Macrolide Resistance in<i>Streptococcus pneumoniae</i>Isolated from Patients with Community-Acquired Lower Respiratory Tract Infections in Portugal: Results of a 3-Year (1999-2001) Multicenter Surveillance Study

Melo‐Cristino, José; Ramírez, Mario; Serrano, N; Hänscheid, Thomas

doi:10.1089/107662903764736364

Cited by 19 publications

(11 citation statements)

References 30 publications

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“…This is mainly due to the widespread use of macrolides, mostly azithromycin (8,19). In Portugal, the predominant macrolide phenotype was MLS B , as shown in this study and among isolates recovered from respiratory tract infections (24). The majority of southern European countries also have a high prevalence of the MLS B phenotype (34).…”

Section: Resultssupporting

confidence: 63%

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Dias

Louro

Caniça

2006

Antimicrob Agents Chemother

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Streptococcus pneumoniae is an important pathogen responsible for serious invasive diseases, including meningitis and septicemia. The spread of multidrug-resistant (MDR) pneumococci has become a worldwide problem, making treatment more difficult (18). Indeed, in addition to resistance to penicillin, resistance to other antibiotics, including erythromycin, tetracycline, and chloramphenicol, has emerged and is spreading (10).Since 1989, the National Institute of Health Dr. Ricardo Jorge reference laboratory has been continually monitoring the in vitro activity of antimicrobial agents against S. pneumoniae collected from invasive sources. This program for monitoring susceptibility to antibiotics in Portugal (ARSIP) provides a unique collection of Portuguese pneumococcal isolates. This national surveillance study reported that 4.6% of isolates were penicillin nonsusceptible in 1989, and this value remained generally stable until 1991 (6.4%) (32). Fully penicillin-resistant isolates (MIC of 2 g/ml) were reported for the first time in 1992 (0.8%) and made up 5.5% of isolates in the following year (32).Here, we describe the surveillance of pneumococci by the reference laboratory in Portugal. We report the in vitro activities of different antimicrobial agents used against S. pneumoniae isolated from invasive sources over 11 years (from 1994 to 2004). MATERIALS AND METHODSPatients and bacterial isolates. Between 1 January 1994 and 31 December 2004, the ARSIP survey conducted by the Antibiotic Resistance Unit (ARU) from the National Institute of Health Dr. Ricardo Jorge constantly monitored pneumococcal isolates from cases of invasive disease in various regions of Portugal. The national laboratory-based surveillance system collected 1,331 invasive pneumococcal strains, which were isolated in 24 bacteriology laboratories in hospitals and public health institutions. In the period 1994 to 1998, 12 hospitals participated in the study, and since 1999, 12 more hospitals have been added to the network. Isolates were included if they were nonrepetitive or consecutive blood, cerebrospinal fluid (CSF), or pleural fluid samples from patients with symptoms compatible with invasive pneumococcal disease. No changes were made to the methods of data collection during the study. Some isolates were from outpatients, but most were from patients hospitalized with communityacquired invasive pneumococci disease. Only one isolate per patient was considered. Patients over 15 years old were considered to be adults.Identification and serotyping. The isolates were sent at Ϫ20°C by hospital laboratories to the reference laboratory, ARU, in Trypticase soy broth (TSB; Oxoid, Basingstoke, England) containing 20% glycerol. On reception by the ARU, the purity of the pneumococcal isolate was checked using standard methods, and the isolate was then stored at Ϫ80°C in TSB containing 20% glycerol. Isolates were serotyped by dot blotting, the Quellung reaction, or both (11).Antimicrobial susceptibility testing. Susceptibility testing was performed by the aga...

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Section: Resultssupporting

confidence: 63%

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Dias

Louro

Caniça

2006

Antimicrob Agents Chemother

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“…Macrolide resistance is reported to be frequently associated with resistance to other antibiotics (23,(43)(44)(45)(46). In our study, macrolide-resistant isolates were more likely to have reduced susceptibility to other antibiotics, namely, penicillin (66%) and TMP-SMX (82%).…”

Section: Discussionmentioning

confidence: 53%

Molecular Resistance Mechanisms of Macrolide-Resistant Invasive Streptococcus pneumoniae Isolates from Alaska, 1986 to 2010

