Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: A report of three cases

Naba, Mazen R.; Araj, George F.; Baban, Tania A.; Tabbarah, Zuhayr; Awar, Ghassan; Kanj, Souha S.

doi:10.1016/j.jiph.2010.07.003

Cited by 11 publications

(7 citation statements)

References 20 publications

(34 reference statements)

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“…LAU-23F showed an intermediate resistance to ciprofloxacin, cefuroxime and penicillin. Fluoroquinolone and penicillin resistant S. pneumoniae were previously described in Lebanon [6][7][8]. However, with the recent increase in the number of refugees and lack of vaccination among children, streptococcal infections are on the rise [3].…”

Section: Discussionmentioning

confidence: 99%

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Genome analysis of a MDR Streptococcus pneumoniae 23F serotype causing meningoencephalitis in a 10-months refugee infant

Salloum

Tannous

Merheb-Ghoussoub

et al. 2018

J Infect Dev Ctries

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Purpose: Streptococcus pneumoniae is an important human pathogen causing invasive pneumococcal diseases (IPD). The re-emergence of eradicated S. pneumoniae-associated meningoencephalitis in Lebanon is a major point of concern. Methods: We aimed at conducting a comparative genome analysis of a multi-drug resistant S. pneumoniae, LAU-23F, linked to meningoencephalitis and fatality in a 10-months Syrian refugee infant in Lebanon, and 24 related publically available genome sequences. Serotype, capsular genes, MLST, SNPs, phylogenetic relatedness and repertoire of resistance genes were investigated. Genes encoding penicillin binding proteins (PBPs) were examined for mosaicity. Virulence factors were screened for SNPs as compared to reference strains. Results: The isolate belonged to ST-277 and was of serotype 23F. It showed an intermediate resistance to ciprofloxacin, cefuroxime and penicillin and carried multiple components of different efflux pumps. Gene mosaicity was observed in pbp2x, it was also distinct from other penicillin-resistant strains; pbp1a and pbp2b appeared to be conserved between LAU-23F and the reference strain SP49. The arrangement of capsular gene loci was similar to ATCC 700669 though polymorphism was detected in the cpsABCD region, believed to be conserved among different Streptococcus species. Amplitude of virulence factors was detected showing varying degrees of conservation compared to reference strains. Observed zones of high heterogeneity were associated with phage encoded regions. Conclusions: The fine levels of diversity throughout the genome could account for the pronounced invasiveness of this isolate. The genomics-based methods used support the importance of implementing WGS in routine clinical diagnostics and surveillance of streptococcal diseases.

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Section: Discussionmentioning

confidence: 99%

“…Fluoroquinolone and penicillin resistant S. pneumoniae were previously described in Lebanon [6][7][8]. Moreover, resistance to β-lactams through modifications in the penicillin-binding proteins (PBPs) is a hallmark of adaptability in pneumococci [6].…”

Section: Introductionmentioning

confidence: 99%

Genome analysis of a MDR Streptococcus pneumoniae 23F serotype causing meningoencephalitis in a 10-months refugee infant

Salloum

Tannous

Merheb-Ghoussoub

et al. 2018

J Infect Dev Ctries

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“…There is also emerging evidence of fluoroquinolone resistance occurring in pneumococcal isolates. [143][144][145] Fluoroquinolones target mainly DNA gyrase or topoisomerase IV. 143 The main mechanism of fluoroquinolone resistance is the occurrence of mutations in the quinolone resistance-determining regions of parC and gyrA, which encode topoisomerase IV and DNA gyrase, respectively.…”

