Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995

Johnson, Alan P.; Speller, D. C. E.; George, Robert C.; Warner, Marina; Domingue, G.; Efstratiou, Androulla

doi:10.1136/bmj.312.7044.1454

Cited by 82 publications

(54 citation statements)

References 11 publications

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“…The prevalence of erythromycin resistance in S. pneumoniae has increased in several countries over the past few years (13,17,24). However, there are considerable differences between countries in the relative contributions of the M and MLS B phenotypes to the overall prevalence of resistance.…”

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confidence: 99%

Molecular Epidemiology of Erythromycin Resistance in Streptococcus pneumoniae Isolates from Blood and Noninvasive Sites

et al. 2002

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Erythromycin-resistant isolates of Streptococcus pneumoniae from blood cultures and noninvasive sites were studied over a 3-year period. The prevalence of erythromycin resistance was 11.9% (19 of 160) in blood culture isolates but 4.2% (60 of 1,435) in noninvasive-site isolates. Sixty-two of the 79 resistant isolates were available for study. The M phenotype was responsible for 76% (47 of 62) of resistance, largely due to a serotype 14 clone, characterized by multilocus sequence typing as ST9, which accounted for 79% (37 of 47) of M phenotype resistance. The ST9 clone was 4.8 times more common in blood than in noninvasive sites. All M phenotype isolates were PCR positive for mef(A), but sequencing revealed that the ST9 clone possessed the mef(A) sequence commonly associated with Streptococcus pyogenes. All M phenotype isolates with this mef(A) sequence also had sequences consistent with the presence of the Tn1207.1 genetic element inserted in the celB gene. In contrast, isolates with the mef(E) sequence normally associated with S. pneumoniae contained sequences consistent with the presence of the mega insertion element. All MLS B isolates carried erm(B), and two isolates carried both erm(B) and mef(E). Fourteen of the 15 MLS B isolates were tetracycline resistant and contained tet(M). However, six M phenotype isolates of serotypes 19 (two isolates) and 23 (four isolates) were also tetracycline resistant and contained tet(M). MICs for isolates with the mef(A) sequence were significantly higher than MICs for isolates with the mef(E) sequence (P < 0.001). Thus, the ST9 clone of S. pneumoniae is a significant cause of invasive pneumococcal disease in northeast Scotland and is the single most important contributor to M phenotype erythromycin resistance.

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confidence: 99%

Molecular Epidemiology of Erythromycin Resistance in Streptococcus pneumoniae Isolates from Blood and Noninvasive Sites

et al. 2002

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“…9 Although sepsis due to penicillin-resistant strains is considered to be rare in splenectomised patients, 10 the rate is increasing. 11 If the rate at which resistance has progressed is maintained, the morbidity and mortality as a result of resistant pneumococcal infections is likely to increase significantly. 12 Owing to the resistant nature of the S. pneumoniae isolated from our patient and the failure of penicillin prophylaxis a novel prophylactic antibiotic regimen had to be considered.…”

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confidence: 99%

Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma

Tauro¹,

Dobie²,

Richardson

et al. 2000

Bone Marrow Transplant

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Summary:Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neiserria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues. 5 They are also immunised with 23-valent polysaccharide pneumococcal vaccine but the ability to generate an adequate antigen-specific immune response in recipients of alloBMT is time-dependent and may not be consistent. 6,7 To highlight the challenges in the primary prevention of sepsis with encapsulated bacteria in this group of patients, we report on the recurrence of serious penicillin-resistant pneumococcal sepsis in a patient, 8 months post-MUD transplantation for refractory T cell lymphoma. Case reportA 27-year-old man presented with splenomegaly and pancytopenia. A diagnosis of T cell NHL was made on trephine biopsy. He was treated with nine courses of CHOP chemotherapy. A splenectomy was performed 5 months after the initial diagnosis and nodular collections of small lymphocytic cells with slightly irregular nuclei and low mitotic rate, were detected on splenic sections. The cells expressed CD3, CD5 and CD43, thus confirming a diagnosis of lowgrade peripheral T cell lymphoma. Prior to the splenectomy he was immunised with 23-polyvalent polysaccharide pneumococcal vaccine, H. influenza type b (Hib) conjugate vaccine and meningococcal type A and C polysaccharide vaccine. He was subsequently treated with more chemotherapy (miniBEAM and subsequently a combination of idarubicin and cytosine arabinoside). However, marrow examination after completing chemotherapy continued to show infiltration with lymphoma, indicating refractory disease.Since the patient's sister was not HLA compatible, matched unrelated donor transplantation was performed 17 months after the initial diagnosis. The pretransplant conditioning regimen consisted of fractionated total body irradiation 1...

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“…Pneumococcal vaccine contains purified capsular polysaccharide from each of 23 capsular types of pneumococcus, which account fory90% of the pneumococcal isolates causing serious infection [32]. A single dose is usually recommended for patients at high risk from developing pneumococcal disease [33], including those with chronic heart and lung disease, while some authorities advocate immunisation of all persons aged w65 yrs [34].…”

Section: Prevention Of Acute Respiratory Infectionsmentioning

confidence: 99%

Determinants of prognosis of COPD in the elderly: mucus hypersecretion, infections, cardiovascular comorbidity

Pistelli¹,

Lange²,

Miller³

2003

European Respiratory Journal

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In this paper, the authors update the present knowledge about three risk factors for the prognosis of chronic obstructive pulmonary disease (COPD), which may be particularly relevant in elderly people: mucus hypersecretion, respiratory infections, and cardiovascular comorbidity. Chronic mucus hypersecretion (CMH) is a common respiratory symptom in old age, the relevance of which is analysed on the basis of data collected during the first three rounds of the Copenhagen City Heart Study. In subjects aged o65 yrs, CMH was a strong predictor of the incidence of respiratory infections in a 10-yr follow-up period and it was also a strong predictor of death from COPD (relative risk=2.5). However, CMH was associated with consistently lower forced expiratory volume in one second (FEV1) values, but not with an accelerated decline of FEV1 in this sample of an elderly population.Acute respiratory infections (ARI) are extremely common at all ages, mostly mild self-limiting illnesses at a young age, but severe often fatal illnesses in elderly people already affected by a chronic disease such as COPD. This paper summarises the present knowledge about aetiology, pathology, prognostic relevance, and prevention of ARI. Furthermore, the areas in which further research is needed are listed. Clinical cohort studies clearly support the relevance of cardiovascular comorbidity for the shortand long-term prognosis of elderly subjects affected by severe COPD.In this paper, the recently demonstrated association between particulate air pollution and cardiovascular events is reported to suggest the presence of an extremely susceptible cluster of elderly subjects in the population identified by the copresence of chronic obstructive pulmonary disease and cardiovascular comorbidity.

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Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995

Cited by 82 publications

References 11 publications

Molecular Epidemiology of Erythromycin Resistance in Streptococcus pneumoniae Isolates from Blood and Noninvasive Sites

Molecular Epidemiology of Erythromycin Resistance in Streptococcus pneumoniae Isolates from Blood and Noninvasive Sites

Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma

Determinants of prognosis of COPD in the elderly: mucus hypersecretion, infections, cardiovascular comorbidity

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