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INTRODUCTION: Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. METHODS: This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study's duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. RESULTS: This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. DISCUSSION: To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.
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BACKGROUND: Streptococcus pneumoniae is an opportunistic human-adapted pathogen driven by nasopharyngeal carriage. AIMS: To find the pneumococcal carriage rate, resistance, serotypes, and coverage of pneumococcal conjugate vaccines (PCVs) among infants in the first six months of age in the period from March 2008 to April 2016. METHODS: Nasopharyngeal swabs (NP) were taken from healthy infants from the northern part of Jordan. Swabs were processed for cultivation, identification, resistance testing and serotyping according to standard methods. RESULTS: During the surveillance period, 484 infants of this age group were tested, with a total carriage rate of 56.2%. 96.2% of infants one to two months of age got one PCV7 injection and were 58% carriers at the time of the first injection. At age three to four months, 84.9% had received two injections, with a carriage rate of 54.9% at the time of the second injection. At ages five to six months, 12.5% had received one to three injections, with a carriage rate of 43.8%. Predominant serotypes in all age groups were 19F (12.5%), 6A (11.4%), 11A (8.4%), 19A (7.0%), 6B (6.6%), 23F (5.9%), 15B (5.1%), 15A and 23A (4.0% each). Coverage of PCV7, PCV13 and the future PCV20 among all cases were 30.5%, 50.7% and 70.6%, respectively. The highest coverage rate of 78.6% was noticed in the age group at five to six months with the future PCV20. Antibiotic resistance was the highest in the first age group. CONCLUSIONS: Pneumococcal carriage starts from the first month of the infant's life. The highest coverage was noticed for PCV20, which implies the necessity for inoculation with future vaccines.
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BACKGROUND: A pneumococcal carriage surveillance study took place examining Jordanian children in urban and rural areas in the period 2015-2019. OBJECTIVES: To determine urban and rural differences in pneumococcal carriage rate, resistance, and serotypes among healthy Jordanian children from Amman (urban) and eastern Madaba (rural). METHODS: Nasopharyngeal swabs (NP) were taken from 682 children aged 1 to 163 months. Pneumococcal identification, serotyping, and resistance were performed according to standard method. RESULTS: The number of cases tested for Amman was 267 and there were 415 cases tested for eastern Madaba. Carriage rate for eastern Madaba was 39.5% and 31.1% for Amman. Predominant serotypes for eastern Madaba and Amman were 19F (21.3%; 15.7%), 23F (12.2%; 9.6%), 14 (6.7%; 2.4%), 19A (4.9%; 2.4%), and 6A (5.5%; 3.6%). Resistance rates for eastern Madaba and Amman were as follows: penicillin (95.8%; 81.9%), clarithromycin (68.9%; 59.0%), clindamycin (40.8%; 31.3%), and trimethoprim-sulfamethoxazole (73.2%; 61.4%). Coverage of PCV7, PCV13, and the future PCV20 for Amman was 42.2%, 48.2%, and 60.2%; for eastern Madaba, coverage was 50.0%, 62.2%, and 73.2%, respectively. In Amman 25.8% of children received 1-3 PCV7 injections compared to 1.9% of children in eastern Madaba. CONCLUSIONS: There were significant differences in carriage, resistance, and coverage between both regions. The potential inclusion of a PCV vaccination program for rural areas is essential.
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Streptococcus pneumoniae is one of the leading causes of death worldwide. It disseminates through colonizers and causes serious infections. Aims of this study are to determine pneumococcal carriage rate, resistance, serotype distribution, and coverage of pneumococcal conjugate vaccines from children attending day care centers from Irbid and Madaba in Jordan. Nasopharyngeal swabs were collected from day care centers (DCCs) of healthy Jordanian children 2-4 years of age from four regions of Madaba (n = 596), and from eastern Irbid (n = 423). Swabs were cultivated on Columbia blood agar base supplemented with 5% sheep blood and incubated for 18-24 hours at 37°C with 5% CO2. Alpha-hemolytic isolates were tested for optochin sensitivity and bile solubility for identification. Isolates were analyzed for antimicrobial susceptibility by the Vitek2 system and E-test (BioMérieux). Serotyping was performed using the Neufeld Quellung method. A total of 341 pneumococcal strains were isolated from 1019 nasopharyngeal (NP) samples of healthy children attending DCCs for two winter seasons from 2017-2019. Carriage rate in eastern Irbid for both seasons was 29.6% and for Madaba 37.9%. Resistance rates for Irbid and Madaba, respectively, were as follows: Penicillin (86.3%; 94.4%), erythromycin (57.0%; 78.2%), clindamycin (30.8%; 47.2%), trimethoprim-sulfamethoxazole (68.6%; 86.6%), and tetracycline (45.7%; 51.9%). Predominant serotypes for Irbid were 19F (20.8%), 23F (12.0%), 6A (10.4%), and 6B (9.6%); whereas for Madaba were 19F (24.5%), 14 (7.4%), 6A (6.9%) and 23F (6.5%). Serotype coverage of the thirteen valent pneumococcal conjugate vaccine (PCV13) was about 65% for both regions. Over 96% of isolates with PCV13 serotypes in this study were resistant to penicillin with the exception of serotypes 3 and 5. As a conclusion resistance and carriage rates among the age group 2 to 4 years reached an alarming rate especially among vaccine types, which can be controlled by pneumococcal conjugate vaccination strategies.
