Antibiotic Resistance of Non-pneumococcal Streptococci and Its Clinical Impact

Desai, Nainee; Steenbergen, Judith N.; Katz, David

doi:10.1007/978-3-319-47266-9_2

Cited by 3 publications

(5 citation statements)

References 186 publications

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“… 19 Non-susceptibility to penicillin in VGS is caused by mutations in the PBP binding site. 20 Though increases in the prevalence of more resistant VGS species cannot be ruled as a cause for the observed changes in non-speciated VGS over time, the decreases in susceptibility for S. mitis at least suggests that this is not the only explanation. Furthermore, there is little difference in the clindamycin susceptibility rates between VGS species in previous studies, 9 making it unlikely that changes in the distribution of species accounts for changes in clindamycin susceptibility rates over time we observed.…”

Section: Discussionmentioning

confidence: 97%

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020

Singh

Poggensee

Huang

et al. 2022

JAC-Antimicrobial Resistance

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Background Viridans group streptococci (VGS) are typically part of the commensal flora but can also cause severe invasive diseases such as infective endocarditis. There are limited data available showing antibiotic susceptibility over time for VGS. Objectives To evaluate antibiotic susceptibility trends in VGS over time. Methods In vitro susceptibility patterns for 33 antibiotics were examined for Streptococcus mitis, Streptococcus oralis, and non-speciated VGS isolates from patients in Veterans Affairs (VA) Medical Centers in the United States between 2010 and 2020. Susceptibility determinations were made by the individual clinical microbiology laboratories and data were retrospectively collected from the VA Corporate Data Warehouse. Susceptibility trends were analysed using Poisson regression. Results A total of 14 981 VGS isolates were included of which 19.5%, 0.7% and 79.8% were S. mitis, S. oralis and non-speciated VGS isolates, respectively. Cumulative susceptibility rates across all years were similar between species for ceftriaxone (range: 96.0% to 100%), clindamycin (81.3% to 84.5%), and vancomycin (99.7% to 100%). For penicillin, susceptibility rates were 71.0%, 80.9% and 86.3% for S. mitis, S. oralis and non-speciated isolates, respectively. From 2010 to 2020, susceptibility of non-speciated VGS isolates decreased for erythromycin (P = 0.0674), penicillin (P = 0.0835), and tetracycline (P = 0.0994); though the decrease was only significant for clindamycin (P = 0.0033). For S. mitis, a significant susceptibility rate decrease was observed for erythromycin (P = 0.0112). Conclusions Susceptibility rates for some clinically relevant antibiotics declined between 2010 and 2020. This worrisome trend highlights the need to improve antimicrobial stewardship efforts to limit unnecessary antibiotic use and preserve empirical treatment options.

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Section: Discussionmentioning

confidence: 97%

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020

Singh

Poggensee

Huang

et al. 2022

JAC-Antimicrobial Resistance

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“…Despite the fact that these bacteria are generally commensal microorganisms from the oropharynx ( Aas et al., 2005 ), it has been demonstrated to be a causative role in local and disseminated infections. VGS are a common cause of bacteremia and infective endocarditis ( Desai et al., 2017 ). Gram-negative bacteria such as Prevotella , Porphyromonas , and Veillonella and gram-positive cocci such as Granulicatella are isolated from a considerable proportion of mixed anaerobic infections in children ( Brook, 2002 ).…”

Section: Discussionmentioning

confidence: 99%

“…A higher abundance of VGS and typical oral taxa in the nasopharynx of antibiotic-exposed cases despite active treatment could be explained by the considerable rates of resistance to beta-lactam antibiotics described in these bacteria ( Nyfors et al., 2003 ; Desai et al., 2017 ; Arredondo et al., 2020 ), or to the biofilm mode of life of some of these species, which may restrict antibiotic penetration ( Kouidhi et al., 2015 ). In addition, VGS constitute a reservoir of antimicrobial resistance genes that have been described to be transferred to more pathogenic organisms like S. pneumoniae ( Jensen et al., 2015 ), while anaerobic gram-negative bacteria may protect penicillin-susceptible bacteria through beta-lactamase production, contributing to antibiotic failures ( Brook, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Rapid Increase of Oral Bacteria in Nasopharyngeal Microbiota After Antibiotic Treatment in Children With Invasive Pneumococcal Disease

Henares

Rocafort

Brotons

et al. 2021

Front. Cell. Infect. Microbiol.

