Antimicrobial Resistance in Streptococcus pneumoniae before and after the Introduction of Pneumococcal Conjugate Vaccines in Brazil: A Systematic Review

Abstract

Streptococcus pneumoniae causes serious illnesses, such as pneumonia, bacteremia, and meningitis, mainly in immunocompromised individuals and those of extreme ages. Currently, pneumococcal conjugate vaccines (PCVs) are the best allies against pneumococcal diseases. In Brazil, the 10-valent and 13-valent PCVs have been available since 2010, but the threat of antimicrobial resistance persists and has been changing over time. We conducted a systematic review of the literature with works published since 2000, generating a parallel between susceptibility data on isolates recovered from colonization and invasive diseases before and after the implementation of PCVs for routine childhood use in Brazil. This systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines. Despite the inclusion of PCVs at a large scale in the national territory, high frequencies of non-susceptibility to important drugs used in pneumococcal diseases are still observed, especially penicillin, as well as increasing resistance to macrolides. However, there are still drugs for which pneumococci have a comprehensive sensitivity profile.

Serotype Distribution and Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae in COVID-19 Pandemic Era in Brazil

“…Faced with this situation, since 2010, Brazil has introduced restrictions for over-the-counter sales of antimicrobials, determining that sales should be associated with the presentation and retention of a medical prescription, promoting control over the use of these products in the country [ 38 ]. This measure, associated with the introduction of PCVs, which contained the prevalent serotypes associated with the antimicrobial resistance causing the IPD in question, resulted in an initial reduction in the non-susceptibility rates to antimicrobials, mainly to beta-lactams, used for the treatment of pneumococcal infections [ 38 , 39 , 40 , 41 ].…”

“…In Brazil, studies evaluating the long-term impact of the use of PCV10 on antimicrobial resistance have demonstrated that the benefit of controlling antimicrobial resistance has impacted by pneumococcal infections caused by non-PCV10 serotypes associated with antimicrobial resistance, mainly serotypes 19A and 6C [ 25 , 30 , 31 , 39 , 40 , 42 ].…”