Emergence of invasive pneumococcal disease caused by multidrug-resistant serotype 19A among children in Barcelona

Muñoz-Almagro, Carmen; Esteva, Cristina; Sevilla, Mariona Fernández de; Selva, Laura; Gené, Amadeu; Pallarés, Román

doi:10.1016/j.jinf.2009.05.012

Cited by 71 publications

(38 citation statements)

References 36 publications

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“…The ST276 clone, only present in San Sebastian before 2001, was successfully disseminated from 2002 in both cities and was the main contributor to the overall increase of serotype 19A infections. This multidrugresistant clone was also found as a frequent clone in other studies of serotype 19A carried out in Spain [10,11], Portugal [12], and France [9], but, until recently, has rarely been found in the USA [7,8,13].…”

Section: Discussionsupporting

confidence: 60%

“…Multidrug-resistant ST320 infections increased in the USA [7,8,13] and Korea [4], probably related to the additional survival advantage conferred by antibiotic resistance. Although antimicrobial resistance has been considered to be an advantage in clonal spread due to selection, ST199 isolates from the present and from other studies [7,9,10] were antimicrobial-susceptible, suggesting that other factors may be responsible for the successful spread of this clone.…”

Section: Discussionmentioning

confidence: 50%

“…This clone was sporadically isolated throughout the study period. ST2013, although a common CC230 ST, was only detected in Barcelona from children aged <5 years [10].…”

Section: Discussionmentioning

confidence: 95%

“…This increase has been observed in countries with and without the introduction of the PCV7 in children [3][4][5]. Moreover, the increase of multidrugresistant pneumococci serotype 19A, such as ST320 in the USA, Europe, and Asia, and ST276 in Europe, is especially worrisome [4,[6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Molecular characterization of Streptococcus pneumoniae invasive serotype 19A isolates from adults in two Spanish regions (1994–2009)

Marimón

Alonso

Rolo

et al. 2011

Eur J Clin Microbiol Infect Dis

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From 1994 to 2009, the incidence of invasive serotype 19A pneumococci isolated from adults in Barcelona and San Sebastian almost doubled every 4 years. Genotyping of the 167 invasive isolates studied showed serotype 19A to be highly heterogeneous, with 35 different sequence types (STs) and a different clonal structure in each region and time period. Multiresistance, defined as non-susceptibility to three or more antimicrobials, was found in 86 (51.5%) isolates. The most frequent ST was the multidrug-resistant ST276 (n=28), which is a single-locus variant of the Denmark 14

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 50%

“…This clone was sporadically isolated throughout the study period. ST2013, although a common CC230 ST, was only detected in Barcelona from children aged <5 years [10].…”

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Molecular characterization of Streptococcus pneumoniae invasive serotype 19A isolates from adults in two Spanish regions (1994–2009)

Marimón

Alonso

Rolo

et al. 2011

Eur J Clin Microbiol Infect Dis

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“…Indeed, the nasopharynx of children is the main reservoir of pneumococci, and a decrease in carriage of PCV7 serotypes has been observed in vaccinated children (5). In addition to that, a replacement of PCV7 serotypes by non-PCV7 serotypes has been observed in carriage and disease (20,25,27,38).PCV7 became commercially available in Portugal in June 2001 but has not been introduced in the National Vaccination Program and is not reimbursed by the state. However, available data indicate that vaccination of children through the private sector has been increasing steadily, reaching ca.…”

mentioning

confidence: 99%

Clonal Evolution Leading to Maintenance of Antibiotic Resistance Rates among Colonizing Pneumococci in the PCV7 Era in Portugal