Subject(s)
Pneumococcal Infections/diagnosis , Streptococcus pneumoniae/isolation & purification , Animals , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Drug Resistance, Bacterial , Female , Humans , Jordan/epidemiology , Male , Pneumococcal Infections/drug therapy , Pneumococcal Infections/epidemiology , Seasons , Serotyping , Sheep , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effectsABSTRACT
Streptococcus pneumoniae is a major cause of bacterial pneumonia, sepsis and meningitis worldwide. Prevalence of levofloxacin-resistant S. pneumoniae isolates in Germany and associated mutations in the quinolone resistance determining regions (QRDRs), as well as serotype distribution and multi locus sequence types (MLST) are shown. 21,764 invasive S. pneumoniae isolates from Germany, isolated in the epidemiological seasons from 2004/05 to 2014/15 were analyzed at the German National Reference Centre for Streptococci (GNRCS) for their levofloxacin resistance by micro broth dilution method. All resistant (minimal inhibitory concentration (MIC) ≥8µg/ml) and intermediate (MIC >2µg/ml and <8µg/ml) isolates were selected for the present study. Additionally, 29 susceptible isolates were randomly selected. A total of ninety isolates were tested for their levofloxacin-MIC by Etest, their serotype and sequence type, as well as for point-mutations at the QRDRs in the genes parC, parE, gyrA and gyrB. Twenty-five isolates exhibited levofloxacin MICs <2µg/ml (Etest) and no mutations in the QRDRs. Four isolates with MICs=2µg/ml had one mutation in parC; isolates with MICs >2µg/ml all had one or more mutations in the QRDRs. Four of nine intermediate isolates had a mutation in either parC or gyrA, and four isolates had mutations in both parC and gyrB. One isolate had mutations in both parC and gyrA. All isolates with MICs ≥8µg/ml (52) had mutations in both topoisomerase IV and gyrase. Serotypes associated with levofloxacin resistance shifted from a majority of PCV13 serotypes before the introduction of the PCV13 vaccine towards non-PCV serotypes. Resistant isolates were almost exclusively found among adults (98.1%).
Subject(s)
Drug Resistance, Bacterial/genetics , Genes, Bacterial , Streptococcus pneumoniae/genetics , Streptococcus pneumoniae/isolation & purification , Anti-Infective Agents/pharmacology , DNA, Bacterial/genetics , Germany , Humans , Levofloxacin/pharmacology , Microbial Sensitivity Tests , Multilocus Sequence Typing , Mutation , Sequence Analysis, DNA , Streptococcus pneumoniae/drug effectsABSTRACT
BACKGROUND: An experimental 26-valent M protein Group A streptococcal (GAS) vaccine has entered clinical studies. Pharyngeal GAS emm type surveillances in different areas and time-periods enhance the understanding of the epidemiology of GAS pharyngitis. Moreover, these surveillances, combined with the data on GAS invasive disease, can play a significant role in the formulation of multivalent type-specific vaccines. METHODS: During a 7-year period (1999-2005), 2408 GAS isolates were recovered from consecutive children with pharyngitis in Western Greece. The overall macrolide resistance rate was 22.8%. Along the study period we noted a tendency towards significantly decreased rates of resistance, with the lowest rates occurring in 2002 (15.3%), 2003 (15%) and 2004 (16.7%). A random sample of isolates from each year, 338 (61.7%) of the 548 macrolide-resistant and 205 (11%) of the macrolide-susceptible, underwent molecular analysis, including emm typing. RESULTS: The 543 typed isolates had 28 different emm types. A statistically significant association was found between macrolide resistance and emm4, emm22 and emm77, whereas emm1, emm3, emm6, emm12, emm87 and emm89 were associated with macrolide susceptibility. A significant yearly fluctuation was observed in emm4, emm28 and emm77. The most common macrolide-resistant GAS were emm77 isolates harboring erm(A), either alone or in combination with mef(A), emm4 carrying mef(A), emm28 possessing erm(B), emm75 carrying mef(A), emm12 harboring mef(A) and emm22 carrying erm(A). We estimated that 82.8% of the isolates belonged to emm types included in the novel 26-valent M protein vaccine. The vaccine coverage rate was determined mainly by the increased frequency of nonvaccine emm4 isolates. CONCLUSIONS: A limited number of emm types dominated among macrolide-susceptible and macrolide-resistant GAS isolates. We observed seasonal fluctuations, which were significant for emm4, emm28 and emm77. This type of data can serve as baseline information if the novel 26-valent M protein GAS vaccine is introduced into practice.