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IntroductionAntibiotics are commonly prescribed to young children for treating bacterial infections such as invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae. Despite the obvious benefits of antibiotics, little is known about their possible side effects on children’s nasopharyngeal microbiota. In other ecological niches, antibiotics have been described to perturb the balanced microbiota with short- and long-term effects on children’s health. The present study aims to evaluate and compare the nasopharyngeal microbiota of children with IPD and different degree of antibiotic exposure.MethodsWe investigated differences in nasopharyngeal microbiota of two groups of children <18 years with IPD: children not exposed to antibiotics before sample collection (n=27) compared to children previously exposed (n=54). Epidemiological/clinical data were collected from subjects, and microbiota was characterized by Illumina sequencing of V3-V4 amplicons of the 16S rRNA gene.ResultsMain epidemiological/clinical factors were similar across groups. Antibiotic-exposed patients were treated during a median of 4 days (IQR: 3–6) with at least one beta-lactam (100.0%). Higher bacterial richness and diversity were found in the group exposed to antibiotics. Different streptococcal amplicon sequence variants (ASVs) were differentially abundant across groups: antibiotic use was associated to lower relative abundances of Streptococcus ASV2 and Streptococcus ASV11 (phylogenetically close to S. pneumoniae), and higher relative abundances of Streptococcus ASV3 and Streptococcus ASV12 (phylogenetically close to viridans group streptococci). ASVs assigned to typical bacteria from the oral cavity, including Veillonella, Alloprevotella, Porphyromonas, Granulicatella, or Capnocytophaga, were associated to the antibiotic-exposed group. Common nosocomial genera such as Staphylococcus, Acinetobacter, and Pseudomonas were also enriched in the group exposed to antibiotics.ConclusionOur results point toward a reduction of S. pneumoniae abundance on the nasopharynx of children with IPD after antibiotic treatment and a short-term repopulation of this altered niche by oral and nosocomial bacteria. Future research studies will have to evaluate the clinical implications of these findings and if these populations would benefit from the probiotic/prebiotic administration or even from the improvement on oral hygiene practices frequently neglected among hospitalized children.

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“…However, VGS have become increasingly resistant, which has created significant problems for clinicians in recent years. The percentage of resistance against penicillin and erythromycin in the medical literature ranges from 30% to 40% [ 21 , 22 , 25 ]. This resistance is believed to be due to the alteration of penicillin-binding protein [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of resistance against penicillin and erythromycin in the medical literature ranges from 30% to 40% [ 21 , 22 , 25 ]. This resistance is believed to be due to the alteration of penicillin-binding protein [ 25 ]. The subtype isolated in our case was intermediate to penicillin, leading to the use of ceftriaxone for the entire 2 weeks of therapy.…”

Section: Discussionmentioning

confidence: 99%

Viridans Group Streptococcus Meningitis in an Immunocompetent Child: A Case Report

et al. 2021

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Patient: Female, 14-month-old Final Diagnosis: Viridans group streptococcus meningitis Symptoms: Fever • irritability • vomiting Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Viridans group streptococci (VGS) are commensal organisms in humans that are considered contaminants when isolated from culture specimens. However, VGS can be pathogenic when recovered multiple times from blood cultures or when in immunocompromised hosts. VGS are the leading cause of dental abscesses and infective endocarditis in children with underlying congenital heart diseases. They are not commonly involved in meningeal infections, but meningitis due to VGS can be fatal if not treated. The onset is usually preceded by an upper respiratory tract infection or in association with neurological surgical procedures. Case Report: Our patient was a 14-month-old girl with no significant past medical history who presented with fevers and irritability for 2 weeks. A full sepsis workup, including blood, urine, and cerebrospinal fluid (CSF) cultures, was obtained. Culture results were notable for the abundant growth of VGS in the CSF. However, brain imaging and echocardiogram were normal, with no evidence of brain abscesses or cardiac vegetations, respectively. The patient had shown marked clinical improvement after receiving 2 weeks of intravenous ceftriaxone, which was selected based on the VGS susceptibility profile. Conclusions: Bacterial meningitis is one of the most burdensome infectious diseases worldwide, despite improvements in diagnostic methods, management, and national immunization programs. Clinicians should consider VGS in the differential diagnosis of potential infections that can cause meningitis.

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Antibiotic Resistance of Non-pneumococcal Streptococci and Its Clinical Impact

Cited by 3 publications

References 186 publications

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020

Rapid Increase of Oral Bacteria in Nasopharyngeal Microbiota After Antibiotic Treatment in Children With Invasive Pneumococcal Disease

Viridans Group Streptococcus Meningitis in an Immunocompetent Child: A Case Report

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