Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Abstract

Purpose. Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold.Methodology. This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries.Key findings. Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq.Conclusion. In order to better survey, control and prevent the emergence of multidrug-and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: A systematic review

“…1. pneumoniae was less represented than other pathogens in this review, however a su cient number of studies allowed to attempt a quantitative summary of the proportion of penicillin resistance observed: the ndings of this review are consistent with those of other studies conducted in the region, and con rm that penicillin non-susceptibility among S. pneumoniae in the Middle East is frequently reported around 50% (197).…”

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

“…This results from dimethylation of a critical adenine nucleotide (A2058) located in the peptidyl transferase region of domain V of the 23S rRNA component of the 50S subunit of the bacterial ribosome, thereby interfering with the affinity of members of this class of antibiotics for their microbial target. 46,47 Antibiotic resistance mediated by the erm(B) gene encompasses all types of macrolides (14-,15-and 16-membered), lincosamides (clindamycin, lincomycin), and streptogramins B. 47 In this context, our recent studies have revealed that exposure of an erm(B)-expressing, macrolide-resistant strain of the pneumococcus (strain 2507, serotype 23F) to cigarette smoke condensate (CSC) in vitro in the presence of the macrolide antibiotic, clarithromycin, resulted in significant upregulation of expression of the erm(B) gene relative to that observed in the presence of the antibiotic alone.…”

<p>Serotype Distribution and Antibiotic Susceptibility of <em>Streptococcus pneumoniae</em> Isolates in Tehran, Iran: A Surveillance Study</p>

“…7 High carriage rate and genome remodeling capability, expedite the spread of antibiotic resistance and evasion of vaccine-induced immunity. 8 The increase of multi-drug resistant (MDR) S. pneumoniae has been reported in the Middle Eastern countries, which is becoming a serious problem around the world. 9 High antibiotic resistances have been reported in some serotypes, such as 23F, 19A, 19F, and 14.…”