Bernard W Beall
- Streptococcus Laboratory, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia, 30333, USA
| | - Keith P Klugman
- Hubert Department of Global Health Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Julian Parkhill
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Regine Hakenbeck
- Department of Microbiology, University Kaiserslautern, Paul-Ehrlich-Straße, 67663 Kaiserslautern, Germany
| | - Stephen D Bentley
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Angela B Brueggemann
- Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
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Changing trends in antimicrobial susceptibility of Streptococcus pneumoniae isolates in Taiwan, 2006–2007. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:305-10. [DOI: 10.1016/j.jmii.2011.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/01/2011] [Accepted: 08/22/2011] [Indexed: 11/18/2022]
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Hakenbeck R, Brückner R, Denapaite D, Maurer P. Molecular mechanisms of β-lactam resistance in Streptococcus pneumoniae. Future Microbiol 2012; 7:395-410. [PMID: 22393892 DOI: 10.2217/fmb.12.2] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Alterations in the target enzymes for β-lactam antibiotics, the penicillin-binding proteins (PBPs), have been recognized as a major resistance mechanism in Streptococcus pneumoniae. Mutations in PBPs that confer a reduced affinity to β-lactams have been identified in laboratory mutants and clinical isolates, and document an astounding variability of sites involved in this phenotype. Whereas point mutations are selected in the laboratory, clinical isolates display a mosaic structure of the affected PBP genes, the result of interspecies gene transfer and recombination events. Depending on the selective β-lactam, different combinations of PBP genes and mutations within are involved in conferring resistance, and astoundingly in non-PBP genes as well.
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Affiliation(s)
- Regine Hakenbeck
- Department of Microbiology, University of Kaiserslautern, Paul Ehrlich Strasse 23, D-67663 Kaiserslautern, Germany.
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Zapun A, Contreras-Martel C, Vernet T. Penicillin-binding proteins and beta-lactam resistance. FEMS Microbiol Rev 2008; 32:361-85. [PMID: 18248419 DOI: 10.1111/j.1574-6976.2007.00095.x] [Citation(s) in RCA: 415] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A number of ways and means have evolved to provide resistance to eubacteria challenged by beta-lactams. This review is focused on pathogens that resist by expressing low-affinity targets for these antibiotics, the penicillin-binding proteins (PBPs). Even within this narrow focus, a great variety of strategies have been uncovered such as the acquisition of an additional low-affinity PBP, the overexpression of an endogenous low-affinity PBP, the alteration of endogenous PBPs by point mutations or homologous recombination or a combination of the above.
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Affiliation(s)
- André Zapun
- Laboratoire d'Ingénierie des Macromolécules, Institut de Biologie Structurale Jean-Pierre Ebel, UMR 5075-CNRS, CEA, Université Joseph Fourier, Grenoble, France
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Pletz MWR, Shergill AP, McGee L, Beall B, Whitney CG, Klugman KP. Prevalence of first-step mutants among levofloxacin-susceptible invasive isolates of Streptococcus pneumoniae in the United States. Antimicrob Agents Chemother 2006; 50:1561-3. [PMID: 16569885 PMCID: PMC1426940 DOI: 10.1128/aac.50.4.1561-1563.2006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
By use of a PCR-restriction fragment length polymorphism assay, we screened 496 levofloxacin-susceptible invasive pneumococcal strains (MIC<or=2 mg/liter) for quinolone resistance-determining region mutations known to confer fluoroquinolone resistance. Among those with a levofloxacin MIC of 2 mg/liter, 16.2% of isolates recovered from nursing home residents and 6.4% from non-nursing home residents had first-step mutations.
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Affiliation(s)
- Mathias W R Pletz
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Smith AJ, Jefferies J, Clarke SC, Dowson C, Edwards GFS, Mitchell TJ. Distribution of epidemic antibiotic-resistant pneumococcal clones in Scottish pneumococcal isolates analysed by multilocus sequence typing. Microbiology (Reading) 2006; 152:361-365. [PMID: 16436424 DOI: 10.1099/mic.0.28419-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sequence types of pneumococci isolated in Scotland between 1996 and 2003 were compared with those of globally prevalent antibiotic-resistant clones. Multilocus sequence typing was performed on 252 invasive pneumococcal isolates referred to the Scottish Meningococcus and Pneumococcus Reference Laboratory. Isolates were not preselected for antimicrobial resistance, patient age or disease caused. Sequence types were compared with globally significant antimicrobial-resistant clones identified by the Pneumococcal Molecular Epidemiology Network (PMEN). Sequence types identical with three of the 26 PMEN clones were present in the Scottish collection; the clones were the Spain9V-3 clone (sequence type 156, seven isolates), the England14-9 clone (sequence type 9, eight isolates) and the Utah35B-24 clone (sequence type 377, one isolate). Many Scottish isolates related to PMEN clones had lower antimicrobial MICs than those described for the corresponding PMEN type strain. A number of single- (SLVs) and double-locus variants (DLVs) were present. Fifteen SLVs related to PMEN sequence types 37, 67, 90, 81, 156, 236 and 377 were detected. The collection contained 10 DLVs related to PMEN sequence types 37, 156, 173 and 338. The majority of SLVs and DLVs were penicillin- or erythromycin-sensitive variants of the resistant PMEN type strains. Capsule switching in isolates related to the PMEN clones was also detected. The highest levels of penicillin resistance were detected in sequence type 320 (serotype 19F), which is not a PMEN clone. These data suggest that PMEN clones are not widely distributed in disease-causing isolates in Scotland.
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Affiliation(s)
- A J Smith
- Infection Research Group, Level 9, Glasgow Dental Hospital, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - J Jefferies
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
| | - S C Clarke
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Stobhill Hospital, Glasgow, UK
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
| | - C Dowson
- Department of Biological Sciences, University of Warwick, UK
| | - G F S Edwards
- Scottish Meningococcus and Pneumococcus Reference Laboratory, Stobhill Hospital, Glasgow, UK
| | - T J Mitchell
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, UK
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Ribes S, Taberner F, Domenech A, Cabellos C, Tubau F, Liñares J, Fernández Viladrich P, Gudiol F. Evaluation of ceftriaxone, vancomycin and rifampicin alone and combined in an experimental model of meningitis caused by highly cephalosporin-resistant Streptococcus pneumoniae ATCC 51916. J Antimicrob Chemother 2005; 56:979-82. [PMID: 16174686 DOI: 10.1093/jac/dki323] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of the study was to assess the in vitro and in vivo efficacy of ceftriaxone, vancomycin and rifampicin alone and combined against Streptococcus pneumoniae ATCC 51916 (MIC of ceftriaxone: 32 mg/L). METHODS In vitro killing curves were performed with clinically achievable CSF antibiotic concentrations. In the rabbit model of pneumococcal meningitis, we studied the efficacy of and effects on inflammation of treatment with ceftriaxone 100 mg/kg/day, vancomycin 30 mg/kg/day and rifampicin 15 mg/kg/day, alone and combined, over a 26 h period. RESULTS Time-kill curves showed that vancomycin was bactericidal, and ceftriaxone and rifampicin produced a bacteriostatic effect. An additive effect was observed when combinations of ceftriaxone plus vancomycin were studied at subinhibitory concentrations. Emergence of resistance to rifampicin was detected both when rifampicin was studied alone and when combined with ceftriaxone or vancomycin. In the rabbit meningitis model, ceftriaxone was bacteriostatic, whereas rifampicin and vancomycin were bactericidal at 24 h. Although not synergistic, the combinations of ceftriaxone plus vancomycin or rifampicin, and vancomycin plus rifampicin, improved the efficacy of any antibiotic tested alone--all combinations were bactericidal from 6 h--and significantly decreased inflammatory parameters in CSF compared with control and ceftriaxone groups. CONCLUSION Ceftriaxone plus vancomycin, and vancomycin plus rifampicin appeared to be effective in the therapy of experimental pneumococcal meningitis caused by highly cephalosporin-resistant strains such as ATCC 51916. Our results provide an experimental basis for using these combinations as empirical therapy for pneumococcal meningitis, regardless of the degree of cephalosporin resistance of the causative strain.
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Affiliation(s)
- Sandra Ribes
- Laboratory of Experimental Infection, Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge-Universitat de Barcelona, L'Hospitalet, Barcelona, Spain.
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Gums JG, Epstein BJ. Update on Resistance among Respiratory Tract Pathogens: Results of the Antimicrobial Resistance Management Program. Hosp Pharm 2004. [DOI: 10.1177/001857870403901106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose This update from the Antimicrobial Resistance Management (ARM) Program reports surveillance data for Streptrococcus pneumoniae and Haemophilus influenzae isolates from 1994 to 2002. Methods Antibiograms and sensitivity reports submitted to the ARM program database were reviewed for resistance to commonly prescribed antibiotics Results Nationally S. pneumoniae resistance to penicillin was 37.4% (n = 37,688); to erythromycin, 29.6% (n = 18,774); and to clindamycin, 9.9% (n = 5510). Resistance to cefotaxime was 25.5% (n = 10,527) and 16.8% to ceftriaxone (26,594). For H. influenzae, resistance to cefotaxime was 4.3% (n = 4,927) and to ceftriaxone 1% (n = 10,353), a difference seen largely in the Northeast. Conclusions Resistance to penicillin appears to have reached a plateau above 40%; however, sparing of beta-lactam antibiotics may occur at the expense of other agents (ie, macrolides). Clindamycin remains active against penicillin-resistant S. pneumoniae (PRSP), but use of agents with antianaerobic properties is discouraged. The ARM program suggests important differences between cefotaxime and ceftriaxone.