Section: Fluoroquinolone Resistancementioning

confidence: 99%

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

Feldman

Anderson

2020

Semin Respir Crit Care Med

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AbstractWith the notable exceptions of the United States and Canada in particular, the global burden of disease in adults due to invasive infection with the dangerous respiratory, bacterial pathogen, Streptococcus pneumoniae (pneumococcus) remains. This situation prevails despite the major successes of inclusion of polysaccharide conjugate vaccines (PCVs) in many national childhood immunization programs and associated herd protection in adults, as well as the availability of effective antimicrobial agents. Accurate assessment of the geographic variations in the prevalence of invasive pneumococcal disease (IPD) has, however, been somewhat impeded by the limitations imposed on the acquisition of reliable epidemiological data due to reliance on often insensitive, laboratory-based, pathogen identification procedures. This, in turn, may result in underestimation of the true burden of IPD and represents a primary focus of this review. Other priority topics include the role of PCVs in the changing epidemiology of IPD in adults worldwide, smoking as a risk factor not only in respect of increasing susceptibility for development of IPD, but also in promoting pneumococcal antibiotic resistance. The theme of pneumococcal antibiotic resistance has been expanded to include mechanisms of resistance to commonly used classes of antibiotics, specifically β-lactams, macrolides and fluoroquinolones, and, perhaps somewhat contentiously, the impact of resistance on treatment outcome. Finally, but no less importantly, the role of persistent antigenemia as a driver of a chronic, subclinical, systemic proinflammatory/procoagulant phenotype that may underpin the long-term sequelae and premature mortality of those adults who have recovered from an episode of IPD, is considered.

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“…Naba et al have described the emergence of three isolated strains of levofloxacin resistant Streptococcus pneumoniae [19]. In a study by Kanj et al, looking at the antibiogram of respiratory pathogens collected between 2003 and 2004 in a tertiary care center in Lebanon, resistance in Streptococcus pneumoniae isolates using MIC > 8 mg/L was not detected [20].…”

Section: Level III (Low)mentioning

confidence: 99%

The Lebanese Society for Infectious Diseases and Clinical Microbiology ( LSIDCM ) Guidelines for Adult Community-Acquired Pneumonia ( CAP ) in Lebanon

Moghnieh¹,

Sakr²,

Kanj³

2014

LMJ

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The pandemic of antimicrobial resistance has become a serious threat globally [1]. This situation is aggravated by the paucity of antimicrobials in the pharmaceutical industry pipelines which led to the famous alarm raised by the Infectious Diseases Society of America (IDSA) of "Bad Bugs, No Drugs" situation [2]. The situation in Lebanon is not an exception as the antimicrobial resistance is a rapidly evolving situation in the country as shown by Araj et al. [3]. Susceptibility to fluoroquinolones in Escherichia coli has decreased during the past decade from 75% to 53%, and extended spectrum ß-lactamase (ESßL) production in Klebsiella pneumoniae has increased from 12% to 28% [3-4]. The susceptibility of Enterobacteriaceae to trimethoprim/sulphamethoxazole has remained consistently low (50%), in addition to the emergence of extensively drugresistant (XDR) Acinetobacter, Pseudomonas and carbapenem resistant Enterobacteriaceae [3, 5]. Although antimicrobial resistance is an ancient phenomenon on the genetic level, the use of antibiotic is directly related to emergence and propagation of this resistance at the phenotypic level [6]. Antimicrobial stewardship has become a must to promote judicious use of antibiotics [7]. In this context, the Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM), an official society of the Lebanese Order of Physicians whose members are specialized in infectious diseases and or clinical microbiology, has initiated practice guidelines for common infectious diseases in Lebanon. This working group started the first of these guidelines with community-acquired pneumonia, where a large armamentarium of drugs is being used and where fluoroquinolones play a major role in treatment [8]. Recommendations The recommendations of these guidelines are based on the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) Consensus Guidelines on the Management of CAP in Adults [9] and European

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Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: A report of three cases

Cited by 11 publications

References 20 publications

Genome analysis of a MDR Streptococcus pneumoniae 23F serotype causing meningoencephalitis in a 10-months refugee infant

Genome analysis of a MDR Streptococcus pneumoniae 23F serotype causing meningoencephalitis in a 10-months refugee infant

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

The Lebanese Society for Infectious Diseases and Clinical Microbiology ( LSIDCM ) Guidelines for Adult Community-Acquired Pneumonia ( CAP ) in Lebanon

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