Subject(s)
Genes, Bacterial/genetics , Pharyngitis/epidemiology , Pharyngitis/microbiology , Population Surveillance , Streptococcus pyogenes/genetics , Streptococcus pyogenes/isolation & purification , Adolescent , Antigens, Bacterial/immunology , Bacterial Outer Membrane Proteins/immunology , Carrier Proteins/immunology , Child , Child, Preschool , Drug Resistance, Bacterial/drug effects , Genotype , Greece/epidemiology , Humans , Infant , Infant, Newborn , Macrolides/pharmacology , Microbial Sensitivity Tests , Pharyngitis/immunology , Pharyngitis/prevention & control , Pharynx/drug effects , Pharynx/microbiology , Pharynx/pathology , Phenotype , Streptococcal Vaccines/immunology , Streptococcus pyogenes/classification , Streptococcus pyogenes/drug effectsABSTRACT
Human TLR1 plays an important role in host defense against Mycobacterium tuberculosis. Our aim was to analyze the association of the loss of TLR1 surface expression and TLR1 SNPs with susceptibility to TB. TLR1neg and TLR1pos cells from healthy individuals were identified by flow cytometry and compared by sequencing. TLR1 expression was measured using quantitative real-time PCR and immunoblotting. TLR1 SNP analyses of healthy individuals and TB patients from EU-C and Ghana were performed, and association of the TLR1 genotypes with increased risk of developing TB was statistically evaluated. Lack of TLR1 surface expression accompanied by impaired function was strongly associated with TLR1 SNP G743A. Genotyping of EU-C controls and TB patients revealed an association of TLR1 743A/1805G alleles [OR 2.37 (95% CI 1.13, 4.93), P=0.0219; OR 2.74 (95% CI 1.26, 6.05), P=0.0059] as well as TLR1neg 743AA/1805GG versus TLR1pos genotypes 743AG/1805TG [OR 4.98 (95% CI 1.64, 15.15), P=0.0034; OR 5.70 (95% CI 1.69, 20.35), P=0.0015] and 743AG + GG/1805TG + TT [OR 3.54 (95% CI 1.29, 9.90), P=0.0086; OR 4.17 (95% CI 1.52, 11.67), P=0.0025] with increased susceptibility to TB. No association of G743A with TB was found in Ghana as a result of a low frequency of genotype 743AA. Our data gain new insights in the role of TLR1 in M. tuberculosis defense and provide the first evidence that TLR1 variants are associated with susceptibility to TB in a low-incidence country.