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Affiliation(s)
- John G. Gums
- Departments of Pharmacy Practice and Community Health and Family Medicine, Colleges of Pharmacy and Medicine; University of Florida, Gainesville, FL
| | - Benjamin J. Epstein
- Internal Medicine Resident, North Florida/South Georgia Veterans Affairs Health System; currently Postdoctoral Fellow, Departments of Pharmacy Practice and Community Health and Family Medicine, Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL
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Pletz MWR, McGee L, Jorgensen J, Beall B, Facklam RR, Whitney CG, Klugman KP. Levofloxacin-resistant invasive Streptococcus pneumoniae in the United States: evidence for clonal spread and the impact of conjugate pneumococcal vaccine. Antimicrob Agents Chemother 2004; 48:3491-7. [PMID: 15328116 PMCID: PMC514755 DOI: 10.1128/aac.48.9.3491-3497.2004] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The emergence of fluoroquinolone resistance in sterile-site isolates of Streptococcus pneumoniae is documented in this study characterizing all invasive levofloxacin-resistant (MIC, > or = 8 mg/liter) S. pneumoniae isolates (n = 50) obtained from the Centers for Disease Control and Prevention Active Bacterial Core Surveillance from 1998 to 2002. Resistance among all isolates increased from 0.1% in 1998 to 0.6% in 2001 (P = 0.008) but decreased to 0.4% in 2002, while resistance among vaccine serotypes continued to increase from 0.3% in 1998 to 1.0% in 2002, suggesting that fluoroquinolones continue to exert selective pressure on these vaccine serotypes. Only 22% of resistant isolates were not covered by the conjugate vaccine serogroups. Multilocus sequence typing revealed that 58% of resistant strains were related to five international clones identified by the Pneumococcal Molecular Epidemiology Network, with the Spain(23F)-1 clone being most frequent (16% of all isolates). Thirty-six percent of the isolates were coresistant to penicillin, 44% were coresistant to macrolides, and 28% were multiresistant to penicillin, macrolides, and fluoroquinolones. Fifty percent of the isolates were resistant to any three drug classes. Ninety-four percent of the isolates had multiple mutations in the quinolone resistance-determining regions of the gyrA, gyrB, parC, and parE genes. In 16% of the isolates, there was evidence of an active efflux mechanism. An unusual isolate was found that showed only a single parE mutation and for which the ciprofloxacin MIC was lower (2 mg/liter) than that of levofloxacin (8 mg/liter). Our results suggest that invasive pneumococcal isolates resistant to levofloxacin in the United States show considerable evidence of multiple resistance and of clonal spread.
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Affiliation(s)
- Mathias W R Pletz
- Department of International Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA.
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Schrag SJ, McGee L, Whitney CG, Beall B, Craig AS, Choate ME, Jorgensen JH, Facklam RR, Klugman KP. Emergence of Streptococcus pneumoniae with very-high-level resistance to penicillin. Antimicrob Agents Chemother 2004; 48:3016-23. [PMID: 15273115 PMCID: PMC478489 DOI: 10.1128/aac.48.8.3016-3023.2004] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Penicillin resistance threatens the treatment of pneumococcal infections. We used sentinel hospital surveillance (1978 to 2001) and population-based surveillance (1995 to 2001) in seven states in the Active Bacterial Core surveillance of the Emerging Infections Program Network to document the emergence in the United States of invasive pneumococcal isolates with very-high-level penicillin resistance (MIC > or = 8 microg/ml). Very-high-level penicillin resistance was first detected in 1995 in multiple pneumococcal serotypes in three regions of the United States. The prevalence increased from 0.56% (14 of 2,507) of isolates in 1995 to 0.87% in 2001 (P = 0.03), with peaks in 1996 and 2000 associated with epidemics in Georgia and Maryland. For a majority of the strains the MICs of amoxicillin (91%), cefuroxime (100%), and cefotaxime (68%), were > or =8 microg/ml and all were resistant to at least one other drug class. Pneumonia (50%) and bacteremia (36%) were the most common clinical presentations. Factors associated with very highly resistant infections included residence in Tennessee, age of <5 or > or =65 years, and resistance to at least three drug classes. Hospitalization and case fatality rates were not higher than those of other pneumococcal infection patients; length of hospital stay was longer, controlling for age. Among the strains from 2000 and 2001, 39% were related to Tennessee(23F)-4 and 35% were related to England(14-)9. After the introduction of the pneumococcal conjugate vaccine, the incidence of highly penicillin resistant infections decreased by 50% among children <5 years of age. The emergence, clonality, and association of very-high-level penicillin resistance with multiple drug resistance requires further monitoring and highlights the need for novel agents active against the pneumococcus.
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Affiliation(s)
- Stephanie J Schrag
- Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Klugman KP. Vaccination: A Novel Approach to Reduce Antibiotic Resistance. Clin Infect Dis 2004; 39:649-51. [PMID: 15356777 DOI: 10.1086/422655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Indexed: 11/03/2022] Open
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Gupta K, Hooton TM. Duration of therapy for urinary tract infection: the long and the short of it. Clin Infect Dis 2004; 39:665-6. [PMID: 15356780 DOI: 10.1086/423004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 05/06/2004] [Indexed: 11/03/2022] Open
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Karlowsky JA, Jones ME, Draghi DC, Sahm DF. Clinical isolates of Streptococcus pneumoniae with different susceptibilities to ceftriaxone and cefotaxime. Antimicrob Agents Chemother 2004; 47:3155-60. [PMID: 14506024 PMCID: PMC201161 DOI: 10.1128/aac.47.10.3155-3160.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ceftriaxone and cefotaxime are extended-spectrum cephalosporins previously demonstrated to possess very similar in vitro activities against Streptococcus pneumoniae. Anecdotal reports of isolates with divergent in vitro susceptibilities to ceftriaxone and cefotaxime have been published. To determine the prevalence of pneumococcal isolates with divergent ceftriaxone and cefotaxime susceptibilities, we tested 1,000 clinical isolates collected by U.S. laboratories in 2001-2002 by broth microdilution and E-test. The percentages of isolates susceptible to ceftriaxone and cefotaxime were significantly different by both broth microdilution (98.6 and 96.6%, respectively; P < 0.05) and E-test (98.3 and 95.8%; P < 0.001). The differences observed were due solely to the activities of the two agents against penicillin-resistant isolates. Twenty-six of 188 penicillin-resistant isolates (13.8%) demonstrated different ceftriaxone and cefotaxime MIC interpretative phenotypes when tested by broth microdilution; 18 isolates were concurrently ceftriaxone susceptible and cefotaxime intermediate, 6 were ceftriaxone intermediate and cefotaxime resistant, and 2 were ceftriaxone susceptible and cefotaxime resistant (1.1% of penicillin-resistant isolates; 0.2% of all isolates tested). Sixteen of the 26 isolates (65%) were from southern U.S. states. The 26 isolates had serogroups and serotypes (6, 9, 14, 19, and 23) commonly associated with penicillin-resistant isolates; SmaI pulsed-field gel electrophoresis identified 18 isolates (69%) dispersed among five subtype groups and 8 isolates that were unrelated to any of the other isolates. We conclude that certain isolates of penicillin-resistant pneumococci are less susceptible to cefotaxime than to ceftriaxone and that these isolates are not the result of the spread of a single clone. Whether such isolates have increased in prevalence over time remains unknown.
