Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

Vila-Córcoles, Ángel; Bejarano-Romero, Ferran; Salsench, Elisabet; Ochoa-Gondar, Olga; Diego, Cinta de; Gómez, Frederic; Raga-Luria, Xavier; Cliville-Guasch, Xavier; Arija, Victoria

doi:10.1186/1471-2334-9-36

Cited by 20 publications

(17 citation statements)

References 23 publications

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“…In the present study, overall levels of nonsusceptibility to oral benzylpenicillin (13.4%), amoxicillin (2%), cefotaxime (1%), erythromycin (12%), and levofloxacin (0.8%) in S. pneumoniae isolates from elderly patients with pneumonia were lower than the percentages of resistance described in other studies of pneumococcal pneumonia performed in Spain (7,14,30,31). Additionally, and in agreement with recent studies (10,24,31), the trend toward a decrease in nonsusceptible S. pneumoniae isolates seems to be continuing and is associated with a decrease in episodes of pneumonia caused by PCV7 serotypes. PCV7 childhood vaccination in our region seems to have had a beneficial effect in diminishing the (8), none of the isolates causing pneumonia were resistant and only 1% of the isolates obtained during AECOPD episodes showed resistance.…”

Section: Discussioncontrasting

confidence: 50%

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Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Pérez-Trallero

Marimón

Larruskain

et al. 2011

Antimicrob Agents Chemother

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In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of >65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n ‫؍‬ 401) and AECOPD (n ‫؍‬ 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P ‫؍‬ 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.The elderly are generally accepted to be more vulnerable to infections than younger people. Infectious diseases are a major cause of morbidity and mortality in the geriatric population. Increased susceptibility to infections has been attributed not only to anatomical, physiological, and/or immunological aging but also to an increase in the prevalence of chronic diseases, especially cardiovascular and pulmonary diseases (18). Pneumococcal pneumonia is the leading cause of death attributable to infectious diseases in developed countries. To prevent pneumococcal disease in people over the age of 64 years, the 23-valent polysaccharide pneumococcal vaccine (PPV23) was introduced in our region (Basque Country, northern Spain) in autumn 2007. The 7-valent pneumococcal conjugate vaccine (PCV7) for children was introduced in Spain in June 2001, but the 13-valent conjugate vaccine (PCV13) was not introduced until June 2010.Bacterial colonization in chronic obstructive pulmonary disease (COPD) contributes to airway inflammation and modulates exacerbations. The prevalence of bacterial colonization of the airways in stable COPD is high (20,25,28). Most exacerbations are infectious, and Streptococcus pneumoniae is frequently found both in stable periods and in exacerbations. As a consequence of acute exacerbations, patients with COPD receive frequent courses of antimicrobial treatment, which has been associated directly with a higher prevalence of resistant pneumococci (2).The main aim of this study was to determine whether the ser...

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Section: Discussioncontrasting

confidence: 50%

“…In fact, gender, previous antibiotic treatment, and cardiopathy were the only differences between patients with pneumonia with and without COPD. Another two studies performed in Spain found no differences in the antimicrobial resistance of pneumococci causing pneumonia in COPD and non-COPD patients (7,31).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Pérez-Trallero

Marimón

Larruskain

et al. 2011

Antimicrob Agents Chemother

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“…Existing vaccines were even withdrawn from the market. By now, in many parts of the world, the antibiotic resistance of S. pneumoniae bacteria has increased: America [32,33], Africa [34], Europe [35,36], Asia [37][38][39], and Australia [40]. This makes treatment of pneumococcal infections more difficult and stresses the importance of the development of effective vaccines as a strategy to reduce morbidity and mortality caused by S. pneumoniae infection worldwide.…”

Section: Development Of Pneumococcal Vaccinesmentioning

confidence: 99%

The Future of Synthetic Carbohydrate Vaccines: Immunological Studies on Streptococcus pneumoniae Type 14

