Capsular Serotype and Antibiotic Resistance of Streptococcus pneumoniae Isolates in Malaysia

Abstract

Background Streptococcus pneumoniae is a major causative agent of severe infections, including sepsis, pneumonia, meningitis, and otitis media, that has since become a major public health concern. In this study, the serotypes distribution of pneumococcal isolates was investigated to predict the efficacy of the 7-valent pneumococcal conjugate vaccine (PCV7) among the Malaysian populations.Methodology/Principal FindingsA total of 151 clinical isolates were serotyped using multiplex PCR assays. Out of them, there were 21.2% penicillin-resistant, 29.1% penicillin-intermediate, and 49.7% penicillin-susceptible S.pneumoniae strains. Serotypes detected among the Malaysian isolates were 1, 3, 10A, 11A/11D, 12F/12A, 14, 15A, 15B/15C, 16F, 18C/18B/18A/18F, 19A, 19F, 23F, 35B, 35F/47F, 6A/6B, 7C/7B/40, 7F/7A, 9V/9A, and 34. Serotype 19F and 23F were the two most prevalent serotypes detected. Serotypes are highly associated with invasiveness of isolates (p = 0.001) and penicillin susceptibility (p<0.001). Serotype 19F was observed to have increased resistance against penicillin while serotype 19A has high invasive tendency. Age of patients was an important factor underlying the pneumococcal serotypes (p = 0.03) and clinical sites of infections (p<0.001). High prevalence of pneumococcal isolates were detected among children <5 years old at nasopharyngeal sites while elderly adults ≥60 years old were at increased risk for pneumococcal bacteremia.Conclusion/SignificanceCurrent study revealed that a number of serotypes, especially those associated with high penicillin resistance, have been formulated in the PCV7. Therefore, the protections expected from the routine use of PCV7 would be encouraging for the Malaysian. However, it is not possible to predict serotypes that might become predominant in the future and hence continued surveillance of circulating serotypes will be needed.

Evolution of Erythromycin Resistance among &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt; Isolates in Malaysia from 2005 and 2010

“…This data suggest that almost 56% (144/255 isolates) are resistant to erythromycin and carry the resistant genes. Similar findings [21], which found more than 50% of the pneumococcal isolates from Asia carry the ermB and mefA gene. Based on these findings, it may be suggested that the use of single macrolide for the treatment of pneumococcal diseases may result in failure of antimicrobial therapy.…”

Regional epidemiology of invasive pneumococcal disease in Asian adults: epidemiology, disease burden, serotype distribution, and antimicrobial resistance patterns and prevention

“…28,[111][112][113][114] A recent study in Malaysia showed that serotype 19F had increased antibiotic resistance and was highly invasive. 88 This study also found that out of 151 clinical isolates, 21.2% were penicillin-resistant S. pneumoniae strains, 29.1% penicillin-intermediate, and 49.7% penicillin-susceptible, 88 whereas another study published in 2011 estimated the penicillin resistance rate to be higher, at 31.78%. 115 Besides, erythromycin resistance rates also appeared to be increasing from 3% (1996-1997) to 36.8% (1998-2001).…”

Current Trend in Pneumococcal Serotype Distribution in Asia

“…In Malaysia, serotype 19F predominated the population at the rate of 20.7%, followed by serotype 6B (9.4%), 19A (6.5%), 23F (6.3%), 14 (5.8%), 1 (5.3%), and 6A (3.8%, not differentiated 6B/A in our previous study [115]). These serotypes accounted for 57.9% of the circulating serotypes in Malaysia.…”