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Castanheira M, Jones RN, Silbert S, Brandileone MCC, Sader HS. Typing and Molecular Characterization ofStreptococcus pneumoniaewith Reduced Susceptibility to Cefotaxime Isolated in Latin America. Microb Drug Resist 2003; 9:345-51. [PMID: 15000740 DOI: 10.1089/107662903322762770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The treatment of systemic infections, especially meningitis, caused by Streptococcus pneumoniae nonsusceptible to third-generation cephalosporins, is extremely difficult due to the paucity of therapeutic options. The main objective of this study was to characterize isolates of S. pneumoniae with reduced susceptibility to cefotaxime (MICs, > or = 1 microg/ml) by different typing methods and to evaluate whether clonal dissemination of this pathogen had occurred among Latin American medical centers. A total of 46 isolates collected from respiratory tract specimens, blood cultures, cerebrospinal fluid, eye, and other sources were analyzed. The isolates were collected from Latin American medical centers located in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay through two multicenter surveillance programs, in 1997 and 1998. Isolates were serotyped and molecular typed by pulsed-field gel electrophoresis (PFGE) and automated ribotyping. Antimicrobial susceptibilities were determined to 19 drugs by reference broth microdilution methods. Ten isolates (21.7%) had cefotaxime MICs > or = 2 microg/ml, whereas 36 (78.3%) had cefotaxime MIC results at 1 microg/ml. All isolates were susceptible to gatifloxacin, levofloxacin, and vancomycin. The isolates were distributed among five major serotypes (%): 23F (39.1%), 14 (32.6%), 19F (23.9%), 9V (2.2%), and 6B (2.2%). However, distinct molecular patterns were detected among isolates with a unique serotype. Six and four PFGE patterns were identified among isolates with serotype 23F and 19F, respectively. When PFGE and automated ribotyping analyses were combined, four clusters were identified. The largest cluster (10 isolates) was represented by isolates with ribotype 18-2, major PFGE pattern I, and serotype 14. ATCC 700671 (international clone Spain 9V-3) also showed ribotype 18-2. This clone was detected in four countries: Argentina, Brazil, Chile, and Uruguay. A second cluster (8 isolates) were characterized by isolates with ribotype 17-4, PFGE type D, and serotype 23F, similar to ATCC 700669 (international clone Spain23F-1). Isolates from this cluster were identified in three countries: Brazil, Chile, and Mexico. Our results indicated that clonal dissemination of S. pneumoniae with reduced susceptibility to cefotaxime has occurred in Latin America mainly among serogroups 14, 19F, and 23F.
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Affiliation(s)
- Mariana Castanheira
- Laboratório Especial de Microbiologia Clínica, Disciplina de Doenças Infecciosas e Parasitárias, Universidade Federal de São Paulo, Brazil
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Gertz RE, McEllistrem MC, Boxrud DJ, Li Z, Sakota V, Thompson TA, Facklam RR, Besser JM, Harrison LH, Whitney CG, Beall B. Clonal distribution of invasive pneumococcal isolates from children and selected adults in the United States prior to 7-valent conjugate vaccine introduction. J Clin Microbiol 2003; 41:4194-216. [PMID: 12958247 PMCID: PMC193785 DOI: 10.1128/jcm.41.9.4194-4216.2003] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Theseven-valent pneumococcal conjugated polysaccharide vaccine PC7V was licensed for use among children in 2000. Since 90 serotypes of pneumococci exist, an increase in nonvaccine serotypes could occur through immune selection for capsular type switching. Eleven hundred sixty-eight invasive isolates (24 serotypes), recovered primarily from pediatric patients (855 isolates = 73%) and 22 reference strains of known multilocus sequence types (STs) were subjected to macrorestriction profiling (pulsed-field gel electrophoresis [PFGE]). The correlation of 187 ST results (including 49 newly discovered STs) with the PFGE data assigned 1,042 (89.2%) study isolates to 46 defined clonal complexes or genetic lineages based on related multilocus STs (BURST). Seventeen clonal complexes were represented by 2 to 10 related allelic profiles (STs), while 33 lineages (including reference strains) consisted of single STs with 4 or fewer allelic identities to other STs found in the study. Expansion of the BURST analysis to a global analysis of all known pneumococcal STs (as of 27 November 2002) reduced the number of single ST lineages from 33 to 8, and the number of multi-ST clonal complexes was reduced from 17 to 13. In this work, we established the basic genetic structure within individual serotypes prior to PC7V use. The resultant database will be useful for detecting potential selective effects of this vaccine in postvaccine surveillance.
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Affiliation(s)
- Robert E Gertz
- Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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17
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Zhao GM, Black S, Shinefield H, Wang CQ, Zhang YH, Lin YZ, Lu JL, Guo YF, Jiang QW. Serotype distribution and antimicrobial resistance patterns in Streptococcus pneumoniae isolates from hospitalized pediatric patients with respiratory infections in Shanghai, China. Pediatr Infect Dis J 2003; 22:739-42. [PMID: 12913778 DOI: 10.1097/01.inf.0000078373.54515.40] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surveillance for pneumococcal respiratory illness was conducted in children hospitalized at Affiliated Pediatric Hospital of Fudan University in Shanghai from August 2000 to August 2001. METHODS Sputum cultures were obtained from pediatric patients admitted with pneumonia or respiratory distress by tracheal aspirate. Blood cultures were also performed on a subset of patients. All pneumococcal isolates were serotyped and tested for antibiotic susceptibility. In addition clinical information on the patients including prior antibiotic history was abstracted. Streptococcus pneumoniae tracheal isolations were attempted in a total of 1013 pediatric patients hospitalized during this period. Among these samples 112 specimens were S. pneumoniae-positive. These positive isolates underwent serotyping and antibiotic susceptibility testing. RESULTS Five serotypes (19F, 23F, 6A, 14, 6B) of S. pneumonia accounted for 81% (91 of 112 cases). Other serotypes accounted only for 12% (13 of 112 cases), and 7% (8 of 112 cases) of isolates could not be typed by quelling test. Only one blood culture isolate was positive, probably reflecting the frequent use of antibiotic treatment before hospitalization. Fifty-one and 8.0% of isolates had intermediate and high level penicillin resistance, respectively. Fifty-eight percent were resistant to ampicillin, 6.6% to cefazolin, 25.0% to cefaclor, 6.6% to ceftriaxone, 85.7% to erythromycin, 66.7% to clindamycin and 28.2% to chloramphenicol. Among 66 isolates that were not susceptible to penicillin, serotype 19F was the most common, followed by 23F and 14. CONCLUSION S. pneumoniae is a common cause of respiratory illness requiring hospitalization in young children in Shanghai, with antibiotic resistance increasingly common. Five serotypes account for most disease.
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Affiliation(s)
- Gen-Ming Zhao
- School of Public Health, Fudan University, Shanghai, China 200032.
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18
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Johnson CN, Benjamin Jr WH, Moser SA, Hollingshead SK, Zheng X, Crain MJ, Nahm MH, Waites KB. Genetic relatedness of levofloxacin-nonsusceptible Streptococcus pneumoniae isolates from North America. J Clin Microbiol 2003; 41:2458-64. [PMID: 12791865 PMCID: PMC156496 DOI: 10.1128/jcm.41.6.2458-2464.2003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We characterized 32 levofloxacin-nonsusceptible Streptococcus pneumoniae (LNSP) isolates obtained from a broad geographic region of North America over a 5-year period by using capsular serotypes, antimicrobial susceptibility profiles, BOX-PCR, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). Sixteen international clones identified by the Pneumococcal Molecular Epidemiology Network also were included for comparison. Fifteen serotypes were represented, with serogroups 6, 9, 14, 19, and 23 accounting for 63% of isolates. Among isolates whose quinolone resistance-determining regions were sequenced, all contained gyrA and parC point mutations. Sixty-three percent were penicillin susceptible, and 84% were erythromycin susceptible. BOX-PCR analysis identified 39 different band patterns among 32 LNSP and 16 international clones and grouped 16 isolates, including 2 international clones, into seven unrelated groups of 2 to 4 isolates each. PFGE analysis identified 35 different band patterns among 32 LNSP and 16 international clones and grouped 21 isolates, including 3 international clones, into eight unrelated groups of 2 to 6 isolates each. MLST performed on 10 isolates identified five allelic profiles and separated 9 isolates into four groups of 2 to 3 isolates each. Overall, each typing method indicated that the LNSP were heterogeneous and that resistance to fluoroquinolones was not closely associated with a particular serotype or with coresistance to other antimicrobial classes and suggests that LNSP have likely arisen through independent mutational events as a result of selective pressure. However, seven LNSP were found to be related to three international clones by PFGE.
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Affiliation(s)
- Crystal N Johnson
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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19
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Butler JC, Lennox JL, McDougal LK, Sutcliffe JA, Tait-Kamradt A, Tenover FC. Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy. Clin Infect Dis 2003; 36:e19-25. [PMID: 12522763 DOI: 10.1086/344965] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 09/12/2002] [Indexed: 11/04/2022] Open
Abstract
Suppurative complications of Streptococcus pneumoniae infections have become uncommon in the antibiotic era. We report a case of pneumococcal bacteremia and pneumonia complicated with epidural abscess and endocarditis in which macrolide resistance (the MLS(B) phenotype) emerged during erythromycin therapy. Genetic determinants known to mediate the most common mechanisms of macrolide resistance (methylation of the 23S rRNA and antibiotic efflux) were not detected by polymerase chain reaction or DNA hybridization. Sequence analysis of the DNA encoding the 23S rRNA of the macrolide-resistant isolate from the patient demonstrated the replacement of adenine by thymine at position 2058 (A2058T) in 2 of 4 alleles. Clinicians should be alert to the possibility of the emergence of resistance during macrolide therapy for community-acquired pneumonia, particularly if suppurative complications of pneumococcal infection are suspected.
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Affiliation(s)
- Jay C Butler
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA.