Rudolph

Bulkow

Bruce

et al. 2013

Antimicrob Agents Chemother

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The rapid emergence of antibiotic-resistant pneumococcal strains has reduced treatment options. The aim of this study was to determine antimicrobial susceptibilities, serotype distributions, and molecular resistance mechanisms among macrolide-resistant invasive pneumococcal isolates in Alaska from 1986 to 2010. We identified cases of invasive pneumococcal disease in Alaska from 1986 to 2010 through statewide population-based laboratory surveillance. All invasive pneumococcal isolates submitted to the Arctic Investigations Program laboratory were confirmed by standard microbiological methods and serotyped by slide agglutination and the Quellung reaction. MICs were determined by the broth microdilution method, and macrolide-resistant genotypes were determined by multiplex PCR. Among 2,923 invasive pneumococcal isolates recovered from 1986 to 2010, 270 (9.2%) were nonsusceptible to erythromycin; 177 (66%) erythromycin-nonsusceptible isolates demonstrated coresistance to penicillin, and 167 (62%) were multidrug resistant. The most frequent serotypes among the macrolide-resistant isolates were serotypes 6B (23.3%), 14 (20.7%), 19A (16.7%), 9V (8.9%), 19F (6.3%), 6A (5.6%), and 23F (4.8%). mef and erm(B) genes were detected in 207 (77%) and 32 (12%) of the isolates, respectively. Nineteen (7%) of the erythromycin-nonsusceptible isolates contained both mef and erm(B) genotypes; 15 were of serotype 19A. There was significant year-to-year variation in the proportion of isolates that were nonsusceptible to erythromycin (P < 0.001). Macrolide resistance among pneumococcal isolates from Alaska is mediated predominantly by mef genes, and this has not changed significantly over time. However, there was a statistically significant increase in the proportion of isolates that possess both erm(B) and mef, primarily due to serotype 19A isolates.

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“…19,30 The prevalence of PRPn in colonization seems to be lower than the one found in LTRI and invasive infections (1.9% versus 4.7%), and the same was observed for the prevalence of PIRPn (18.2% versus 20.6%). Studies documenting resistance to macrolides in S. pneumoniae isolates from LTRI and invasive infections in Portugal have shown an increase of resistance to this antibiotic during the last decade, from 2.4% in 1991 24 to 12.8% in 2001, 20 and 13.6% in 2002. 9,30 Most erythromycin-resistant strains recovered in these studies were, in addition, resistant to clindamycin.…”

Section: Discussionmentioning

confidence: 99%

Natural History of Drug-Resistant Clones ofStreptococcus pneumoniaeColonizing Healthy Children in Portugal

Mato

Sanches

Simas

et al. 2005

Microbial Drug Resistance

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A total of 3,539 Streptococcus pneumoniae (Pn) were recovered from 4,969 nasopharyngeal samples of children attending 13 day-care centers (DCCs) located in Lisbon, Portugal, during a surveillance study from January, 2001, through March, 2003, integrated in the European intervention project (EURIS, European Resistance Intervention Study). All Pn isolates were tested for anti-biotyping and drug-resistant pneumococci (DRPn) were further tested by serotyping and pulsed-field gel electrophoresis (PFGE). Overall carriage of Pn was very high (71.2%) and 39.9% of the isolates were resistant to antimicrobials (22.5% with decreased susceptibility to penicillin and 17.4% susceptible to penicillin and resistant to other antimicrobials). Serotypes 6B, 14, 23 F, 19F, and 19 A were prevalent among the 1,287 DRPn and 5.8% of the isolates were non-typeable. Eighty PFGE patterns were identified among 1,285 DRPn, and 93.1% of the DRPn belonged to 26 major clonal types that comprised: Pneumococcal Molecular Epidemiology Network (PMEN) clones (76.3%), Portuguese (PT)-DCC clones, previously detected in 1996-1999 (14.3%), and EURIS PT-DCC new clones, identified for the first time in the EURIS study, during 2001-2003 (9.4%). Comparing with previous Portuguese surveillance studies carried out since 1996, we observed that carriage increased from 47% to 71%, but no major changes were detected on the prevalence of pneumococcal serotypes. Moreover, although PMEN clones were predominant in all DCCs, in the present study the majority of them were gradually decreasing in time whereas several PT-DCC and new clones seemed to be increasing.

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Macrolide Resistance inStreptococcus pneumoniaeIsolated from Patients with Community-Acquired Lower Respiratory Tract Infections in Portugal: Results of a 3-Year (1999-2001) Multicenter Surveillance Study

Cited by 19 publications

References 30 publications

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Isolates in Portugal over an 11-Year Period

Molecular Resistance Mechanisms of Macrolide-Resistant Invasive Streptococcus pneumoniae Isolates from Alaska, 1986 to 2010

Natural History of Drug-Resistant Clones ofStreptococcus pneumoniaeColonizing Healthy Children in Portugal

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