Molecular Characterization and Antimicrobial Susceptibility of Fluoroquinolone-Resistant or -Susceptible
            <i>Streptococcus pneumoniae</i>
            from Hong Kong

Morrissey, Ian; Farrell, David J.; Bakker, S.; Buckridge, Sylvie; Felmingham, D.

doi:10.1128/aac.47.4.1433-1435.2003

Cited by 26 publications

(24 citation statements)

References 11 publications

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“…The profiles of 7 of the 51 isolates with previously identified MLST profiles matched the profile of clone Spain 23F -1, which has been highlighted as an important clone causing high-level fluoroquinolone resistance in Hong Kong (16,18,26). However, unlike in Hong Kong, the fluoroquinolone-resistant Spain 23F -1 clone did not dominate at any U.S. center.…”

Section: Discussionmentioning

confidence: 52%

“…Sequencing was conducted with an ABI Prism 3100 genetic analyzer (Applied Biosystems, Warrington, United Kingdom) (26). Multilocus sequence typing (MLST), as described by Enright and Spratt (9), was conducted with all levofloxacin-resistant isolates to identify the existence of clonality among them.…”

Section: Amplification and Detection Of Erm(a) Erm(a) Subclass Erm(tmentioning

confidence: 99%

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Prevalence and Molecular Analysis of Macrolide and Fluoroquinolone Resistance among Isolates of Streptococcus pneumoniae Collected during the 2000-2001 PROTEKT US Study

2004

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The PROTEKT US (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin in the United States) surveillance program was established to determine the prevalence and mechanisms of antibacterial resistance among bacterial pathogens from patients with community-acquired respiratory tract infections. In year 1 of the PROTEKT US study, 10,103 isolates of Streptococcus pneumoniae, including 3,133 erythromycin-resistant strains and 81 levofloxacin-resistant strains, were collected from 206 centers. We report on the molecular analyses of these resistant strains. The resistance genotypes among the 3,044 typed macrolide-resistant isolates overall were mef(A) (n ‫؍‬ 2,157; 70.9%), erm(B) (n ‫؍‬ 530; 17.4%), mef(A) erm(B) (n ‫؍‬ 304; 10.0%), and erm(A) subclass erm(TR) (n ‫؍‬ 5; 0.2%). Fifty (1.6%) macrolide-resistant isolates were negative for the mef and the erm resistance genes. Seventy-eight (96.3%) of the 81 levofloxacin-resistant isolates analyzed possessed multiple mutations in the gyrA, gyrB, parC, and/or parE quinolone resistance-determining regions. A total of 43 known multilocus sequence typing (MLST) profiles (or single-or double-locus variants) accounted for 75 of 81 isolates. There was no evidence of dissemination of fluoroquinolone-resistant clones within the United States; however, 12 isolates with the same MLST profile were located in one center in Massachusetts. Almost 90% of the erythromycin-resistant isolates and approximately one-third of the levofloxacin-resistant isolates were multidrug resistant.

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Section: Discussionmentioning

confidence: 52%

Section: Amplification and Detection Of Erm(a) Erm(a) Subclass Erm(tmentioning

confidence: 99%

Prevalence and Molecular Analysis of Macrolide and Fluoroquinolone Resistance among Isolates of Streptococcus pneumoniae Collected during the 2000-2001 PROTEKT US Study

2004

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“…These strains are obviously very efficient at global dissemination, and hence it is very important to monitor their progress through continued surveillance. As evidence of this, we recently described the successful expansion of a fluoroquinolone-resistant Spain 23F -1-14 variant clone (MLST 81) in Hong Kong (19). We are currently in the process of defining all of the isolates testing positive for both erm(B) and mef(A) from PROTEKT global years 2 (2000 to 2001) and 3 (2001 to 2002) to monitor further resistance development and changes in distribution and prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…Discrimination between mef(A) and mef(A) subclass mef(E) was performed by amplifying a segment of the mef(A) gene and then comparing the sequence to the sequences with GenBank accession numbers U70055 [mef(A)] and U83667 [mef(A) subclass mef(E)]. Detection of type II topoisomerase genes gyrA, gyrB, parC, and parE was performed as described previously (19).…”

Section: Methodsmentioning

confidence: 99%

Molecular Epidemiology of Multiresistant Streptococcus pneumoniae with Both erm (B)- and mef (A)-Mediated Macrolide Resistance

et al. 2004

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Of a total of 1,043 macrolide-resistant Streptococcus pneumoniae isolates collected from 24 countries as part of PROTEKT 1999-2000, 71 isolates tested positive for both the mef(A) and erm(B) genes. Of 69 isolates subjected to further molecular investigations, all were resistant to tetracycline, 63 (91.3%) were resistant to penicillin, and 57 (82.6%) were resistant to trimethoprim-sulfamethoxazole. One isolate was also fluoroquinolone resistant, and another was resistant to quinupristin-dalfopristin. The ketolide telithromycin retained activity against all of the isolates. Of the 69 of these 71 isolates viable for further testing, 46 were from South Korea, 13 were from the United States, 8 came from Japan, and 1 each came from Mexico and Hungary. One major clonal complex (59 [85.5%] of 69 isolates) was identified by serotyping (with 85.5% of the isolates being 19A or 19F), pulsed-field gel electrophoresis, and multilocus sequence typing. The remaining isolates were less clonal in nature. Representative isolates were shown to carry the mobile genetic elements Tn1545 and mega, were negative for Tn1207.1, had tetracycline resistance mediated by tet(M), and contained the mef(E) variant of mef(A). All isolates were positive for mel, a homologue of the msr(A) efflux gene. These clones are obviously very efficient at global dissemination, and hence it will be very important to monitor their progress through continued surveillance. Telithromycin demonstrated high levels of activity (MIC for 90% of the strains tested, 0.5 g/ml; MIC range, 0.06 to 1 g/ml) against all isolates.