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20
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Ribes S, Doménech A, Cabellos C, Tubau F, Liñares J, Viladrich PF, Gudiol F. Meningitis experimental producida por una cepa de Streptococcus pneumoniae serotipo 23F con elevada resistencia a cefalosporinas. Enferm Infecc Microbiol Clin 2003; 21:329-33. [PMID: 14525687 DOI: 10.1016/s0213-005x(03)72958-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The increasing prevalence of high-level cephalosporin-resistant strains of Streptococcus pneumoniae could complicate the treatment of severe infections such as meningitis. There are still questions as to the characteristics of these strains, their ability to produce severe infection, and the inflammatory response they induce in CSF. METHODS Using a rabbit model of meningitis, we sought to determine the pathogenicity and differences in inflammatory parameters in two serotype 23F S. pneumoniae strains with different susceptibility to betalactams. Minimal inhibitory concentrations of the two strains were as follows: strain A--PEN 4 micro g/mL, CRO/CTX 2 micro g/mL--and strain B--PEN 0.12 micro g/mL, CRO/CTX 32 micro g/mL. RESULTS Strain A resulted in a greater incidence of secondary bacteremia and higher inflammatory parameters during the early phases of infection. Strain B caused brain edema, a more severe inflammatory response and significantly higher mortality at the end of the experiment. CONCLUSIONS Both strains induced meningitis in the animal model. The differences in inflammatory response produced by the two strains could be related to the variations that determine the betalactam resistance level.
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Affiliation(s)
- Sandra Ribes
- Laboratorio de Infección Experimental. Hospital Universitario de Bellvitge. Hospitalet de Llobregat. Barcelona. España
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21
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Richter SS, Heilmann KP, Coffman SL, Huynh HK, Brueggemann AB, Pfaller MA, Doern GV. The molecular epidemiology of penicillin-resistant Streptococcus pneumoniae in the United States, 1994-2000. Clin Infect Dis 2002; 34:330-9. [PMID: 11774080 DOI: 10.1086/338065] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2001] [Revised: 08/18/2001] [Indexed: 11/03/2022] Open
Abstract
The genetic relatedness of 672 penicillin-resistant isolates of Streptococcus pneumoniae (PRSP) recovered during national surveillance studies conducted in the United States during the periods of 1994-1995, 1997-1998, and 1999-2000 was determined by use of pulsed-field gel electrophoresis (PFGE). Overall, 104 different PFGE types were elucidated. For all study periods combined, the 12 most prevalent PFGE types included >75% of all isolates, and 5 types were closely related to widespread clones (Spain(23F)-1, France(9V)-3, Spain(6B)-2, Tennessee(23F)-4, and Taiwan(19F)-14). From 1994-1995 to 1999-2000, 3 major PFGE types (not closely related to 16 recognized clones) increased in prevalence. Multidrug resistance was identified among 96%-100% of the isolates in 9 of 12 predominant PFGE types. The prevalence of erythromycin resistance increased within 4 major PFGE types. These observations support the hypothesis that the dominant factor in the emergence of PRSP in the United States during the 1990s has been human-to-human spread of relatively few clonal groups that harbor resistance determinants to multiple classes of antibiotics.
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Affiliation(s)
- S S Richter
- Medical Microbiology Division, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
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22
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Quale JM, Landman D, Flores C, Ravishankar J. Comparison of automated ribotyping to pulsed-field gel electrophoresis for genetic fingerprinting of Streptococcus pneumoniae. J Clin Microbiol 2001; 39:4175-7. [PMID: 11682553 PMCID: PMC88510 DOI: 10.1128/jcm.39.11.4175-4177.2001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fifty-two isolates of Streptococcus pneumoniae were characterized by pulsed-field gel electrophoresis (PFGE) and automated ribotyping by using HindIII and PvuII. HindIII ribotypes correlated well with PFGE. PvuII produced fewer bands and was less discriminatory. Automated ribotyping with HindIII is an accurate method for genetic fingerprinting of S. pneumoniae and can complement PFGE.
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Affiliation(s)
- J M Quale
- Division of Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA
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23
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McGee L, McDougal L, Zhou J, Spratt BG, Tenover FC, George R, Hakenbeck R, Hryniewicz W, Lefévre JC, Tomasz A, Klugman KP. Nomenclature of major antimicrobial-resistant clones of Streptococcus pneumoniae defined by the pneumococcal molecular epidemiology network. J Clin Microbiol 2001; 39:2565-71. [PMID: 11427569 PMCID: PMC88185 DOI: 10.1128/jcm.39.7.2565-2571.2001] [Citation(s) in RCA: 381] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2001] [Accepted: 04/22/2001] [Indexed: 11/20/2022] Open
Abstract
The emergence of disease caused by penicillin-resistant and multidrug-resistant pneumococci has become a global concern, necessitating the identification of the epidemiological spread of such strains. The Pneumococcal Molecular Epidemiology Network was established in 1997 under the auspices of the International Union of Microbiological Societies with the aim of characterizing, standardizing, naming, and classifying antimicrobial agent-resistant pneumococcal clones. Here we describe the nomenclature for 16 pneumococcal clones that have contributed to the increase in antimicrobial resistance worldwide. Guidelines for the recognition of these clones using molecular typing procedures (pulsed-field gel electrophoresis, BOX-PCR, and multilocus sequence typing) are presented, as are the penicillin-binding profiles and macrolide resistance determinants for the 16 clones. This network can serve as a prototype for the collaboration of scientists in identifying clones of important human pathogens and as a model for the development of other networks.
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Affiliation(s)
- L McGee
- MRC/SAIMR/WITS Pneumococcal Diseases Research Unit, Johannesburg, South Africa.
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24
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Chiou CC, McEllistrem MC. Novel penicillin-, cephalosporin-, and macrolide-resistant clones of Streptococcus pneumoniae serotypes 23F and 19F in Taiwan which differ from international epidemic clones. J Clin Microbiol 2001; 39:1144-7. [PMID: 11230444 PMCID: PMC87890 DOI: 10.1128/jcm.39.3.1144-1147.2001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A cluster (14 of 18) of Streptococcus pneumoniae serotype 23F isolates that were resistant to penicillin (PEN), cephalosporin, and macrolide was found in one day care center in Kaohsiung, Taiwan. We analyzed the 18 isolates by pulsed field gel electrophoresis (PFGE). All but one serotype 23F isolate demonstrated identical PFGE patterns, which were different from the established pattern of the internationally spread Spanish 23F clone. The three strains of serotype 19F also showed a uniform pattern. These data strongly suggest that two novel clones of PEN-, cephalosporin-, and macrolide-resistant S. pneumoniae serotypes 23F and 19F are present in Taiwan.
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Affiliation(s)
- C C Chiou
- Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang Ming University Kaohsiung, Taipei, Taiwan.
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25
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Mirelis B, Sánchez F, Pericas R, Miró E, Roig C, Coll P, Prats G. Sensibilidad del neumococo a los antimicrobianos. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s1576-9887(01)70228-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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McEllistrem MC, Pass M, Elliott JA, Whitney CG, Harrison LH. Clonal groups of penicillin-nonsusceptible Streptococcus pneumoniae in Baltimore, Maryland: a population-based, molecular epidemiologic study. J Clin Microbiol 2000; 38:4367-72. [PMID: 11101566 PMCID: PMC87607 DOI: 10.1128/jcm.38.12.4367-4372.2000] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Few data are available on the molecular subtypes of all penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) from a defined population base. Pulsed-field gel electrophoresis (PFGE), serotyping, and antibiotic susceptibility testing were performed for all available invasive PNSP isolates for which the penicillin (MIC) was > or =0.1 microg/ml from Baltimore, Md., during 1995-1996 (n = 143). The dendrogram analysis of PFGE patterns included 32 distinct clonal groups. Six major clonal groups included two-thirds of the PNSP strains. Major clonal groups 2, 3, 4, and 6 strains were genetically related to four previously described international clones and were all multidrug resistant. Major clonal group 3 was genetically related to the Tennessee(23F)-4 clone and contained all four strains for which the penicillin MIC was 8 microg/ml. Most of the clonal group 1 and 5 strains had intermediate susceptibility to penicillin and were rarely multidrug resistant. The latter clonal groups represent two previously undescribed penicillin-intermediate pneumococcal clones. Clonal group homogeneity was greater for serotype 9V, 19A, and 23F strains than for serotype 6A, 6B, 14, and 19F strains. The classification of PNSP strains into clonal groups is essential for future population-based epidemiologic studies of PNSP.
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Affiliation(s)
- M C McEllistrem
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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27
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Charpentier E, Tuomanen E. Mechanisms of antibiotic resistance and tolerance in Streptococcus pneumoniae. Microbes Infect 2000; 2:1855-64. [PMID: 11165930 DOI: 10.1016/s1286-4579(00)01345-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Streptococcus pneumoniae is a major pathogen causing potentially life-threatening community-acquired diseases in both the developed and developing world. Since 1967, there has been a dramatic increase in the incidence of penicillin-resistant and multiply antibiotic-resistant pneumococci worldwide. Prevention of access of the antibiotic to the target, inactivation of the antibiotic and alteration of the target are mechanisms that S. pneumoniae has developed to resist antibiotics. Recent studies on antibiotic-tolerant pneumococcal mutants permitted development of a novel model for the control of bacterial cell death.
