Serotype Distribution and Antibiotic Susceptibilities of Clinical Streptococcus pneumoniae Strains

Purpose: Streptococcus pneumoniae is a pathogen that cause significant mortality and morbidity in humans. In particular, bacteremia,pneumonia, meningitis and middle ear inflammation. S.pneumoniae can cause many diseases in children and adults. Recently, S.pneumoniaeis the most important cause of acute respiratory tract diseases in developing countries. Increasing antibiotic resistance in S.pneumoniae strainshas recently gained importance. The aim of our study was to investigate the antimicrobial susceptibility and distribution of pneumococcalserotypes of S.pneumoniae strains isolated in our University Hospital.Methods: In this study we evaluated 80 S.pneumoniae strains isolated from adults and children between September 2012 and September 2013.The isolates were obtained from sputum (n=56), nasal secretions (n=4), throat swabs (n=1), blood (n=9), tracheal aspirat (n=2), conjunctivalsmear (n=1), bronchoalveolar lavage (n=6), and biopsy (n=1). Seventy-six isolates were from adults and four were from children. Antibioticsusceptibility testing to penicillin were performed on Mueller-Hinton agar supplemented with 5% sheep blood by the E-test method(bioMerieux, France); erythromycin, clindamycin, vancomycin, chloramphenicol, tetracycline, ofloxacine, levofloxacin, trimethoprim/sulfamethoxazole, rifampin, linezolid, and oxacillin susceptibilities performed by disc diffusion method and 7-10-13-valent Pneumotest-Latex(Statens Serum Institude, Denmark) kit was used for serotyping.Results: A total of 39/80 isolates (48.75%) were intermediate, and 5/80 (6.25%) were resistant to penicillin according to Clinical & LaboratoryStandards Institude (CLSI) guidelines for oral penicillin. Penicillin resistance was not found for parenteral penicillin. Resistance rates oferythromycin, clindamycin, vancomycin, chloramphenicol, tetracycline, ofloxacine, levofloxacin, trimethoprim/sulfamethoxazole, rifampin,and linezolid were as 31.25%, 21.25%, 0%, 5%, 28.75%, 15%, 2.5%, 45%, 0%, and 0% respectively. The most common S.pneumoniae serotypeswere determined as serotypes 19, 6, and 23. Serotyping showed serotype 19 to be the leading serotype among the macrolide-resistant isolates,and serotype coverage of 7-10-13-valent pneumococcal vaccine was 68.75%.Conclusion: The increase in intermediate penicillin resistance in S.pneumoniae in our hospital should be monitored carefully and thedistribution of pneumococcal serotypes is similar to countries where the Pneumococcal Conjugate Vaccine (PCV) has been introduced.

PDF

___

Cherian T. WHO expert consultation on serotype composition of pneumococcal conjugate vaccines for use in resource-poor developing countries, 26–27 October 2006, Geneva. Vaccine 2007;25:6557–6564. [CrossRef]
Reinert RR. The antimicrobial resistance profile of Streptococcus pneumoniae. Clin Microbiol Infect 2009;15 Suppl 3:7–11. [CrossRef]
Van Eldere J, Mera RM, Miller LA, Poupard JA, Amrine-Madsen H. Risk factors for development of multiple-class resistance to Streptococcus pneumoniae strains in Belgium over a 10-year period: Antimicrobial consumption, population density, and geographic location. Antimicrob Agents Chemother 2007;51:3491–97. [CrossRef]
Richter SS, Heilmann KP, Dohrn CL, Riahi F, Beekmann SE, Doern GV. Changing epidemiology of antimicrobial-resistant Streptococcus pneumoniae in the United States, 2004–2005. Clin Infect Dis 2009;1:48:e23–33. [CrossRef]
Kim SH, Song JH, Chung DR, et al. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) study. Antimicrob Agents Chemother 2012;56:1418–1426. [CrossRef]
Altinkanat Gelmez G, Soysal A, Kuzdan C, et al. Serotype Distribution and antibiotic susceptibilities of Streptococcus pneumonia causing acute exacerbations and pneumonia in children with chronic respiratory diseases. Mikrobiyol Bul 2013;47(4):684–692.
Gonullu N, Catal F, Kucukbasmaci O, Ozdemir S, Torun MM, Berkiten R. Comparison of in vitro activities of tigecycline with other antimicrobial agents against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in two university hospitals in Istanbul, Turkey. Chemotherapy 2009;55:161–167. [CrossRef]
Hsueh PR, Teng LJ, Lee LN, Yang PC, Ho SW, Luh KT. Extremely high incidence of macrolide and trimethoprim-sulfamethoxazole resistance among clinical isolates of Streptococcus pneumoniae in Taiwan. J ClinMicrobiol 1999;37:897–901.
Sessegolo JF, Levin AS, Levy CE, Asensi M, Facklam RR, Teixeira LM. Distribution of serotypes and antimicrobial resistance of Streptococcus pneumoniae strains isolated in Brazil from 1988 to 1992. J Clin Microbiol 1994;32:906–911.
Ozalp M, Kanra G, Gür D. Distribution of serotypes and antimicrobial resistance of Streptococcus pneumoniae in a children’s hospital in Turkey. Turk J Pediatr 2004;46:329–332.
Centers for Disease Control and Prevention (CDC). Emergence of antimicrobial-resistant serotype 19A Streptococcus pneumoniae - Massachusetts, 2001–2006. MMWR Morb Mortal Wkly Rep 2007;56:1077–1080.
Soysal A, Karabağ-Yılmaz E, Kepenekli E, et al. The impact of a pneumococcal conjugate vaccination program on the nasopharyngeal carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae among healthy children in Turkey. Vaccine 2016:34 33:3894–3900. [CrossRef]
Arvas A, Çokuğraş E, Gür E, Gönüllü N, Taner Z, Tokman HB. Pneumococcal Nasopharyngeal Carriage in Young Healthy Children After Pneumococcal Conjugate Vaccine in Turkey. Balkan Med J 2017:34:362–366. [CrossRef]