Emergence of invasive erythromycin-resistant Streptococcus pneumoniae strains in Portugal: contribution and phylogenetic relatedness of serotype 14

Dias, Ricardo; Caniça, Manuela

doi:10.1093/jac/dkh469

Cited by 41 publications

(32 citation statements)

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“…The rates of resistance to macrolides have increased worldwide (19), consistent with our findings in Portugal. This is mainly due to the widespread use of macrolides, mostly azithromycin (8,19). In Portugal, the predominant macrolide phenotype was MLS B , as shown in this study and among isolates recovered from respiratory tract infections (24).…”

Section: Resultssupporting

confidence: 64%

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Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Dias

Louro

Caniça

2006

Antimicrob Agents Chemother

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Streptococcus pneumoniae is an important pathogen responsible for serious invasive diseases, including meningitis and septicemia. The spread of multidrug-resistant (MDR) pneumococci has become a worldwide problem, making treatment more difficult (18). Indeed, in addition to resistance to penicillin, resistance to other antibiotics, including erythromycin, tetracycline, and chloramphenicol, has emerged and is spreading (10).Since 1989, the National Institute of Health Dr. Ricardo Jorge reference laboratory has been continually monitoring the in vitro activity of antimicrobial agents against S. pneumoniae collected from invasive sources. This program for monitoring susceptibility to antibiotics in Portugal (ARSIP) provides a unique collection of Portuguese pneumococcal isolates. This national surveillance study reported that 4.6% of isolates were penicillin nonsusceptible in 1989, and this value remained generally stable until 1991 (6.4%) (32). Fully penicillin-resistant isolates (MIC of 2 g/ml) were reported for the first time in 1992 (0.8%) and made up 5.5% of isolates in the following year (32).Here, we describe the surveillance of pneumococci by the reference laboratory in Portugal. We report the in vitro activities of different antimicrobial agents used against S. pneumoniae isolated from invasive sources over 11 years (from 1994 to 2004). MATERIALS AND METHODSPatients and bacterial isolates. Between 1 January 1994 and 31 December 2004, the ARSIP survey conducted by the Antibiotic Resistance Unit (ARU) from the National Institute of Health Dr. Ricardo Jorge constantly monitored pneumococcal isolates from cases of invasive disease in various regions of Portugal. The national laboratory-based surveillance system collected 1,331 invasive pneumococcal strains, which were isolated in 24 bacteriology laboratories in hospitals and public health institutions. In the period 1994 to 1998, 12 hospitals participated in the study, and since 1999, 12 more hospitals have been added to the network. Isolates were included if they were nonrepetitive or consecutive blood, cerebrospinal fluid (CSF), or pleural fluid samples from patients with symptoms compatible with invasive pneumococcal disease. No changes were made to the methods of data collection during the study. Some isolates were from outpatients, but most were from patients hospitalized with communityacquired invasive pneumococci disease. Only one isolate per patient was considered. Patients over 15 years old were considered to be adults.Identification and serotyping. The isolates were sent at Ϫ20°C by hospital laboratories to the reference laboratory, ARU, in Trypticase soy broth (TSB; Oxoid, Basingstoke, England) containing 20% glycerol. On reception by the ARU, the purity of the pneumococcal isolate was checked using standard methods, and the isolate was then stored at Ϫ80°C in TSB containing 20% glycerol. Isolates were serotyped by dot blotting, the Quellung reaction, or both (11).Antimicrobial susceptibility testing. Susceptibility testing was performed by the aga...

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Section: Resultssupporting

confidence: 64%

“…In children, this mainly involved resistance to macrolides; in adults, it was mostly nonsusceptibility to penicillin, macrolides, and ciprofloxacin. The increasing resistance may be associated with the increased use of these antibiotics in recent years (8,13).…”

Section: Resultsmentioning

confidence: 99%

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Dias

Louro

Caniça

2006

Antimicrob Agents Chemother

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“…In Portugal, the emergence of erythromycin-resistant strains, especially serotype 14, correlated with the use of azithromycin (3). Since the efficacy of long-term macrolide therapy for diffuse panbronchiolitis has been established, this has been widely introduced in Japan for diffuse panbronchiolitis and other relevant diseases, such as bronchiectasis and cystic fibrosis (28).…”