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Affiliation(s)
- E Charpentier
- Department of Molecular Pathogenesis, Skirball Institute of Biomolecular Medicine, New York, NY 10016, USA
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28
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Chenoweth CE, Saint S, Martinez F, Lynch JP, Fendrick AM. Antimicrobial resistance in Streptococcus pneumoniae: implications for patients with community-acquired pneumonia. Mayo Clin Proc 2000; 75:1161-8. [PMID: 11075746 DOI: 10.4065/75.11.1161] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia. During the past decade, the prevalence of penicillin resistance in S pneumoniae has increased dramatically, with resistance rates approaching 45% in some areas of the United States. Streptococcus pneumoniae has also acquired resistance to other commonly used antimicrobials, including cephalosporins, macrolides, and trimethoprim-sulfamethoxazole. While vancomycin and the newer quinolones are currently highly active against most strains of S pneumoniae, reduced susceptibilities to these agents have been identified in some strains. Prior use of antimicrobial agents is the major risk factor for colonization and infection with antibiotic-resistant strains. beta-Lactam antibiotics remain the treatment of choice for infections caused by susceptible S pneumoniae. The optimum therapy for penicillin-resistant strains remains unclear. Appropriate empirical therapy for patients with community-acquired pneumonia depends in part on the community-specific resistance patterns of S pneumoniae to various antibiotics. In this article, we provide an overview of the development of S pneumoniae resistance to commonly used antibiotics and discuss the implications of the development of resistance on treatment decisions.
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Affiliation(s)
- C E Chenoweth
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor 48109-0378, USA.
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29
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Jorgensen JH, Weigel LM, Swenson JM, Whitney CG, Ferraro MJ, Tenover FC. Activities of clinafloxacin, gatifloxacin, gemifloxacin, and trovafloxacin against recent clinical isolates of levofloxacin-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother 2000; 44:2962-8. [PMID: 11036007 PMCID: PMC101587 DOI: 10.1128/aac.44.11.2962-2968.2000] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The activities of two investigational fluoroquinolones and three fluoroquinolones that are currently marketed were determined for 182 clinical isolates of Streptococcus pneumoniae. The collection included 57 pneumococcal isolates resistant to levofloxacin (MIC >/= 8 microg/ml) recovered from patients in North America and Europe. All isolates were tested with clinafloxacin, gatifloxacin, gemifloxacin, levofloxacin, and trovafloxacin by the National Committee for Clinical Laboratory Standards broth microdilution and disk diffusion susceptibility test methods. Gemifloxacin demonstrated the greatest activity on a per gram basis, followed by clinafloxacin, trovafloxacin, gatifloxacin, and levofloxacin. Scatterplots of the MICs and disk diffusion zone sizes revealed a well-defined separation of levofloxacin-resistant and -susceptible strains when the isolates were tested against clinafloxacin and gatifloxacin. DNA sequence analyses of the quinolone resistance-determining regions of gyrA, gyrB, parC, and parE from 21 of the levofloxacin-resistant strains identified eight different patterns of amino acid changes. Mutations among the four loci had the least effect on the MICs of gemifloxacin and clinafloxacin, while the MICs of gatifloxacin and trovafloxacin increased by up to six doubling dilutions. These data indicate that the newer fluoroquinolones have greater activities than levofloxacin against pneumococci with mutations in the DNA gyrase or topoisomerase IV genes. Depending upon pharmacokinetics and safety, the greater potency of these agents could provide improved clinical efficacy against levofloxacin-resistant pneumococcal strains.
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Affiliation(s)
- J H Jorgensen
- Department of Pathology, The University of Texas Health Science Center, San Antonio, Texas 78229, USA. jorgensen2uthscsa.edu
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30
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Beall B, Gherardi G, Facklam RR, Hollingshead SK. Pneumococcal pspA sequence types of prevalent multiresistant pneumococcal strains in the United States and of internationally disseminated clones. J Clin Microbiol 2000; 38:3663-9. [PMID: 11015380 PMCID: PMC87453 DOI: 10.1128/jcm.38.10.3663-3669.2000] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2000] [Accepted: 08/01/2000] [Indexed: 11/20/2022] Open
Abstract
In a recent genotypic survey of beta-lactam-resistant pneumococci recovered in different areas of United States during 1997, eight clonal types that each represented 3 to 40 isolates accounted for 134 of 144 isolates (G. Gherardi, C. Whitney, R. Facklam, and B. Beall, J. Infect. Dis. 181:216-229, 2000). We determined the degree of pspA gene diversity among these 134 isolates and for 11 previously characterized internationally disseminated multiresistant strains. Thirty-four different pspA restriction profiles were determined for an amplicon encompassing the variable portion of the structural gene that encodes the surface-exposed domain of PspA and a variable-length proline-rich putative cell wall-associated domain. These restriction profiles closely correlated with those of 33 different pspA sequence types of an approximately 230-residue region corresponding to residues 182 to 410 of the strain Rx1 PspA. These residues encompass a 100-residue clade-defining region known to contain cross-protective epitopes for which 17 sequence types were found. Distinct, conserved pspA sequence types were found for the majority of strains within seven of the eight U.S. clonal types assessed, while one pulsed-field gel electrophoresis type was represented by isolates of three distinct PspA clades. Sequence typing of pspA provides an added level of specificity in the subtyping of isolates and is a necessary first step in determining the components needed in a PspA vaccine which could elicit effective cross-protective coverage.
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Affiliation(s)
- B Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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31
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Jorgensen JH, Barry AL, Traczewski MM, Sahm DF, McElmeel ML, Crawford SA. Rapid automated antimicrobial susceptibility testing of Streptococcus pneumoniae by use of the bioMerieux VITEK 2. J Clin Microbiol 2000; 38:2814-8. [PMID: 10921932 PMCID: PMC87118 DOI: 10.1128/jcm.38.8.2814-2818.2000] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The VITEK 2 is a new automated instrument for rapid organism identification and susceptibility testing. It has the capability of performing rapid susceptibility testing of Streptococcus pneumoniae with specially configured cards that contain enriched growth medium and antimicrobial agents relevant for this organism. The present study compared the results of testing of a group of 53 challenge strains of pneumococci with known resistance properties and a collection of clinical isolates examined in two study phases with a total of 402 and 416 isolates, respectively, with a prototype of the VITEK 2. Testing was conducted in three geographically separate laboratories; the challenge collection was tested by all three laboratories, and the unique clinical isolates were tested separately by the individual laboratories. The VITEK 2 results of tests with 10 antimicrobial agents were compared to the results generated by the National Committee for Clinical Laboratory Standards reference broth microdilution MIC test method. Excellent interlaboratory agreement was observed with the challenge strains. The overall agreement within a single twofold dilution of MICs defined by the VITEK 2 and reference method with the clinical isolates was 96.3%, although there were a number of off-scale MICs that could not be compared. The best agreement with the clinical isolates was achieved with ofloxacin and chloramphenicol (100%), and the lowest level of agreement among those drugs with sufficient on-scale MICs occurred with trimethoprim-sulfamethoxazole (89.7%). Overall there were 1.3% very major, 6.6% minor, and no major interpretive category errors encountered with the clinical isolates, although >80% of the minor interpretive errors involved only a single log(2) dilution difference. The mean time for generation of susceptibility results with the clinical isolates was 8.1 h. The VITEK 2 provided rapid, reliable susceptibility category determinations with both the challenge and clinical isolates examined in this study.
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Affiliation(s)
- J H Jorgensen
- Department of Pathology, The University of Texas Health Science Center, San Antonio, Texas 78284, USA.
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Abstract
The emergence of novel infectious diseases, and the re-emergence of others, is not new. The global ecosystem is constantly changing, influencing the micro- and macroenvironments in which humans and their microbial companions reside and interact. Sometimes the environmental circumstances favour the pathogen and there is an unexpected increase in disease activity or emergence of a new infection. Alternatively, pathogenicity factors are acquired by the microbe, allowing new diseases to emerge or old diseases to increase in importance. The forces that drive the emergence, submergence and re-emergence of infectious diseases are varied, but the influence that humans have on the global ecosystem is often of central importance. This review considers infections that are of particular emerging importance.
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Affiliation(s)
- Andrew J. Pollard
- Division of Infectious and Immunological Diseases, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
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Vergnaud M, Prévost JN, Malbruny B, Brun J, Leclercq R. Isolation in France of a clinical strain of Streptoccus pneumoniae susceptible to amoxycillin and resistant to cefotaxime. Clin Microbiol Infect 2000; 6:283-4. [PMID: 11168130 DOI: 10.1046/j.1469-0691.2000.00077.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hakenbeck R, Kaminski K, König A, van der Linden M, Paik J, Reichmann P, Zähner D. Penicillin-binding proteins in beta-lactam-resistant streptococcus pneumoniae. Microb Drug Resist 2000; 5:91-9. [PMID: 10432270 DOI: 10.1089/mdr.1999.5.91] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Hakenbeck
- Department of Microbiology, University of Kaiserslautern, Germany.
