Genotyping and serotyping of macrolide and multidrug resistant Streptococcus pneumoniae isolated from carrier children

Aims: Streptococcus pneumoniae, an opportunistic pathogen commonly carried asymptomatically in the nasopharynx of children, is associated with increasing rates of treatment failures due to a worldwide increase in drug resistance. We investigated the carriage of S. pneumoniae in children 5 years or younger, the identity of prevalent serotypes, the rates of resistance to macrolides and other antimicrobial agents and the genotypes responsible for macrolide resistance. Materials and Methods: Nasopharyngeal swabs were collected from 157 children under 5 years for cultural isolation of S. pneumoniae. Antibiogram of isolates  was determined using the disk diffusion test, and the minimal inhibitory concentration to macrolides was determined using the E-test. Isolate serotypes and macrolide resistance genes, erm(B) and mef(E), were identified using multiplex polymerase chain reactions. Results: S. pneumoniae was recovered from 33.8% of children; 41.9% among males and 21.9% among females (P = 0.009). The highest carriage rate occurred among age groups 7-12 months and 49-60 months. Most frequent serotypes were 19F, 6A/B, 11A, 19A, 14 and 15B/C.  Resistance to macrolides was 60.4%. Resistance to oxacillin, trimethoprim/sulfamethoxazole and clindamycin was present among 90.6%, 54.7% and 32.1% of isolates, respectively. All isolates were susceptible to chloramphenicol, levofloxacin and vancomycin. Isolates resistant to one or more macrolide drugs were more likely to be multidrug resistant. Resistance to clindamycin or oxacillin coexisted with macrolide resistance. Among the erythromycin-resistant isolates, erm(B), mef(E) and erm(B) and mef(E) genes were present at rates of 43.8%, 37.5% and 6.3%, respectively. Erm(B) and mef(E) were associated with very high level and moderate-to-high level resistance to macrolides, respectively. Conclusion: A significant proportion of children harboured macrolide and multidrug-resistant S. pneumoniae.

[1]  Hajeej Alhawsawi.  Teacher educators' approaches to teaching Islamic education at a university in the Kingdom of Saudi Arabia, KSA , 2017 .

[2]  Z. Memish,et al.  Antibiotic resistance and serotype distribution of invasive pneumococcal diseases before and after introduction of pneumococcal conjugate vaccine in the Kingdom of Saudi Arabia (KSA). , 2012, Vaccine.

[3]  A. Karimi,et al.  Nasopharyngeal carrier rate of Streptococcus pneumoniae in children: serotype distribution and antimicrobial resistance. , 2012, Archives of Iranian medicine.

[4]  S. Bentley,et al.  Streptococcus pneumoniae: the evolution of antimicrobial resistance to beta-lactams, fluoroquinolones and macrolides. , 2012, Microbes and infection.

[5]  G. Dbaibo,et al.  Genotypes and serotype distribution of macrolide resistant invasive and non- invasive Streptococcus pneumoniae isolates from Lebanon , 2012, Annals of Clinical Microbiology and Antimicrobials.

[6]  M. P. van der Linden,et al.  mef(A) is the predominant macrolide resistance determinant in Streptococcus pneumoniae and Streptococcus pyogenes in Germany. , 2011, International journal of antimicrobial agents.

[7]  Scott Williams,et al.  Changing epidemiology of invasive pneumococcal disease in Australian children after introduction of a 7‐valent pneumococcal conjugate vaccine , 2011, The Medical journal of Australia.

[8]  M. Nahm,et al.  Nasopharyngeal Pneumococcal Carriage of Children Attending Day Care Centers in Korea: Comparison between Children Immunized with 7-valent Pneumococcal Conjugate Vaccine and Non-immunized , 2011, Journal of Korean medical science.

[9]  P. Paradiso,et al.  Advances in pneumococcal vaccines: the 13-valent pneumococcal conjugate vaccine received market authorization in Europe , 2010, Expert review of vaccines.

[10]  D. Beek.  Effect of Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis , 2010 .

[11]  R. Gertz,et al.  Sequential multiplex PCR approach for determining capsular serotypes of Streptococcus pneumoniae isolates. , 2006, Journal of clinical microbiology.

[12]  A. Pantosti,et al.  Evolution of erythromycin resistance in Streptococcus pneumoniae in Italy. , 2005, The Journal of antimicrobial chemotherapy.

[13]  S. Doktor,et al.  Characterization and Prevalence of MefA, MefE, and the Associated msr(D) Gene in Streptococcus pneumoniae Clinical Isolates , 2004, Journal of Clinical Microbiology.

[14]  R. de Groot,et al.  Streptococcus pneumoniae colonisation: the key to pneumococcal disease. , 2004, The Lancet. Infectious diseases.

[15]  I. Morrissey,et al.  Molecular Epidemiology of Multiresistant Streptococcus pneumoniae with Both erm(B)- and mef(A)-Mediated Macrolide Resistance , 2004, Journal of Clinical Microbiology.

[16]  R. Leclercq,et al.  Resistance to Macrolides and Related Antibiotics in Streptococcus pneumoniae , 2002, Antimicrobial Agents and Chemotherapy.

[17]  A. Marchese,et al.  Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children: Implications for the Use of Heptavalent Pnemococcal Conjugate Vaccine , 2002, Emerging infectious diseases.

[18]  R. Adegbola,et al.  The pneumococcus: carriage, disease and conjugate vaccines. , 2002, Journal of medical microbiology.

[19]  J. Kolman,et al.  Susceptibilities to Telithromycin and Six Other Agents and Prevalence of Macrolide Resistance Due to L4 Ribosomal Protein Mutation among 992 Pneumococci from 10 Central and Eastern European Countries , 2002, Antimicrobial Agents and Chemotherapy.

[20]  R. Leclercq,et al.  Diversity of Ribosomal Mutations Conferring Resistance to Macrolides, Clindamycin, Streptogramin, and Telithromycin in Streptococcus pneumoniae , 2002, Antimicrobial Agents and Chemotherapy.

[21]  N. Aydın,et al.  Evaluation of resistance mechanisms and serotype and genotype distributions of macrolide-resistant strains in clinical isolates of Streptococcus pneumonia in Aydın, Turkey , 2011, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy.