Distribution of Multidrug-Resistant Invasive Serotypes of Streptococcus pneumoniae during the Period 2007–2021 in Madrid, Spain

Abstract

After the systematic use of conjugate vaccines, the invasive pneumococcal disease (IPD) was included into the Madrid Notifiable Diseases Surveillance System through an Epidemiological Surveillance Network. Furthermore, Streptococcus pneumoniae was included in the Spanish Plan of Antibiotic Resistance. The aim of this study was to analyse the multidrug-resistant (MDR) phenotype distribution among invasive strains of Streptococcus pneumoniae isolated during 2007–2021 from usually sterile clinical samples in Madrid, Spain. A total number of 7133 invasive pneumococcal isolates were studied during the period from February 2007 to December 2021. Serotyping was characterised using the Pneumotest-Latex and by the Quellung reaction. Antibiotic susceptibility testing to penicillin (PEN), erythromycin (ERY), and levofloxacin (LVX) was performed using the E-test according to the EUCAST guidelines and breakpoints. Combination of non-susceptibility to PEN at standard dosing regimen (PNSSDR), resistance to ERY (ERYR) and to LVX (LVXR) was considered to be multidrug-resistant at standard dosing regimen of penicillin (MRPSDR), whereas the combination of resistance to PEN (PENR), ERYR, and LVXR was considered multidrug-resistant (MDR). The number of MDRPSDR and or MDR strains in the entire population (n = 7133) during the complete period (2007–2021) were 51 (0.7%) and 6 (0.1%), respectively. All MDRPSDR and/or MDR strains belonged to nine serotypes: 19A (n = 13), 15A (n = 12), 9V (n = 12), 14 (n = 7), 24F (n = 3), 15F (n = 1), 19F (n = 1), 6B (n = 1) and 6C (n = 1). Only two serotypes (9V and 19A) were found among MDR strains, and most of them (5/6) belonged to serotype 9V. Only 12.4% of the strains typified as serotype 9V were MDRPSDR and only 5.2% as MDR. The levels of pneumococcal MDRPSDR and/or MDR in this study were low and all six MDR strains were isolated between 2014 and 2018. These results reinforce the importance of monitoring the evolution of non-susceptible serotypes including those with MDR in the coming years, especially after the introduction of new conjugate vaccines of a broader spectrum.

Surgical Treatment of Pleural Empyema in Children

“…Other germs such as Pseudomonas have appeared as etiological agents. It is due to the appearance of non-susceptible serotypes and multidrug-resistant phenotypes especially after the introduction of new conjugate vaccines of a broader spectrum [28][29][30]. To reduce resistance to antibiotics, it is necessary to strictly comply with the schemes indicated by the infectious diseases committee of each hospital, and be attentive to changes in the frequency of etiological germs and their sensitivity and the appearance of new serotypes that may be resistant.…”

A Review of the Impact of Streptococcal Infections and Antimicrobial Resistance on Human Health

“…The highest level of resistance (92.3%) to clindamycin was detected in recent years in China [35]; in Tunisia it was 64.0% [36], in Turkey 52.4% [29], in Poland 51.0% [21], and in Bulgaria 46.9% [16]. Combined resistance to ß-lactams and macrolides-lincosamides in S. pneumoniae, particularly in childhood, has rapidly spread and become a difficult global problem to overcome [3,13].…”

“…Multiple streptococcal isolates quickly become resistant to macrolides and less to lincosamides, which are alternative drugs for patients with an allergy to penicillin, or failed beta-lactam therapy [10]. This resistance toward macrolides in streptococci from various geographical areas has emerged less than 20 years since the discovery and use of the first macrolide erythromycin [6,[11][12][13][14][15]. The resistance to tetracyclines is another very common one in many countries, and new problematic resistance to the notable fluoroquinolones has appeared in recent years [3,[16][17][18].…”