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35
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Hori R, Araki H, Yonezawa M, Minami S, Watanabe Y. Therapeutic effects of parenteral beta-lactam antibiotics on experimental otitis media caused by penicillin-resistant Streptococcus pneumoniae in guinea-pigs. J Antimicrob Chemother 2000; 45:311-4. [PMID: 10702549 DOI: 10.1093/jac/45.3.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The therapeutic effects of parenteral beta-lactam antibiotics were evaluated in experimental acute otitis media caused by penicillin-resistant Streptococcus pneumoniae (PRSP) in guinea-pigs. Cefotaxime, ceftriaxone and piperacillin significantly reduced viable cell counts of PRSP in the middle ear at a dose of 50 mg/kg bd for 3 days (P < 0.01 compared with control). The therapeutic effects of cefotaxime, ceftriaxone and piperacillin were superior to those of cefotiam and ceftazidime. These therapeutic effects reflected both in vitro activity and pharmacokinetic properties of the drugs.
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Affiliation(s)
- R Hori
- Research Laboratories, Toyama Chemical Co. Ltd, 2-4-1 Shimookui, Toyama City, Toyama 930-8508, Japan
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36
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Gherardi G, Inostrozo JS, O'Ryan M, Prado V, Prieto S, Arellano C, Facklam RR, Beall B. Genotypic survey of recent beta-lactam-resistant pneumococcal nasopharyngeal isolates from asymptomatic children in Chile. J Clin Microbiol 1999; 37:3725-30. [PMID: 10523585 PMCID: PMC85740 DOI: 10.1128/jcm.37.11.3725-3730.1999] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To assess pneumococcal strain variability among young asymptomatic carriers in Chile, we used serotyping, antibiotic susceptibility testing, and genotyping to analyze 68 multidrug-resistant pneumococcal isolates recovered from 54 asymptomatic children 6 to 48 months of age. The isolates represented capsular serotypes 19F (43 isolates), 14 (14 isolates), 23F (7 isolates), 6B (3 isolates), and 6A (1 isolate). Genotypic analysis, which included pulsed-field gel electrophoresis (PFGE) of chromosomal digests, penicillin binding protein (PBP) gene fingerprinting, and dhf gene fingerprinting, revealed that the isolates represented six different genetic lineages. Clear circumstantial evidence of capsular switching was seen within each of four of the genetically related sets. The majority of the isolates, consisting of the 43 19F isolates and 2 type 6B isolates, appeared to represent a genetically highly related set distinct from previously characterized pneumococcal strains. Each of three other genetically defined lineages was closely related to one of the previously characterized clones Spain(6B)-2, France(9V)-3, or Spain(23F)-1. A fifth lineage was comprised of four type 23F isolates that, by the techniques used for this study, were genetically indistinguishable from three recent type 19F sterile-site isolates from the United States. Finally, a sixth lineage was represented by a single type 23F isolate which had a unique PFGE type and unique PBP and dhf gene fingerprints.
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Affiliation(s)
- G Gherardi
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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37
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Fitoussi F, Doit C, Geslin P, Bingen E. Killing activities of trovafloxacin alone and in combination with beta-lactam agents, rifampin, or vancomycin against Streptococcus pneumoniae isolates with various susceptibilities to extended-spectrum cephalosporins at concentrations clinically achievable in cerebrospinal fluid. Antimicrob Agents Chemother 1999; 43:2372-5. [PMID: 10508009 PMCID: PMC89485 DOI: 10.1128/aac.43.10.2372] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The killing activities of trovafloxacin alone and in combination with beta-lactam agents (extended-spectrum cephalosporins, meropenem), rifampin, or vancomycin were evaluated against 20 genotypically characterized Streptococcus pneumoniae isolates for which amoxicillin MICs were >/=4 microg/ml (cefotaxime MICs, >/=4 microg/ml for six strains) at concentrations clinically achievable in cerebrospinal fluid. At 6 h the mean killing activity of trovafloxacin alone (range, 2.6 to 2.9 log(10) CFU/ml) did not vary significantly according to the susceptibility of the strains to beta-lactam agents. The activities of trovafloxacin or vancomycin added to the beta-lactam agents and the combination trovafloxacin-vancomycin were additive or indifferent. Against the ceftriaxone-resistant isolates, the killing activity of the combination of a beta-lactam agent and trovafloxacin did not differ significantly from that of a beta-lactam agent and vancomycin.
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Affiliation(s)
- F Fitoussi
- Service de Microbiologie, Hôpital Robert Debré, 75019 Paris, France
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38
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Doit C, Loukil C, Fitoussi F, Geslin P, Bingen E. Emergence in france of multiple clones of clinical Streptococcus pneumoniae isolates with high-level resistance to amoxicillin. Antimicrob Agents Chemother 1999; 43:1480-3. [PMID: 10348775 PMCID: PMC89301 DOI: 10.1128/aac.43.6.1480] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genetic relatedness of French isolates of Streptococcus pneumoniae highly resistant to amoxicillin (MIC, >/=4 microg/ml, equal to or exceeding those of penicillin) was investigated by molecular fingerprinting. The results suggest that high-level resistance to amoxicillin has emerged within preexisting penicillin-resistant clones.
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Affiliation(s)
- C Doit
- Laboratoire de Microbiologie, Hôpital Robert Debré, 75019 Paris, France
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39
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Hsueh PR, Teng LJ, Lee LN, Yang PC, Ho SW, Luh KT. Extremely high incidence of macrolide and trimethoprim-sulfamethoxazole resistance among clinical isolates of Streptococcus pneumoniae in Taiwan. J Clin Microbiol 1999; 37:897-901. [PMID: 10074498 PMCID: PMC88621 DOI: 10.1128/jcm.37.4.897-901.1999] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/1998] [Accepted: 12/21/1998] [Indexed: 11/20/2022] Open
Abstract
From January 1996 to December 1997, 200 isolates of Streptococcus pneumoniae recovered from 200 patients treated at National Taiwan University Hospital were serotyped and their susceptibilities to 16 antimicrobial agents were determined by the agar dilution method. Sixty-one percent of the isolates were nonsusceptible to penicillin, exhibiting either intermediate resistance (28%) or high-level resistance (33%). About two-fifths of the isolates displayed intermediate or high-level resistance to cefotaxime, ceftriaxone, cefepime, imipenem, and meropenem. Extremely high proportions of the isolates were resistant to erythromycin (82%), clarithromycin (90%), and trimethoprim-sulfamethoxazole (TMP-SMZ) (87%). Among the isolates nonsusceptible to penicillin, 23.8% were resistant to imipenem; more than 60% displayed resistance to cefotaxime, ceftriaxone, cefepime, and carbapenems; 96.7% were resistant to erythromycin; and 100% were resistant to TMP-SMZ. All isolates were susceptible to rifampin and vancomycin. The MICs at which 50% and 90% of the isolates were inhibited were 0.12 and 1 microgram/ml, respectively, for cefpirome, and 0.12 and 0.25 microgram/ml, respectively, for moxifloxacin. Six serogroups or serotypes (23F, 19F, 6B, 14, 3, and 9) accounted for 77.5% of all isolates. Overall, 92.5% of the isolates were included in the serogroups or serotypes represented in the 23-valent pneumococcal vaccine. The incidence of macrolide and TMP-SMZ resistance for S. pneumoniae isolates in Taiwan in this study is among the highest in the world published to date.
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Affiliation(s)
- P R Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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40
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Jorgensen JH, Weigel LM, Ferraro MJ, Swenson JM, Tenover FC. Activities of newer fluoroquinolones against Streptococcus pneumoniae clinical isolates including those with mutations in the gyrA, parC, and parE loci. Antimicrob Agents Chemother 1999; 43:329-34. [PMID: 9925527 PMCID: PMC89072 DOI: 10.1128/aac.43.2.329] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resistance to fluoroquinolone (FQ) antibiotics in Streptococcus pneumoniae has been attributed primarily to specific mutations in the genes for DNA gyrase (gyrA and gyrB) and topoisomerase IV (parC and parE). Resistance to some FQs can result from a single mutation in one or more of the genes encoding these essential enzymes. A group of 160 clinical isolates of pneumococci was examined in this study, including 36 ofloxacin-resistant isolates (MICs, > or = 8 micrograms/ml) recovered from patients in North America, France, and Belgium. The susceptibilities of all isolates to clinafloxacin, grepafloxacin, levofloxacin, sparfloxacin, and trovafloxacin were examined by the National Committee for Clinical Laboratory Standards reference broth microdilution and disk diffusion susceptibility testing methods. Among the ofloxacin-resistant strains, 32 of 36 were also categorized as resistant to levofloxacin, 35 were resistant to sparfloxacin, 29 were resistant to grepafloxacin, and 19 were resistant to trovafloxacin. In vitro susceptibility to clinafloxacin appeared to be least affected by resistance to the other FQs. Eight isolates with high- and low-level resistance to the newer FQs were selected for DNA sequence analysis of the quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC, and parE. The DNA and the inferred amino acid sequences of the resistant strains were compared with the analogous sequences of reference strain S. pneumoniae ATCC 49619 and FQ-susceptible laboratory strain R6. Reduced susceptibilities to grepafloxacin and sparfloxacin (MICs, 1 to 2 micrograms/ml) and trovafloxacin (MICs, 0.5 to 1 microgram/ml) were associated with either a mutation in parC that led to a single amino acid substitution (Ser-79 to Phe or Tyr) or double mutations that involved the genes for both GyrA (Ser-81 to Phe) and ParE (Asp-435 to Asn). High-level resistance to all of the compounds except clinafloxacin was associated with two or more amino acid substitutions involving both GyrA (Ser-81 to Phe) and ParC (Ser-79 to Phe or Ser-80 to Pro and Asp-83 to Tyr). No mutations were observed in the gyrB sequences of resistant strains. These data indicate that mutations in pneumococcal gyrA, parC, and parE genes all contribute to decreased susceptibility to the newer FQs, and genetic analysis of the QRDR of a single gene, either gyrA or parC, is not predictive of pneumococcal resistance to these agents.
