Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

Kim, Lindsay; McGee, Lesley; Tomczyk, Sara; Beall, Bernard

doi:10.1128/cmr.00058-15

Cited by 238 publications

(210 citation statements)

References 301 publications

(389 reference statements)

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“…The number of multidrug resistant pneumococcal clones, including those with penicillin resistance, was successfully reduced by the PCV7 [47–49] and the PCV13 vaccine programme for infants [50, 51]. Before 1987, the rate of penicillin nonsusceptible isolates (MIC of ≥ 0.1 mg/L) associated with IPD has been estimated at 5% in the USA, but increased to 25.1% in 1999, with PCV7 serotypes accounting for ∼80% of the cases [51].…”

Section: Discussionmentioning

confidence: 99%

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Whole Genome Sequencing of 39 Invasive Streptococcus pneumoniae Sequence Type 199 Isolates Revealed Switches from Serotype 19A to 15B

Makarewicz¹,

Lucas²,

Brandt³

et al. 2017

PLoS ONE

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Streptococcus pneumoniae is a major pathogen that causes different invasive pneumococcal diseases (IPD). The pneumococcal polysaccharide capsule is a main virulence factor. More than 94 capsule types have been described, but only a limited number of capsule types accounted for the majority of IPD cases before the introduction of pneumococcal vaccines. After the introduction of the conjugated pneumococcal vaccine PCV7, which covered the seven most frequent serotypes in IPD in the USA, an increase in IPD caused by non-vaccine serotypes was observed, and serotype 19A, which belongs to sequence type (ST) 199, was among the most prevalent STs. After the introduction of the extended vaccine PCV13, which includes serotype 19A, serogroup 15B/C increased in IPD. Therefore, whole genome sequences of 39 isolates of ST199 from Germany (collected between 1998 and 2011) with serotype 19A (n = 24) and serogroup 15B/C (n = 15) were obtained using an Illumina platform and were analysed to identify capsular switches within ST199. Two 19A to 15B/C serotype switch events were identified. Both events occurred before the introduction of PCV7, which indicates that a capsular switch from 19A to 15B among ST199 isolates is not unusual and is not directly linked to the vaccination. The observed serotype replacement appears to be the result of a vacant niche due to the displacement of vaccine serotypes that is now successfully occupied by ST199 clones.

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Section: Discussionmentioning

confidence: 99%

“…Before 1987, the rate of penicillin nonsusceptible isolates (MIC of ≥ 0.1 mg/L) associated with IPD has been estimated at 5% in the USA, but increased to 25.1% in 1999, with PCV7 serotypes accounting for ∼80% of the cases [51]. These could be reduced to 17% by PCV7 and 14.4% by PCV13 in USA [50].…”

Section: Discussionmentioning

confidence: 99%

Whole Genome Sequencing of 39 Invasive Streptococcus pneumoniae Sequence Type 199 Isolates Revealed Switches from Serotype 19A to 15B

Makarewicz¹,

Lucas²,

Brandt³

et al. 2017

PLoS ONE

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show abstract

“…2015; Kim et al. 2016). The huge intrinsic variation in the pneumococcal population, the high frequency of HGT and the potential for rapid changes in the global frequency of different clonal types suggest that surveillance to monitor and re-evaluate control measures will be essential (Cohen, Biscardi and Levy 2016).…”

Section: Genetic Context and Resistance Phenotypementioning

confidence: 99%

Environmental and genetic modulation of the phenotypic expression of antibiotic resistance

Hughes¹,

Andersson²

2017

FEMS Microbiology Reviews

143

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Antibiotic resistance can be acquired by mutation or horizontal transfer of a resistance gene, and generally an acquired mechanism results in a predictable increase in phenotypic resistance. However, recent findings suggest that the environment and/or the genetic context can modify the phenotypic expression of specific resistance genes/mutations. An important implication from these findings is that a given genotype does not always result in the expected phenotype. This dissociation of genotype and phenotype has important consequences for clinical bacteriology and for our ability to predict resistance phenotypes from genetics and DNA sequences. A related problem concerns the degree to which the genes/mutations currently identified in vitro can fully explain the in vivo resistance phenotype, or whether there is a significant additional amount of presently unknown mutations/genes (genetic ‘dark matter’) that could contribute to resistance in clinical isolates. Finally, a very important question is whether/how we can identify the genetic features that contribute to making a successful pathogen, and predict why some resistant clones are very successful and spread globally? In this review, we describe different environmental and genetic factors that influence phenotypic expression of antibiotic resistance genes/mutations and how this information is needed to understand why particular resistant clones spread worldwide and to what extent we can use DNA sequences to predict evolutionary success.

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“…Clinicians mostly rely on personal experience and local epidemiological evidence to diagnose and treat lobar pneumonia (5). Several controversies exist about the initial course of treatment for children with lobar pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Principles of antibiotic application in children with lobar pneumonia: Step-up or step-down

Feng

Yang

et al. 2017

Experimental and Therapeutic Medicine

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In order to provide a scientific basis for rational use of antibiotics, we studied and compared the therapeutic effects of step-down and step-up antibiotic treatment schemes in children with lobar pneumonia. Eighty cases of children with lobar pneumonia were enrolled in this study and were randomly divided into two groups: The observation group and the control group, with 40 cases in each group. In the observation group, there were 23 cases with mild and 17 cases with severe lobar pneumonia, and in the control group, 25 were mild and 15 were severe cases. Patients in the control group were treated with antibiotics using step-up therapy method, while patients in the observation group were treated using step-down antibiotic therapy. Our results showed no significant differences in white blood cell (WBC) reduction rate, the course of antibiotic treatment, disappearance time of pulmonary rales and total efficiency in children with mild lobar pneumonia in the observation group after 72 h of treatment. The level of high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) in the observation group were significantly lower. After 72 h of treatment of children with severe lobar pneumonia in the observation group, the rate of WBC reduction accelerated significantly. Compared to the patients in the control group, the course of antibiotic treatment and disappearance time of pulmonary rales were shortened significantly, while the total efficiency of treatment was improved considerably in the observation group. Also in the observation group, hs-CRP and PCT levels were significantly lower than that in the control group. In severe cases, step-down therapy showed a better result in relieving the inflammatory reactions. The disappearance time of pulmonary rales and the effective rate of treatment was significantly higher than those of step-up therapy. It was obvious that for children with severe lobar pneumonia, step-down therapy produced better results in relieving the inflammatory reaction.

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Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

Cited by 238 publications

References 301 publications

Whole Genome Sequencing of 39 Invasive Streptococcus pneumoniae Sequence Type 199 Isolates Revealed Switches from Serotype 19A to 15B

Whole Genome Sequencing of 39 Invasive Streptococcus pneumoniae Sequence Type 199 Isolates Revealed Switches from Serotype 19A to 15B

Environmental and genetic modulation of the phenotypic expression of antibiotic resistance

Principles of antibiotic application in children with lobar pneumonia: Step-up or step-down

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