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“…Among invasive isolates, a resistance rate of 3.8% was documented, although it increased to 15.2% in penicillin-resistant S. pneumoniae isolates (8). These strains have been linked to penicillin-nonsusceptible pneumococcal (PNSP) clones (8,16). In Canada, the rate of ciprofloxacin resistance in S. pneumoniae increased from Ͻ1% in 1997 to 4.2% in 2005, with a rise in the levofloxacin resistance rate to 1.1% (1).…”

mentioning

confidence: 99%

Longitudinally Tracking Fluoroquinolone Resistance and Its Determinants in Penicillin-Susceptible and -Nonsusceptible Streptococcus pneumoniae Isolates in Hong Kong, 2000 to 2005

Chau

Feng

et al. 2007

Antimicrob Agents Chemother

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Of 1,388 Streptococcus pneumoniae isolates collected from 2000 to 2005, 10.5% had a ciprofloxacin MIC of >4.0 g/ml and 1.6% (range, 0.8% to 4.3% per year) had a levofloxacin MIC of >4.0 g/ml. Molecular characterization indicated that fluoroquinolone resistance occurred independently in our prevalent Spain 23F -1 clone, expressing serotypes 23F, 19F, and 14. Rates of resistance to levofloxacin in S. pneumoniae have remained stable at a Hong Kong hospital.Drug-resistant Streptococcus pneumoniae is a major concern in Hong Kong. The rate of fluoroquinolone resistance in S. pneumoniae has been reported as one of highest in the world, with a levofloxacin resistance rate (MIC of Ն4 g/ml) of 13.3% (7). Among invasive isolates, a resistance rate of 3.8% was documented, although it increased to 15.2% in penicillin-resistant S. pneumoniae isolates (8). These strains have been linked to penicillin-nonsusceptible pneumococcal (PNSP) clones (8,16). In Canada, the rate of ciprofloxacin resistance in S. pneumoniae increased from Ͻ1% in 1997 to 4.2% in 2005, with a rise in the levofloxacin resistance rate to 1.1% (1). In the United States, levofloxacin resistance increased from 0.6% to 1.3% (18). Among those strains with a levofloxacin MIC of 2 g/ml, first-step mutations were present in 16.2% of isolates recovered from nursing home residents, compared to 6.5% of isolates recovered from others (17). Such strains have been considered precursors to fully resistant strains (3, 21). Treatment failure with fluoroquinolones due to selection with second-step mutation has been reported (5,14).At the Prince of Wales Hospital (PWH), a 1,350-bed teaching hospital in Hong Kong, we longitudinally tracked the prevalence of fluoroquinolone resistance in S. pneumoniae isolates for the period 2000 to 2005. The clonal relationships of S. pneumoniae isolates with a ciprofloxacin MIC of Ն4 g/ml as determined by serotyping and pulsed-field gel electrophoresis (PFGE) and the mutations at the quinolone resistance-determining region (QRDR) of the gyrA, gyrB, parC, and parE genes were studied.Bacterial isolates and susceptibility tests. A total of 1,388 nonduplicate S. pneumoniae isolates from the blood and sputa of patients admitted to the PWH were examined. The MICs of penicillin, cefotaxime, ciprofloxacin, and levofloxacin were determined by the broth dilution method described by the Clinical and Laboratory Standards Institute (2).PFGE and serotyping. One hundred eight isolates with ciprofloxacin MICs of Ն4 g/ml were examined by PFGE as described previously (6, 11). Serotyping was performed using Pneumotest antisera (Statens Serum Institute, Copenhagen, Denmark). Representative isolates of the Spain 23F -1 clone which produced the indistinguishable PFGE pattern type A were included. Other PFGE types and subtypes were assigned as done by Tenover et al. (23).Analysis of fluoroquinolone resistance genes. The mutations in the QRDRs of the gyrA, gyrB, parC, and parE genes were examined by PCR-restriction fragment-single-strand conformational polymorphism a...

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Molecular Characterization and Antimicrobial Susceptibility of Fluoroquinolone-Resistant or -Susceptible Streptococcus pneumoniae from Hong Kong

Cited by 26 publications

References 11 publications

Prevalence and Molecular Analysis of Macrolide and Fluoroquinolone Resistance among Isolates of Streptococcus pneumoniae Collected during the 2000-2001 PROTEKT US Study

Prevalence and Molecular Analysis of Macrolide and Fluoroquinolone Resistance among Isolates of Streptococcus pneumoniae Collected during the 2000-2001 PROTEKT US Study

Molecular Epidemiology of Multiresistant Streptococcus pneumoniae with Both erm (B)- and mef (A)-Mediated Macrolide Resistance

Longitudinally Tracking Fluoroquinolone Resistance and Its Determinants in Penicillin-Susceptible and -Nonsusceptible Streptococcus pneumoniae Isolates in Hong Kong, 2000 to 2005

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