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Affiliation(s)
- J H Jorgensen
- Department of Pathology, University of Texas Health Science Center, San Antonio 78284, USA.
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41
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Hsueh PR, Teng LJ, Lee LN, Yang PC, Ho SW, Luh KT. Dissemination of high-level penicillin-, extended-spectrum cephalosporin-, and erythromycin-resistant Streptococcus pneumoniae clones in Taiwan. J Clin Microbiol 1999; 37:221-4. [PMID: 9854097 PMCID: PMC84215 DOI: 10.1128/jcm.37.1.221-224.1999] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/1998] [Accepted: 10/15/1998] [Indexed: 11/20/2022] Open
Abstract
Sixty-seven clinical isolates of Streptococcus pneumoniae (40 of serotype 23F, 19 of serotype 19F, and 8 of serotype 6B) with decreased susceptibilities to penicillin and erythromycin were characterized by antimicrobial susceptibility patterns; DNA restriction endonuclease cleavage profiles of the penicillin-binding protein genes pbp1a, pbp2b, and pbp2x; random amplified polymorphic DNA (RAPD) patterns generated by arbitrarily primed PCR; and chromosomal macrorestriction profiles based on pulsed-field gel electrophoresis. A total of 22 clones (identical or closely related pulsotypes and identical RAPD patterns) were identified; 14 clones of 23F, 6 of 19F, and 2 of 6B. Three 23F clones (26 isolates) and one 19F clone (9 isolates) expressed high-level resistance to penicillin, cefotaxime, and erythromycin (MICs >/= 256 microg/ml). These data strongly suggest that multiple high-level penicillin-, extended-spectrum cephalosporin-, and macrolide-resistant clones of S. pneumoniae have been disseminated in Taiwan.
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Affiliation(s)
- P R Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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42
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Fotopoulou N, Tsiplakou S, Maniatis AN, Pangali A, Kouppari G, Legakis NJ, Tassios PT. Gradual increase in the minimum inhibitory concentration of penicillin among both susceptible and resistant Streptococcus pneumoniae isolates from Greek children during 1995-1997. Int J Antimicrob Agents 1999; 11:53-7. [PMID: 10075278 DOI: 10.1016/s0924-8579(98)00062-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A total of 140 non-replicate Streptococcus pneumoniae community isolates from Greek children collected during the period 1995-1997 were studied. Combined intermediate and high penicillin resistance rates were 23% in 1995, 29% in 1996, and 27% in 1997. The proportion of highly resistant isolates steadily increased from 2% in 1995 to 12% in 1997. There was no significant difference in penicillin resistance rates among colonizing and infecting isolates (23 and 27%, respectively). Over the study period, a clear shift towards higher penicillin MIC was observed among both the susceptible and resistant groups. Thus, penicillin resistance rates were equally high among colonizing and infecting isolates and resistance levels appeared to be gradually increasing throughout the entire S. pneumoniae population.
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Affiliation(s)
- N Fotopoulou
- Department of Microbiology, Medical School, University of Athens, Greece
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43
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Shi ZY, Enright MC, Wilkinson P, Griffiths D, Spratt BG. Identification of three major clones of multiply antibiotic-resistant Streptococcus pneumoniae in Taiwanese hospitals by multilocus sequence typing. J Clin Microbiol 1998; 36:3514-9. [PMID: 9817864 PMCID: PMC105231 DOI: 10.1128/jcm.36.12.3514-3519.1998] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/1998] [Accepted: 09/24/1998] [Indexed: 11/20/2022] Open
Abstract
In this paper we demonstrate the advantages of a new molecular typing procedure, multilocus sequence typing, for the unambiguous characterization of penicillin-resistant pneumococci. The sequences of approximately 450-bp fragments of seven housekeeping genes were determined for 74 penicillin-resistant Taiwanese isolates of Streptococcus pneumoniae (MIC of penicillin > 0.5 microgram/ml). The combination of alleles at the seven loci defined an allelic profile for each strain, and a dendrogram, based on the pairwise mismatches in allelic profiles, grouped 86% of the isolates into one of three penicillin-resistant clones for which the MICs of penicillin were 1 to 2 microgram/ml. Isolates within each clone had identical alleles at all seven loci or differed at only a single locus, and the fingerprints of their pbp1A, pbp2B, and pbp2X genes were uniform. Isolates of the Taiwan-19F clone and the Taiwan-23F clone were resistant to penicillin, tetracycline, and erythromycin but were susceptible to chloramphenicol. A second serotype 23F clone and serotype 19F variants of this clone were resistant to penicillin, tetracycline, chloramphenicol, and, in some cases, erythromycin. Comparisons of the allelic profiles of the three major clones with those of reference isolates of the known penicillin-resistant clones showed that the Taiwan-19F and Taiwan-23F clones were previously undescribed, whereas the second serotype 23F clone was indistinguishable from the Spanish multidrug-resistant serotype 23F clone. Single isolates of the Spanish penicillin-resistant serotype 9V clone and the Spanish multidrug-resistant serotype 6B clone were also identified in the collection.
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Affiliation(s)
- Z Y Shi
- School of Biological Sciences, University of Sussex, Brighton BN1 9QG, United Kingdom
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44
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Wang EE, Kellner JD, Arnold S. Antibiotic-resistant Streptococcus pneumoniae. Implications for medical practice. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1998; 44:1881-8. [PMID: 9789668 PMCID: PMC2277883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To review the definition and prevalence of antibiotic-resistant Streptococcus pneumoniae, its links with antibiotic prescribing, data on antibiotic prescribing and prescribing appropriateness, and evidence-based treatment guidelines for common respiratory tract syndromes. QUALITY OF EVIDENCE Primary studies consist of cross-sectional surveys and case-control studies. Treatment guidelines are based on clinical trials, meta-analyses, and cohort studies. Study designs were appropriate for the specific study questions. MAIN FINDINGS The increasing prevalence of penicillin-resistant S pneumoniae is concurrent with increasing antibiotic prescribing. Individual patients show a twofold to ninefold increase in nasopharyngeal carriage of resistant bacteria or invasion with resistant bacteria (among those who have received antibiotics in the preceding 3 months). Cross-sectional data as well as data from medicaid and drug databases attest to overprescribing of antibiotics for respiratory tract infections. Physician surveys and focus groups blame this on parental pressure for antibiotic prescriptions. However, parents in focus groups and surveys deny they pressure their physicians and indicate their main purpose for office visits is to obtain a diagnosis and to seek reassurance that their children are not seriously ill. Evidence-based guidelines suggest treatment strategies that would reduce antibiotic prescribing. CONCLUSIONS The few antibiotics that can be used with resistant organisms are expensive and are increasingly being needed. To control the rise of antibiotic resistance, it is important to limit antibiotic overprescribing.
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Affiliation(s)
- E E Wang
- Department of Pediatrics, University of Toronto
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45
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McDougal LK, Tenover FC, Lee LN, Rasheed JK, Patterson JE, Jorgensen JH, LeBlanc DJ. Detection of Tn917-like sequences within a Tn916-like conjugative transposon (Tn3872) in erythromycin-resistant isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 1998; 42:2312-8. [PMID: 9736555 PMCID: PMC105825 DOI: 10.1128/aac.42.9.2312] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A series of macrolide-lincosamide-streptogramin B (MLS)-resistant pneumococcal isolates of a variety of serotypes was examined and was found to contain Tn917-like elements by DNA-DNA hybridization. Like Tn1545, Tn917 also encodes an ermAM gene but does not mediate resistance to other antimicrobial agents. Furthermore, nucleotide sequence analyses of the DNAs flanking three of the Tn917-like elements revealed that they were inserted into orf9 of a Tn916-like element in a composite transposon-like structure (Tn3872). Other MLS-resistant strains appeared to contain Tn1545-like elements that had suffered a deletion of sequences including the aphA-3 sequences responsible for kanamycin resistance. Thus, the MLS resistance phenotype in pneumococci appears to be mediated by the ermAM present on a much wider variety of genetic elements than was previously appreciated.