et al. 2011

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The introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in Portugal led to extensive serotype replacement among carriers of pneumococci, with a marked decrease of PCV7 types. Although antimicrobial resistance was traditionally associated with PCV7 types, no significant changes in the rates of nonsusceptibility to penicillin, resistance to macrolides, or multidrug resistance were observed. This study aimed to investigate the mechanisms leading to maintenance of antimicrobial resistance, despite marked serotype replacement. We compared, through molecular typing, 252 antibiotic-resistant pneumococci recovered from young carriers in 2006 and 2007 (era of high PCV7 uptake) with collections of isolates from 2002 and 2003 (n ‫؍‬ 374; low-PCV7-uptake era) and 1996 to 2001 (n ‫؍‬ 805; pre-PCV7 era). We observed that the group of clones that has accounted for antimicrobial resistance since 1996 is essentially the same as the one identified in the PCV7 era. The relative proportions of such clones have, however, evolved substantially overtime. Notably, widespread use of PCV7 led to an expansion of two Pneumococcal Molecular Epidemiology Network (PMEN) clones expressing non-PCV7 capsular variants of the original strains: Sweden 15A ST63 (serotypes 15A and 19A) and Denmark 14 ST230 (serotypes 19A and 24F). These variants were already in circulation in the pre-PCV7 era, although they have now become increasingly abundant. Emergence of novel clones and de novo acquisition of resistance contributed little to the observed scenario. No evidence of capsular switch events occurring after PCV7 introduction was found. In the era of PCVs, antimicrobial resistance remains a problem among the carried pneumococci. Continuous surveillance is warranted to evaluate serotype and clonal shifts leading to maintenance of antimicrobial resistance.Streptococcus pneumoniae is a Gram-positive bacterium that frequently colonizes asymptomatically the nasopharynx of young children. However, it is also an important human pathogen that can cause a wide range of diseases, from otitis media to pneumonia and meningitis. Worldwide, it has been estimated that 14.5 million episodes of serious pneumococcal disease and 826,000 deaths per year occur in children aged less than 5 years (23).In 2000, a seven-valent pneumococcal conjugate vaccine (PCV7) targeting the seven most common serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) causing invasive disease among young children in the United States became available. Since then, in countries where the vaccine has been introduced in the universal vaccination plan, a dramatic reduction in the incidence of invasive disease caused by PCV7 serotypes has been observed in all age groups (11,17,35). This extended phenomenon beyond the target group, known as herd immunity, has been attributed to decreased transmission of pneumococci from children to other age groups. Indeed, the nasopharynx of children is the main reservoir of pneumococci, and a decrease in carriage of PCV7 serotypes has been observed in vaccina...

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Serotype 3 is a common serotype causing invasive pneumococcal disease in children less than 5 years old, as identified by real-time PCR

Selva

Ciruela

Esteva

et al. 2011

Eur J Clin Microbiol Infect Dis

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Serotype 3 is one of the most often detected pneumococcal serotypes in adults and it is associated with serious disease. In contrast, the isolation of serotype 3 by bacterial culture is unusual in children with invasive pneumococcal disease (IPD). The purpose of this study was to learn the serotype distribution of IPD, including culture-negative episodes, by using molecular methods in normal sterile samples. We studied all children<5 years of age with IPD admitted to two paediatric hospitals in Catalonia, Spain, from 2007 to 2009. A sequential real-time polymerase chain reaction (PCR) approach was added to routine methods for the detection and serotyping of pneumococcal infection. Among 257 episodes (219 pneumonia, 27 meningitis, six bacteraemia and five others), 33.5% were identified by culture and the rest, 66.5%, were detected exclusively by real-time PCR. The most common serotypes detected by culture were serotypes 1 (26.7%) and 19A (25.6%), and by real-time PCR, serotypes 1 (19.8%) and 3 (18.1%). Theoretical coverage rates by the PCV7, PCV10 and PCV13 vaccines were 10.5, 52.3 and 87.2%, respectively, for those episodes identified by culture, compared to 5.3, 31.6 and 60.2% for those identified only by real-time PCR. Multiplex real-time PCR has been shown to be useful for surveillance studies of IPD. Serotype 3 is underdiagnosed by culture and is important in paediatric IPD.

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Emergence of invasive pneumococcal disease caused by multidrug-resistant serotype 19A among children in Barcelona

Cited by 71 publications

References 36 publications

Molecular characterization of Streptococcus pneumoniae invasive serotype 19A isolates from adults in two Spanish regions (1994–2009)

Molecular characterization of Streptococcus pneumoniae invasive serotype 19A isolates from adults in two Spanish regions (1994–2009)

Clonal Evolution Leading to Maintenance of Antibiotic Resistance Rates among Colonizing Pneumococci in the PCV7 Era in Portugal

Serotype 3 is a common serotype causing invasive pneumococcal disease in children less than 5 years old, as identified by real-time PCR

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