Macrolide‐Resistant<i>Streptococcus pneumoniae</i>and Use of Antimicrobial Agents

Pihlajamäki, Marja; Kotilainen, Pirkko; Kaurila, Teemu; Klaukka, Timo; Palva, Erkki; Huovinen, Pentti

doi:10.1086/322735

Cited by 84 publications

(45 citation statements)

References 9 publications

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“…18,19,20 Penicillin G is no longer recommended in the United States as the rst- choice drug because of limited supply and the increasing resistance of pneumococci to penicillin 21 , whereas in western countries like Finland, 95% of pneumococcal strains still remained sensitive to penicillin. 22 Since a majority of children with CAP responded signi cantly well to CP in our study, it could still be considered a drug of choice in hospitalized children with CAP in low income and resource poor countries like Nepal.…”

Section: Discussionmentioning

confidence: 68%

Crystalline Penicillin for Community Acquired Pneumonia: Does it still work?

Aryal

Neopane

Thapa

et al. 2013

Med. J. Shree Birendra Hosp.

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Introduction: Pneumonia is the most common cause of mortality and morbidity in children in underdeveloped countries. e common bacterial agents are Streptococcus pneumonia followed by Haemophilus in uenzae type b. e only measure to treat bacterial pneumonia is the correct use of antibiotics along with oxygen in moderate to severe cases. e objectives of this study were to see the clinical features of community-acquired pneumonia and to observe the response to treatment with crystalline penicillin in hospitalized children. Methods: is study was a prospective study. e children aged between two months to 59 months with pneumonia were treated with intravenous crystalline penicillin. Response was observed by normalization of respiratory rate and absence of lower chest indrawing. Results: Out of 88 children treated, 79(89.8%) showed improvement in 48 hours. In children who had tachypnoea, 62.9% showed normalization in respiratory rate in the rst 24 hours and 37.1 percent in 48 hours of treatment. Similarly, among children with lower chest indrawing; 61.1% showed improvement in 24 hours and the remaining in 48 hours. In 24 hours of treatment 17.7% of children became afebrile and 46.8% in 48hours of treatment. Conclusion: e most common clinical features like cough, fever, tachypnoea and lower chest indrawing can be used to diagnose CAP where chest X-ray is not possible. e response to treatment with crystalline penicillin is very good and, thus, can be used as the rst line drug in the treatment of children with CAP.

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Section: Discussionmentioning

confidence: 68%

Crystalline Penicillin for Community Acquired Pneumonia: Does it still work?

Aryal

Neopane

Thapa

et al. 2013

Med. J. Shree Birendra Hosp.

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“…Some examples of events causing selective pressure were increasing use of macrolide in medical treatment, which was significantly correlated with an increase in macrolide-resistant S. pneumoniae [31] as well as heavy usage of tetracycline in medicine, agriculture, and livestock management.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance Patterns and Related Mobile Genetic Elements of Pneumococci and β-Hemolytic Streptococci in Thai Healthy Children

et al. 2016

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Transmission of antibiotic resistance genes among Streptococcus pneumoniae and beta-hemolytic streptococcus (BHS) was generally associated with transmissible genetic elements. The objectives of this study were to investigate carriage rate, antibiotic resistance and related mobile genetic elements of pneumococci and BHS from school-children. The pneumococci and BHS were recovered from 220 Thai school-children, and then tested for antibiotic susceptibility pattern by disc diffusion. Antibiotic resistance genes and related genetic elements were detected by PCR with specific primers. A total of 77 pneumococcal isolates were resistant to erythromycin (42 %), tetracycline (44 %), clindamycin (8 %), or penicillin (3 %). Fifty-four BHS isolates were resistant to erythromycin (28 %), tetracycline (52 %), or clindamycin (13 %). All isolates tested were 100 % sensitive to penicillin and levofloxacin. Among erythromycin-resistant streptococcal isolates showed different phenotypes of clindamycin resistance. It was found that isolated pneumococci showed constitutive clindamycin resistance (19 %), and inducible clindamycin resistance (12 %). The BHS isolates exhibited constitutive clindamycin resistance (40 %), and inducible resistance (20 %) phenotypes. The predominant erythromycin resistance genes in pneumococci and BHS were mefE and ermB, while the most common tetracycline resistance gene in this population was tetM. Furthermore, almost all erythromycin-and tetracycline-resistant streptococci (97 %) mainly contained various genetic elements, including mega elements and six different transposon types (Tn2009, Tn2017, Tn917, Tn3872, Tn6002 and Tn916). Therefore, carriages of pneumococci and BHS with multidrug resistance in children might be important reservoirs of antibiotic-resistance genes carried by transposons. Tn916-like elements could lead to dissemination of the antibiotic resistance genes among genus streptococcus in human oral cavity and nasopharynx.

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“…This is probably related to the increase of macrolide-resistant strains observed in recent years (18,19,32). The introduction of the 7-valent pneumococcal conjugate vaccine may also contribute to the emergence of new or less frequent drug-resistant pneumococci expressing capsular serotypes not covered by the vaccine (14,33), since this vaccine was conceived to target seven of the most common serotypes responsible for invasive disease (4, 6B, 9V, 14, 18C, 19F, and 23F), particularly in the United States.…”

Section: Discussionmentioning

confidence: 99%

Properties of Novel International Drug-Resistant Pneumococcal Clones Identified in Day-Care Centers of Lisbon, Portugal

et al. 2005

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In this study, 61 drug-resistant Streptococcus pneumoniae strains were characterized by multilocus sequence typing (MLST). These strains were representatives of 26 major clones (defined using pulsed-field gel electrophoresis) accounting for 93% of the 1,285 drug-resistant Streptococcus pneumoniae isolates recovered from the nasopharynges of healthy children attending day-care centers in Lisbon during 2001 to 2003. Using MLST, 13 of the 26 clones were found to be identical or closely related to 11 Pneumococcal Molecular Epidemiology Network (PMEN) clones, 4 clones were found to be unique as there were no identical or highly related allelic profiles deposited in the MLST database, and the remaining 9 clones had sequence types that matched or differed at a single or double locus from allelic profiles available in the MLST database. These nine clones were of serotypes 33F, 10A, 19A, 19F, 6A, 20, 24F, and 3, one was nontypeable, and, by MLST, they were found to be identical or highly related to isolates from disease origin that were dispersed internationally. Since the majority of these clones had serotypes that are not included in the 7-valent conjugate pneumococcal vaccine, monitoring of these clones is important for surveying their possible spread in the future. We propose the inclusion of these novel international clones in the PMEN.

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Macrolide‐ResistantStreptococcus pneumoniaeand Use of Antimicrobial Agents

Cited by 84 publications

References 9 publications

Crystalline Penicillin for Community Acquired Pneumonia: Does it still work?

Crystalline Penicillin for Community Acquired Pneumonia: Does it still work?

Antibiotic Resistance Patterns and Related Mobile Genetic Elements of Pneumococci and β-Hemolytic Streptococci in Thai Healthy Children

Properties of Novel International Drug-Resistant Pneumococcal Clones Identified in Day-Care Centers of Lisbon, Portugal

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