Section: Discussionmentioning

confidence: 99%

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

Isozumi¹,

Ito²,

Ishida

et al. 2007

J Clin Microbiol

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Although macrolide-resistant Streptococcus pneumoniae strains possessing either the ermB or mefA gene are very common in Japan, clinical and microbial factors in community-acquired pneumonia (CAP) caused by different macrolide resistance genotypes have not been evaluated. A multicenter study of CAP caused by S. pneumoniae was performed in Japan from 2003 to 2005. A total of 156 isolates were tested for susceptibility to antibiotics correlated with ermB and mefA genotyping. Independent relationships between tested variables and possession of either the ermB or the mefA gene were identified. Of 156 isolates, 127 (81.4%) were resistant to erythromycin, with the following distribution of resistance genotypes: ermB alone (50.0%), mefA alone (23.7%), and both ermB and mefA (7.1%). All isolates were susceptible to telithromycin. By multivariate analysis, oxygen saturation of <90% on admission increased the risk for ermBpositive pneumococcal pneumonia (odds ratio [OR] ‫؍‬ 11.1; 95% confidence interval [CI] ‫؍‬ 1.30 to 95.0; P ‫؍‬ 0.03), but there were no associations with mefA or with ermB mefA positivity. Penicillin nonsusceptibility was associated with mefA-positive and with ermB-and mefA-positive isolates (OR ‫؍‬ 14.2; 95% CI ‫؍‬ 4.27 to 46.9; P < 0.0001 and P < 0.0001, respectively) but not with ermB-positive isolates. The overall patient mortality was 5.1%. Mortality, the duration of hospitalization, and the resolution of several clinical markers were not associated with the different erythromycin resistance genotypes. In Japan, S. pneumoniae with erythromycin resistance or possession of ermB, mefA, or both genes was highly prevalent in patients with CAP. The risk factors for ermB-positive, mefA-positive, and double ermB-mefA-positive pneumococcal pneumonia were different, but the clinical outcomes did not differ.

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“…Other less frequent mechanisms have also been described: point mutations in ribosomal proteins L4 and L22 or in 23S rRNA (17,28). The MLS B phenotype is prevalent in Spain and in most European countries, whereas the M phenotype predominates in North America, England, and Greece (1,8,15,21,29).…”

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Increase of the M Phenotype among Erythromycin-Resistant Streptococcus pneumoniae Isolates from Spain Related to the Serotype 14 Variant of the Spain ^9V -3 Clone

Ardanuy

Fenoll

Berrón

et al. 2006

Antimicrob Agents Chemother

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Emergence of invasive erythromycin-resistant Streptococcus pneumoniae strains in Portugal: contribution and phylogenetic relatedness of serotype 14

Abstract: This study suggests that macrolides usage is an important factor enhancing the spread of invasive erythromycin-resistant S. pneumoniae clones in Portugal. The study also makes a contribution to the understanding of spread of erythromycin-resistant clones in an international context.

Cited by 41 publications

References 8 publications

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

Increase of the M Phenotype among Erythromycin-Resistant Streptococcus pneumoniae Isolates from Spain Related to the Serotype 14 Variant of the Spain ^9V -3 Clone

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Emergence of invasive erythromycin-resistant Streptococcus pneumoniae strains in Portugal: contribution and phylogenetic relatedness of serotype 14

Abstract: This study suggests that macrolides usage is an important factor enhancing the spread of invasive erythromycin-resistant S. pneumoniae clones in Portugal. The study also makes a contribution to the understanding of spread of erythromycin-resistant clones in an international context.

Cited by 41 publications

References 8 publications

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

Increase of the M Phenotype among Erythromycin-Resistant Streptococcus pneumoniae Isolates from Spain Related to the Serotype 14 Variant of the Spain 9V -3 Clone

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Increase of the M Phenotype among Erythromycin-Resistant Streptococcus pneumoniae Isolates from Spain Related to the Serotype 14 Variant of the Spain ^9V -3 Clone