Epidemiologic characteristics, serotypes, and antimicrobial susceptibilities of invasive Streptococcus pneumoniae isolates in a nationwide surveillance study in Lebanon

Hanna-Wakim, Rima; Chehab, Hiba; Mahfouz, Imane; Nassar, Farah; Baroud, Maysa; Shehab, Marwa; Pimentel, Guillermo; Wasfy, Momtaz O.; House, Brent; Araj, George F.; Matar, Ghassan M.; Dbaibo, Ghassan

doi:10.1016/j.vaccine.2012.07.020

Cited by 26 publications

(23 citation statements)

References 29 publications

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“…In a neighboring country, Iran, 11A/D was reported as a rare serotype (2.5%) 26. Comparable studies in the Arabian Gulf, Middle East, and North Africa region (MENA) have revealed 19F, 3, 19A and 23F to be among the most common serotypes, similar to our findings 27. Soto-Noguerón et al28 studied the association between S. pneumoniae serotypes and mortality and found that 2 of the serotypes identified in our study (3 and 19A) were significantly associated with poor prognosis in both adult and pediatric age groups.…”

Section: Discussionsupporting

confidence: 91%

“…The results showed high overall rates of resistance to both classes (67.9%) in both typeable and non-typeable isolates (62.5% of cps A+ and 47% of cps A- isolates). This percentage is high compared with that found in a prospective 6-year study in Saudi Arabia and Lebanon 27,33. Nine of our isolates, representing 4 serotypes (11A/D, 19A, 17F, and 14), were resistant only to penicillin, with the majority of isolates belonging to 11A/D, the predominating serotype in this cohort.…”

Section: Discussioncontrasting

confidence: 50%

“…On the other hand, a study of invasive pneumococcal disease (IPD) among Saudi children aged less than five years (between 2005 and 2010) showed these three vaccines to offer 53%, 80%, and 91% serotype coverage, respectively 10. In Lebanon, a 6-year study including 78 hospitals showed 51%, 74% and 80% of PCV7, PCV10 and PCV13 coverage respectively for children of 2-5 years of age 27. A recent review done in Saudi Arabia stated that different IPD causing pneumococcal serotypes vary between the different geographic areas and the vaccination periods of the studies 7.…”

Section: Discussionmentioning

confidence: 99%

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Phenotypic and molecular study of pneumococci causing respiratory tract infections

Alnimr

Farhat

2017

SMJ

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Objectives:To study serotype distribution and antimicrobial resistance to beta-lactams and macrolides in pneumococci causing respiratory diseases after the introduction of the 13-valent pneumococcal conjugate vaccine in Saudi Arabia.Methods:This is a hospital-based and a cross-sectional prospective surveillance study conducted at King Fahad Hospital of the University, AlKhobar, Kingdom of Saudi Arabia, in which respiratory pneumococcal isolates collected between 2012 and 2014 were serotyped by multiplex sequential polymerase chain reaction (PCR) and Pneumotest-Latex. Resistance genes to beta-lactams and macrolides were detected by multiplex PCR.Results:The most common serotypes encountered were 11A, 19A, 17F, 23F, 3, and 19F, representing 64% of the typeable strains. Interestingly, 24% of the 94 isolates were not typeable and 18% were negative for the housekeeping gene cpsA. Among the 53 typeable pneumococci isolates, 36 (67.9%) carried genes encoding resistance to both penicillin and macrolides, 9 (17%) were penicillin-monoresistant, 3 (5.6%) were macrolide-monoresistant, and 5 (9.4%) were designated non-resistant. The high rate of resistance genes did not significantly differ according to serotype (p=0.76). Similarly, non-typeable pneumococci (cpsA+ and cpsA-) had high rates of resistance to both penicillin (62.5%) and macrolides (47%).Conclusion:These data highlight the emergence of a previously rare capsular type, 11A (mean patient age, 29 years; p=0.001). Moreover, the high percentage of non-typeable isolates shows the emergence of possible atypical pneumococcal serotypes not covered by available vaccines.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

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Phenotypic and molecular study of pneumococci causing respiratory tract infections

Alnimr

Farhat

2017

SMJ

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“…The resistance rates to penicillin, erythromycin and cotrimoxazole were 17.4, 29.3 and 54 % respectively; resistance to levofloxacin did not surpass 1 % and no resistance to vancomycin was documented [91]. However, a higher level of resistance to macrolides, penicillin, tetracycline and cotrimoxazole was reported in another survey [92].…”

Section: Epidemiology Of Resistance In the Middle East Regionmentioning

confidence: 90%

“…Although the prevalence of FQ-resistant S. pneumoniae strains in Lebanon was not high [91,93], first-step mutations were detected in QRDRs of parC (two isolates) and parE (one isolate) among 45 levofloxacin-susceptible clinical strains isolated from north Lebanon [95]. These mutations are usually followed by other mutations that can eventually lead to a high level of FQ resistance.…”

Section: Epidemiology Of Resistance In the Middle East Regionmentioning

confidence: 97%

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Moujaber

Osman

Rafei

et al. 2017

Journal of Medical Microbiology

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Purpose. Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold.Methodology. This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries.Key findings. Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq.Conclusion. In order to better survey, control and prevent the emergence of multidrug-and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.

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Emergence of gram‐negative organisms as the cause of infections in patients with sickle cell disease

Khalife

Hanna-Wakim

Ahmad

et al. 2020

Pediatric Blood & Cancer

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Background: Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis and document a vast decrease in Streptococcus pneumoniae bacteremia rates. Methods: We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis. Results: The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew Streptococcus pneumoniae, 14 grew coagulase-negative staphylococci (1.5%), one grew Salmonella enterica Paratyphi B, and three grew Salmonella enterica group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including Enterobacter cloacae, Bacteroides, Pseudomonas aeruginosa, and Salmonella enterica group C. Conclusions: Immunization against Streptococcus pneumoniae and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis in patients with sickle cell disease.

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Epidemiologic characteristics, serotypes, and antimicrobial susceptibilities of invasive Streptococcus pneumoniae isolates in a nationwide surveillance study in Lebanon

Cited by 26 publications

References 29 publications

Phenotypic and molecular study of pneumococci causing respiratory tract infections

Phenotypic and molecular study of pneumococci causing respiratory tract infections

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Emergence of gram‐negative organisms as the cause of infections in patients with sickle cell disease

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