Subject(s)
Antigens, Surface/analysis , Genetic Predisposition to Disease/genetics , Polymorphism, Single Nucleotide , Toll-Like Receptor 1/genetics , Tuberculosis/genetics , Adult , Aged , Aged, 80 and over , Case-Control Studies , Genotype , Ghana/epidemiology , Humans , Incidence , Middle Aged , Molecular Epidemiology , Mycobacterium tuberculosis , Toll-Like Receptor 1/analysis , Tuberculosis/epidemiology , Tuberculosis/etiology , Young AdultABSTRACT
BACKGROUND: In this study, we examined the role of superantigen genes and emm genotypes of clinical Streptococcus pyogenes isolates collected in Germany between 1997 and 2003. METHODS: Multiplex polymerase chain reaction for all 11 currently known superantigen genes and sequencing for emm types were used. RESULTS: Using a 2-step explorative data analysis procedure, we found that after combined analysis of superantigen genes and emm types, only the superantigen genes spea1-spea3, spem, and spea4 have a predictive value for invasiveness, with odds ratios of 7.992, 3.209, and 2.323, respectively. The predictive value for invasiveness of emm1 was lost after combined analysis because of the association between emm type and the highly predictive superantigen genes. On the other hand, presence of the superantigen gene ssa and of emm77 are predictors of noninvasiveness, with odds ratios of 0.370 and 0.271, respectively. CONCLUSIONS: These results indicate that the presence of superantigen genes is more important for the invasiveness of group A Streptococcus infection than emm type and may be the connection between the high-risk HLA type of the host and the pathogen. Furthermore, we found a very clear correlation between the presence of the genes spea1-spea3 and the presence of the gene emm1, which indicates that the relationship between emm1 and invasiveness is based on the superantigen gene profile. Our data suggest that the superantigen gene profile is of high importance for the clinical outcome of group A Streptococcus infections.
Subject(s)
Antigens, Bacterial/genetics , Bacterial Proteins/genetics , Streptococcus pyogenes/genetics , Streptococcus pyogenes/metabolism , Superantigens/genetics , Bacterial Proteins/metabolism , DNA, Bacterial/genetics , Gene Expression Regulation, Bacterial , Humans , Polymerase Chain Reaction/methods , Streptococcal Infections/microbiologyABSTRACT
BACKGROUND: Between 1986 and 2008 Streptococcus pneumoniae was isolated from 41 pets/zoo animals (guinea pigs (n = 17), cats (n = 12), horses (n = 4), dogs (n = 3), dolphins (n = 2), rat (n = 2), gorilla (n = 1)) treated in medical veterinary laboratories and zoos, and 44 laboratory animals (mastomys (multimammate mice; n = 32), mice (n = 6), rats (n = 4), guinea pigs (n = 2)) during routine health monitoring in an animal facility. S. pneumoniae was isolated from nose, lung and respiratory tract, eye, ear and other sites. METHODOLOGY/PRINCIPAL FINDINGS: Carriage of the same isolate of S. pneumoniae over a period of up to 22 weeks was shown for four mastomys. Forty-one animals showed disease symptoms. Pneumococcal isolates were characterized by optochin sensitivity, bile solubility, DNA hybridization, pneumolysin PCR, serotyping and multilocus sequence typing. Eighteen of the 32 mastomys isolates (56%) were optochin resistant, all other isolates were optochin susceptible. All mastomys isolates were serotype 14, all guinea pig isolates serotype 19F, all horse isolates serotype 3. Rats had serotypes 14 or 19A, mice 33A or 33F. Dolphins had serotype 23F, the gorilla serotype 14. Cats and dogs had many different serotypes. Four isolates were resistant to macrolides, three isolates also to clindamycin and tetracycline. Mastomys isolates were sequence type (ST) 15 (serotype 14), an ST/serotype combination commonly found in human isolates. Cats, dogs, pet rats, gorilla and dolphins showed various human ST/serotype combinations. Lab rats and lab mice showed single locus variants (SLV) of human STs, in human ST/serotype combinations. All guinea pig isolates showed the same completely new combination of known alleles. The horse isolates showed an unknown allele combination and three new alleles. CONCLUSIONS/SIGNIFICANCE: The isolates found in mastomys, mice, rats, cats, dogs, gorilla and dolphins are most likely identical to human pneumococcal isolates. Isolates from guinea pigs and horses appear to be specialized clones for these animals. Our data redraw attention to the fact that pneumococci are not strictly human pathogens. Pet animals that live in close contact to humans, especially children, can be infected by human isolates and also carriage of even resistant isolates is a realistic possibility.