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Affiliation(s)
- L K McDougal
- Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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46
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Nuorti JP, Butler JC, Crutcher JM, Guevara R, Welch D, Holder P, Elliott JA. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998; 338:1861-8. [PMID: 9637804 DOI: 10.1056/nejm199806253382601] [Citation(s) in RCA: 198] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma. METHODS We obtained nasopharyngeal swabs for culture from residents and employees. Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis. A retrospective cohort study was conducted to identify factors associated with colonization and disease. RESULTS Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharygeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent). All the serotype 23F isolates were identical according to pulsed-field gel electrophoresis. Recent use of antibiotics was associated with both colonization (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.2) and disease (relative risk, 3.6; 95 percent confidence interval, 1.2 to 10.8). Only three residents (4 percent) had undergone pneumococcal vaccination. After residents received pneumococcal vaccine and prophylactic antibiotics, there were no additional cases of pneumonia, and the rates of carriage decreased substantially. CONCLUSIONS In this outbreak a single pneumococcal strain was disseminated among the residents and employees of a nursing home. The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate. Clusters of pneumococcal disease may be underrecognized in nursing homes, and wider use of pneumococcal vaccine is important to prevent institutional outbreaks of drug-resistant S. pneumoniae infection.
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Affiliation(s)
- J P Nuorti
- Epidemiology Program Office, Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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47
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Hall LM, Duke B. Conservation of restriction sites in isolates of Streptococcus pneumoniae with diverse restriction fragment patterns. J Clin Microbiol 1998; 36:1805-7. [PMID: 9620429 PMCID: PMC104929 DOI: 10.1128/jcm.36.6.1805-1807.1998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Separation of large restriction fragments by pulsed-field gel electrophoresis is a commonly used method for epidemiological typing of Streptococcus pneumoniae and many other bacterial species. Information on the genetic changes underlying the restriction fragment polymorphisms that allow discrimination between isolates is scarce. In this study fragments adjacent to ApaI sites in a clinical isolate of S. pneumoniae were cloned and used to probe HindIII and HindIII-plus-ApaI genomic DNA digests from other isolates with very different ApaI fragment patterns. If for a given isolate the HindIII fragment detected by the probe was reduced in size on digestion with ApaI, it was deduced that the ApaI site was conserved in that isolate. The results demonstrate that of six ApaI sites in PN93/908 examined, five were retained in 11 genetically different isolates and one was retained in 2 isolates but lost in 9 others. It was concluded that point mutations at restriction sites are unlikely to account for the restriction fragment length polymorphism observed and that much of the polymorphism may be due to DNA rearrangements, possibly resulting from the insertion or deletion of mobile DNA elements.
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Affiliation(s)
- L M Hall
- Department of Medical Microbiology, St. Bartholomew's and the Royal London School of Medicine and Dentistry, United Kingdom.
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48
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Abstract
The spread of antibiotic resistance and the development of new vaccines have focused attention on the epidemiology of Streptococcus pneumoniae over recent years. While serotyping and the determination of antibiotic resistance remain primary methods for characterising pneumococci, molecular typing can add greater discrimination and complementary information. Methods based on restriction fragment length polymorphism within total DNA or non-specific polymerase chain reaction provide information representative of the whole genome and can be used to recognise closely related isolates from different sources, whether in the investigation of possible cross infection at the local level or in the investigation of national or international spread of antibiotic resistant strains. Fingerprinting of penicillin binding protein genes adds further information in the analysis of penicillin resistant isolates. The use of a combination of typing methods to analyse both the genome as a whole and specific loci has led to the realisation that pneumococci undergo horizontal gene transfer much more often than most other bacterial species. In particular the spread of penicillin resistance has been characterised by a combination of the spread of epidemic strains, transfer of chromosomal resistance genes from such strains into other genetic backgrounds, and transfer of capsule genes resulting in the switch of serotypes within strains. In the future molecular typing will have an important role in discovering whether widespread vaccination leads to genetic modification of the pneumococcal population causing invasive disease.
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Affiliation(s)
- L M Hall
- Department of Medical Microbiology, St Bartholomew's, London, UK.
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49
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Jorgensen JH, McElmeel ML, Crawford SA. Evaluation of the Dade MicroScan MICroSTREP antimicrobial susceptibility testing panel with selected Streptococcus pneumoniae challenge strains and recent clinical isolates. J Clin Microbiol 1998; 36:788-91. [PMID: 9508313 PMCID: PMC104626 DOI: 10.1128/jcm.36.3.788-791.1998] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The MicroScan MICroSTREP panel is a recently marketed frozen broth microdilution panel for susceptibility testing of various streptococci, including Streptococcus pneumoniae. The panel contains 10 antimicrobial agents in cation-adjusted Mueller-Hinton broth supplemented with 3% lysed horse blood, similar in concept to the National Committee for Clinical Laboratory Standards (NCCLS) reference broth microdilution method for testing streptococci. A group of 210 isolates of S. pneumoniae were selected to include isolates with previously documented resistance to agents incorporated in the MICroSTREP panel, as well as recent invasive clinical isolates. All isolates were tested simultaneously with the MICroSTREP panel and an NCCLS reference panel whose drug concentrations were prepared to coincide with those of the MICroSTREP panel. Of the 210 isolates, 5 failed to grow in the MICroSTREP panel; 3 of those also did not grow in the reference panel. Essential agreement of MICs determined by the two methods (test MIC +/- one dilution of the reference MIC) was 99.6% overall and ranged from 98.0% with chloramphenicol to 100% with penicillin, ceftriaxone, erythromycin, tetracycline, and vancomycin. There were no very major or major interpretive category errors resulting from the MICroSTREP panel tests. Minor interpretive category errors ranged from 12.2% with cefotaxime and 9.8% with ceftriaxone (due mainly to clustering of MICs for the selected strains near the breakpoints) to 0% with chloramphenicol and vancomycin. These results indicate that the MicroScan MICroSTREP frozen panels provide susceptibility results with pneumococci that are essentially equivalent to results derived by the NCCLS reference broth microdilution procedure.
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Affiliation(s)
- J H Jorgensen
- Department of Pathology, The University of Texas Health Science Center, San Antonio 78284-7750, USA.
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50
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Coffey TJ, Enright MC, Daniels M, Morona JK, Morona R, Hryniewicz W, Paton JC, Spratt BG. Recombinational exchanges at the capsular polysaccharide biosynthetic locus lead to frequent serotype changes among natural isolates of Streptococcus pneumoniae. Mol Microbiol 1998; 27:73-83. [PMID: 9466257 DOI: 10.1046/j.1365-2958.1998.00658.x] [Citation(s) in RCA: 219] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serotype 19F variants of the major Spanish multiresistant serotype 23F clone of Streptococcus pneumoniae have been proposed to have arisen by recombinational exchanges at the capsular biosynthetic locus. Members of the Spanish multiresistant serotype 23F clone and the serotype 19F variants were confirmed to be essentially identical in overall genotype, as they were indistinguishable by REP-PCR, and had identical sequences at three polymorphic housekeeping genes. Eight serotype 19F variants were studied and all had large recombinational replacements at the capsular biosynthetic locus. In all cases, one of the recombinational cross-over points appeared to be upstream of dexB, which flanks one end of the capsular locus, and in six of the variants the other cross-over point was downstream of aliA, which flanks the other end of the locus. In two strains a recombinational cross-over point between the introduced serotype 19F capsular region and that of the Spanish serotype 23F clone could be clearly identified, within cpsN in one strain and within cpsM in the other. The differences in the recombinational junctions and sequence polymorphisms within the introduced capsular genes, suggested that the eight serotype 19F variants emerged on at least four separate occasions. Changes in capsular type by recombination may therefore be relatively frequent in pneumococci and this has implications for the long-term efficacy of conjugate pneumococcal vaccines that will protect against only a limited number of serotypes.
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MESH Headings
- Base Sequence
- Crossing Over, Genetic
- DNA Fingerprinting
- DNA, Bacterial/chemistry
- Drug Resistance, Multiple/physiology
- Molecular Sequence Data
- Phenotype
- Polymerase Chain Reaction
- Polymorphism, Restriction Fragment Length
- Polysaccharides, Bacterial/biosynthesis
- Polysaccharides, Bacterial/chemistry
- Polysaccharides, Bacterial/genetics
- Recombination, Genetic/physiology
- Repetitive Sequences, Nucleic Acid
- Sequence Analysis, DNA
- Sequence Homology, Nucleic Acid
- Serotyping
- Spain
- Streptococcus pneumoniae/chemistry
- Streptococcus pneumoniae/classification
- Streptococcus pneumoniae/genetics
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Affiliation(s)
- T J Coffey
- Molecular Microbiology Group, School of Biological Sciences, University of Sussex, Brighton, UK
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