Safari¹,

Rijkers²,

Snippe³

2012

The Complex World of Polysaccharides

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Additional information is available at the end of the chapter http://dx.doi.org/10.5772/48326 IntroductionStudies on synthetic carbohydrates to be used as potential vaccine candidates for polysaccharide encapsulated bacteria were started in the mid-1970s. They were the logical follow-up to studies being performed at that time on the immunogenicity of antigens composed of carrier proteins and synthetic hapten groups. Hapten-carrier complexes were first introduced in immunology by Karl Landsteiner in the early 1900s [1]. He discovered that (i) small organic molecules with a simple structure, such as phenyl arsonates and nitrophenyls, do not provoke antibodies by themselves, but (ii) if those molecules are attached covalently, by simple chemical reactions, to a protein carrier, then antibodies against those small organic molecules are evoked. Since their introduction, these haptencarrier complexes have become excellent tools to elucidate the role of different antigenreactive cells in the immune response [2]. The key players in this immunological process are thymus-derived T cells and bone marrow-derived B cells. The former group of lymphoid cells is responsible for various phenomena of cell-mediated immunity, e.g. delayed hypersensitivity, allograft-, and graft-versus-host reactions, and reacts with specific determinants on the carrier protein (T cell epitopes). The latter group of lymphoid cells (B cells) give rise to the precursors of antibody-secreting cells, and reacts with both the carrier protein and the synthetic haptenic determinants. This results in antibody formation to both the carrier and the hapten.The reason to apply the above concepts and techniques to carbohydrate antigens was to address an immunological problem: polysaccharide molecules are classified as so-called thymus-independent (TI) antigens, because they do not require T cells to induce an immune response of B cells. As a result, the antibodies formed are mainly of the IgM class and have aThe Complex World of Polysaccharides 618 low avidity. Moreover, no immunological memory is generated and the antigens are poorly immunogenic in infants. Latter characteristic has major implications for development of vaccines against polysaccharide encapsulated bacteria. It was hypothesized that by linking small carbohydrates (oligosaccharides) to a carrier protein, the immunogenic behavior would change to that of a thymus-dependent (TD) antigen. Therefore, the studies of both Goebel [3,4] and Campbell and Pappenheimer [5], who first isolated the antigenic determinant of Streptococcus pneumoniae type 3, were combined and extended. The hapteninhibition studies by Mage and Kabat [6] demonstrated that the antibody-combining site of type 3 pneumococcal polysaccharide consists of two to three cellobiuronic acid units. In the dextran-anti-dextran system extensively studied by Kabat and colleagues [7] the upper size limit of the antibody-combining site appeared to be a hexa-or heptasaccharide and the lower limit was estimated to be somewhat larger than a monosac...

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“…Previous studies described a tendency for resistant strains to decrease selectively after reduction of antibiotic usage (8,19). PMEN clones have a high genomic plasticity, leading to fast adaption to clinical interventions like capsule switching and evolution of resistance (3).…”

mentioning

confidence: 99%

International Pneumococcal Clones Match or Exceed the Fitness of Other Strains despite the Accumulation of Antibiotic Resistance

Rudolf

Michaylov

Linden

et al. 2011

Antimicrob Agents Chemother

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A few international pneumococcal clones dominate the population of antibiotic-resistant pneumococci. Despite the scientific paradigm that a loss in fitness is the price for acquisition of resistance, these clones spread successfully. One hundred fifty-four isolates from adult patients with community-acquired pneumonia (CAP) were analyzed. Thirty percent showed a close relationship to international clones and had fitness equal to or exceeding that of other strains (P ‫؍‬ 0.015); these factors may result in the endurance of these strains despite a reduction of antibiotic usage.

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Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

Cited by 20 publications

References 23 publications

Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease

The Future of Synthetic Carbohydrate Vaccines: Immunological Studies on Streptococcus pneumoniae Type 14

International Pneumococcal Clones Match or Exceed the Fitness of Other Strains despite the Accumulation of Antibiotic Resistance

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