Subject(s)
Animals, Domestic/microbiology , Animals, Laboratory/microbiology , Streptococcus pneumoniae/isolation & purification , Animals , Bacterial Typing Techniques , Germany , Macrolides/pharmacology , Murinae/microbiology , Sequence Analysis, DNA , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/geneticsABSTRACT
Among 76 macrolide-nonsusceptible Streptococcus pneumoniae isolates collected between 2003 and 2005 from Central Russia, the resistance mechanisms detected in the isolates included erm(B) alone (50%), mef alone [mef(E), mef(I), or a different mef subclass; 19.7%], or both erm(B) and mef(E) (30.3%). Isolates with dual resistance genes [erm(B) and mef(E)] belonged to clonal complex CC81 or CC271.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/genetics , Macrolides/pharmacology , Streptococcus pneumoniae/drug effects , Bacterial Proteins/genetics , Clindamycin/pharmacology , Erythromycin/pharmacology , Humans , Membrane Proteins/genetics , Methyltransferases/genetics , Microbial Sensitivity Tests , Molecular Sequence Data , Phenotype , Pneumococcal Infections/epidemiology , Pneumococcal Infections/microbiology , Russia/epidemiology , Sequence Analysis, DNA , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/genetics , Streptococcus pneumoniae/isolation & purificationABSTRACT
Superantigens (SAgs) are very potent microbial toxins that are involved in severe diseases such as necrotizing fasciitis and toxic shock syndrome. There are currently 11 different SAgs that have been identified from Streptococcus pyogenes. In the present study, two sets of multiplex PCRs were developed for detection of these 11 SAg genes. The first group comprises spea1-3+5, spec, speg, spej, spek, and spel. The second group consists of spea1-4, speh, spei, spem, ssa, and smez. The presence of Streptococcus pyogenes SAg genes can be immediately identified using a real-time method with SYBR-Green, thus providing an excellent tool in clinical diagnostics. After testing more than 300 clinical isolates, we identified one strain without any SAg gene. This finding contrasts with previous reports describing SAg genes located on every Streptococcus pyogenes genome. This SAg gene-negative strain also did not show any mitogenic activity. It is hypothesized that clinical isolates from patients may overrepresent bacterial strains with pathogenic factors, such as SAgs.
Subject(s)
Polymerase Chain Reaction/methods , Streptococcus pyogenes/genetics , Superantigens/genetics , Bacterial Proteins/genetics , Benzothiazoles , Diamines , Humans , Organic Chemicals/metabolism , Quinolines , Streptococcal Infections/microbiology , Streptococcus pyogenes/classification , Streptococcus pyogenes/immunology , Streptococcus pyogenes/isolation & purificationABSTRACT
BACKGROUND: Telithromycin is a new ketolide increasingly used in Europe and the United States. Only very few telithromycin-resistant isolates have been described to date. METHODS: The anti-pneumococcal activity of telithromycin was determined against four clinical isolates of Streptococcus pneumoniae with reduced susceptibility to telithromycin by time-kill methodology. RESULTS: All four telithromycin non-susceptible strains had the constitutive macrolide-lincosamide-streptogramin B phenotype and the ermB genotype. Pneumococcal strains had telithromycin minimum inhibitory concentrations (MICs) ranging between 2 and 8 microg/ml. Mulitlocus sequence typing and serotyping showed three isolates to harbour the identical serotype (serotype 14) and sequence type (sequence type 143) indicating a genetic relatedness of strains. Telithromycin was only bactericidal against the isolates with telithromycin resistance, with 4-8 times the MIC after 24 h. CONCLUSION: The killing by telithromycin of S. pneumoniae isolates having an ermB resistance determinant and a telithromycin MIC of > or =2 microg/ml is slow. Achievable concentrations in serum, alveolar macrophages and epithelial lining fluid are below the concentrations which are necessary for bactericidal killing of highly telithromycin-resistant strains.
Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Ketolides/pharmacology , Streptococcus pneumoniae/drug effects , Genotype , Kinetics , Microbial Sensitivity Tests , Phenotype , Streptococcus pneumoniae/geneticsABSTRACT
Isolates (3,845) obtained from German adults with invasive pneumococcal disease between 1992 and 2004 were investigated. Of these, 430 isolates (11.2%) were erythromycin A nonsusceptible. Macrolide resistance genotypes and multilocus sequence types were determined. Among the isolates, 35.6% were erm(B) positive and 63.5% were mef positive. Over the study period, the frequency of resistance rose significantly from 2.2 to 17.0% (P < 0.001). A serotype 14, sequence type 9 clone was the most widespread.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Erythromycin/pharmacology , Macrolides/pharmacology , Membrane Proteins/genetics , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/drug effects , Adult , Drug Resistance, Bacterial , Humans , Sequence Analysis, DNA , Streptococcus pneumoniae/geneticsABSTRACT
Pneumococcal surface protein A (PspA) is a possible candidate for the development of a pneumococcal vaccine that has the potential to offer a broad range of protection. PspA genes of pneumococcal meningitis isolates (n=40) isolated as part of an ongoing population-based nation-wide surveillance program on invasive pneumococcal disease in children in Germany were analyzed to expand our knowledge on the distribution of PspA families of this important vaccine candidate in Germany. The serotype distribution of the strains was as follows: serotype 4 (n=3), 6B (5), 9V (2), 14 (8), 18C (6), 19F (5), 23F (6), and 7F (5). The pspA genes of these strains could be assigned to 2 families containing 20 pneumococcal strains each. Family I could be subdivided into 2 clades with 17 strains in clade 1 and 3 strains in clade 2, and family II could be subdivided into 3 subgroups (clades 3-5) containing 16, 3, and 1 strain, respectively. Pneumococcal serotypes were distributed evenly over all clades and families. Interestingly, the distribution of the PspA gene families in Germany was seen to differ slightly that found in other countries.
Subject(s)
Bacterial Proteins/genetics , Streptococcus pneumoniae/genetics , Adolescent , Amino Acid Sequence , Bacterial Proteins/immunology , Child , Child, Preschool , Genetic Variation , Germany/epidemiology , Humans , Meningitis, Pneumococcal/epidemiology , Meningitis, Pneumococcal/microbiology , Molecular Sequence Data , Prospective Studies , Streptococcus pneumoniae/immunology , Streptococcus pneumoniae/isolation & purificationABSTRACT
Telithromycin-nonsusceptible pneumococcal clinical isolates (n = 17) were analyzed for their antimicrobial susceptibility, macrolide resistance mechanisms, and genetic relatedness. All strains showed the erm(B) genotype and showed a wide range of combinations of macrolide resistance mechanisms. The predominant clone (n = 7) was serotype 14, sequence type 143.
Subject(s)
Anti-Bacterial Agents/pharmacology , Ketolides/pharmacology , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/drug effects , Drug Resistance, Bacterial/genetics , Europe , Genotype , Humans , Microbial Sensitivity Tests , Molecular Sequence Data , Phenotype , Reverse Transcriptase Polymerase Chain Reaction , Streptococcus pneumoniae/geneticsABSTRACT
Since the late 1990s, the prevalence of erythromycin-resistant Streptococcus pyogenes has significantly increased in several European countries. Between January 1999 and December 2002, 1,577 isolates of S. pyogenes were recovered from children with tonsillopharyngitis living in various areas of Western Greece. Erythromycin resistance was observed in 379 (24%) of the 1,577 isolates. All erythromycin-resistant strains along with 153 randomly selected erythromycin-susceptible S. pyogenes isolates were tested for their antimicrobial susceptibility, resistance phenotypes, and genotypes. Representative isolates underwent emm gene sequence typing. Isolates with reduced susceptibility to telithromycin (MIC, > or = 2 microg/ml) were studied for multilocus sequence type, L22, L4, and 23S rRNA mutations. Of the total 379 erythromycin-resistant isolates, 193 (50.9%) harbored the mef(A) gene, 163 (43%) erm(A), 1 (0.3%) mef(A) plus erm(A), and 22 (5.8%) the erm(B) gene. Among the erythromycin-susceptible isolates, emm 1 (25%), emm 2 (12.5%), and emm 77 (12.5%) predominated. Furthermore, among the erythromycin-resistant isolates, emm 4 (30.6%), emm 28 (22.2%), and emm 77 (12.5%) prevailed. Resistance to telithromycin was observed in 22 (5.8%) of the erythromycin-resistant isolates. Sixteen (72.7%) of the 22 isolates appeared to be clonally related, since all of them belonged to emm type 28 and multilocus sequence type 52. One of the well-known mutations (T2166C) in 23S rRNA, as well as a new one (T2136C), was detected in erythromycin- and telithromycin-resistant isolates. High incidence of macrolide resistance and clonal spread of telithromycin resistance were the characteristics of the Greek S. pyogenes isolates obtained from 1999 to 2002.
