Macrolide susceptibility and serotype specific macrolide resistance of invasive isolates of Streptococcus pneumoniae in Germany from 1992 to 2008

Abstract

BackgroundMacrolide resistant Streptococcus pneumoniae has been on a gradual increase in Germany for over a decade. The current study was undertaken against the background of the recent observation of declining macrolide resistance rates especially among German children. Nationwide surveillance of invasive pneumococcal disease has been conducted in Germany since 1992. A population- and laboratory-based approach was used to collect data on invasive pneumococcal disease, and isolates sent to the National Reference Center for Streptococci by diagnostic microbiological laboratories from 1992 to 2008 were included in this study.ResultsFrom 1992 to 2008, data on macrolide susceptibility were available for 11,807 invasive isolates. 8,834 isolates (74.8%) were from adults (≥ 16 years), and 2,973 isolates (25.2%) from children (< 16 years). The overall nonsusceptibility rate of all isolates was 16.2% (intermediate, 0.2%; resistant, 16.0%). Higher resistance rates were observed among children (intermediate, 0.2%; resistant, 23.8%) than among adults (intermediate, 0.3%; resistant 13.4%). Maximum nonsusceptibility rates during the period under study were observed in 2005 (children: intermediate, 0.3%; resistant, 32.3%; adults: intermediate, 0.0%; resistant, 18.6%), while nonsusceptibility rates in 2008 were considerably lower, especially for children (children: intermediate, 0.0%; resistant, 15.2%; adults: intermediate, 0.1%; resistant, 12.9%). The rate of resistance was higher among the vaccine serotypes (7-valent, 36.6%; 10-valent, 28.2%; 13-valent, 24.3%) than among the non vaccine serotypes (non 7-valent, 6.5%; non 10-valent, 7.4%; non 13-valent, 6.3%). Serotype 14 (69.6% nonsusceptibility) proved to be the most resistant serotype.ConclusionsThere has been a considerable and statistically significant decrease in macrolide nonsusceptibility in Germany since 2005, especially among children.

Antimicrobial susceptibility of Streptococcus pneumoniae isolates from vaccinated and non-vaccinated patients with a clinically confirmed diagnosis of community-acquired pneumonia in Belgium

“…However, SG19 (mostly ST19A) has now emerged as the predominant strain in these populations, both in this study and elsewhere [24]. Isolates from this SG, together with those from ST14, were largely nonsusceptible to ␤-lactams and resistant to macrolides, as found by others [25,26]. In contrast, ST1, reported as fully or largely susceptible to macrolides in France and Germany [25,27], showed >30% resistance, confirming another Belgian study [28].…”

“…Isolates from this SG, together with those from ST14, were largely nonsusceptible to ␤-lactams and resistant to macrolides, as found by others [25,26]. In contrast, ST1, reported as fully or largely susceptible to macrolides in France and Germany [25,27], showed >30% resistance, confirming another Belgian study [28]. This may perhaps result from local spread of restricted, successful clones [29,30] and indicates that region-specific surveillance is needed.…”

Serotype distribution and antimicrobial resistance of invasiveStreptococcus pneumoniaeisolates in Bulgaria before the introduction of pneumococcal conjugate vaccine

“…These results are comparable to results reported from other European countries. 9,20 The prevalence and spread of serotypes 19F, 6B, and 19A during the period 2005 to 2010 have contributed to the higher predominance of erm(B) genotype now. The efflux mechanism of macrolide resistance (mef genotype), which was predominant among erythromycin resistant isolates in Bulgaria before 2005, 24 now give place to widely spread MLS B genotype.…”

“…8,9 There is a need to monitor pneumococcal resistance to antibiotics, because the use of PCVs is one of the most important and effective strategy in limiting the spread of this resistance. PCV7 was registered in Bulgaria in 2008, but a small number of children of some risk groups were vaccinated.…”

Invasive Pneumokokken-Erkrankungen in Deutschland im Zeitalter der Pneumokokken-Konjugat-Impfung

“…Auch in Deutschland stieg die Makrolidresistenz seit 1992 über etwa 10 Jahre kontinuierlich an. Insgesamt trugen in Deutschland hauptsächlich die Serotypen 14, 6B, 19F, 19A, 9V und 23F durch eine Kombination aus relativ hoher serotypspezifischer Makrolidresistenz und häufigem Vorkommen zur Gesamtmakrolidresistenz bei [13]. Dies sind dieselben Serotypen, die auch maßgeb-lich zur Penicillinresistenz beitragen.…”