Subject(s)
Drug Resistance, Bacterial , Erythromycin/pharmacology , Ketolides/pharmacology , Pharyngitis/epidemiology , Streptococcal Infections/epidemiology , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purification , Tonsillitis/epidemiology , Acute Disease , Child , Child, Preschool , Genotype , Greece/epidemiology , Humans , Pharyngitis/microbiology , Phenotype , Streptococcal Infections/diagnosis , Tonsillitis/microbiologyABSTRACT
In a population-based study, regional differences in incidence, serotype distribution and resistance rates in invasive pneumococcal disease in 1-2-year-old children were related to different day care attendance rates. Day-care attendance appears to be a relevant risk factor in some German states and should be considered for inclusion in the recommendations for pneumococcal vaccination of children at risk.
Subject(s)
Child Day Care Centers , Pneumococcal Infections/epidemiology , Population Surveillance , Streptococcus pneumoniae/classification , Adolescent , Age Distribution , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , Drug Resistance, Bacterial , Erythromycin/pharmacology , Germany/epidemiology , Humans , Incidence , Infant , Meningitis, Pneumococcal/epidemiology , Meningitis, Pneumococcal/microbiology , Microbial Sensitivity Tests , Pneumococcal Infections/microbiology , Serotyping , Streptococcus pneumoniae/drug effectsABSTRACT
High-level penicillin G-resistant as well as multidrug-resistant Streptococcus pneumoniae isolates were first described in South Africa in 1977. The relationship between these original multidrug-resistant South African isolates and other resistant clones was investigated. Twenty-six representative isolates isolated from initial outbreaks in South Africa from 1977 to 1978 were characterized by multilocus sequence typing and pulsed-field gel electrophoresis. Twenty-one isolates were penicillin resistant and five were penicillin intermediate, with variable susceptibilities to macrolides, clindamycin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole. Fourteen isolates were serotype 19A, 11 were serotype 6A, and one was serotype 14. Penicillin-resistant serotype 19A isolates belonged to three closely related sequence types (STs), ST 41 (n = 6), ST 1605 (n = 3), and ST 1656 (n = 1). Penicillin-resistant serotype 6A isolates belonged to two closely related STs, ST 1094 (n = 10) and ST 1607 (n = 1), and were not closely related to other international clones. The serotype 14 penicillin-intermediate isolate was not closely related to the other isolates from South Africa but was a predicted founder of a clonal group with 41 different STs. Five new STs, ST 1605, ST 1607, ST 1608, ST 1610, and ST 1656, are described for the first time in this study. New molecular methods have characterized the original multiply resistant South African pneumococcal isolates from 1977 to 1978 and have shown the relationships of these clones to major pneumococcal clones.
Subject(s)
Bacterial Proteins/genetics , Disease Outbreaks , Drug Resistance, Multiple, Bacterial/genetics , Pneumococcal Infections/epidemiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Electrophoresis, Gel, Pulsed-Field , Humans , Internationality , Microbial Sensitivity Tests , Penicillin G/pharmacology , Penicillin Resistance , Phylogeny , Pneumococcal Infections/microbiology , Sequence Analysis, DNA , Serotyping , South Africa/epidemiology , Streptococcus pneumoniae/geneticsABSTRACT
OBJECTIVES AND METHODS: The new fluoroquinolones WCK 771, WCK 1152 and WCK 1153 were developed to overcome quinolone resistance in Gram-positive bacteria. The activity of these new quinolones was tested against 159 clinical isolates of Streptococcus pneumoniae and 52 clinical isolates of Streptococcus pyogenes using the microbroth dilution method. RESULTS: MIC50/MIC90 values (mg/L) of WCK 771, WCK 1152 and WCK 1153 for quinolone-susceptible S. pneumoniae (n = 119; 54 penicillin G-susceptible, 53 penicillin G-intermediate, and 12 penicillin G-resistant strains) were 0.25/0.5, 0.03/0.06 and 0.016/0.03, respectively. MIC50/MIC90 values (mg/L) for quinolone-resistant pneumococci (n = 40) increased to 4/16, 0.25/1 and 0.125/0.5, respectively. Against S. pyogenes, WCK 771, WCK 1152 and WCK 1153 were also highly active with MIC50/MIC90 values (mg/L) of 0.25/0.25, 0.03/0.06 and 0.03/0.03, respectively. CONCLUSIONS: Overall, WCK 771 was highly active against quinolone-susceptible, but not against quinolone-resistant S. pneumoniae, whereas WCK 1152 and WCK 1153 were more potent and were able to overcome quinolone resistance in both S. pneumoniae and S. pyogenes.