Spread of Meropenem-Resistant<i>Streptococcus pneumoniae</i>Serotype 15A-ST63 Clone in Japan, 2012–2014

Nakano, Satoshi; Fujisawa, Takao; Ito, Yutaka; Chang, Bin; Matsumura, Yasufumi; Yamamoto, Masaki; Nagao, Miki; Suga, Shigeru; Ohnishi, Makoto; Ichiyama, Satoshi

doi:10.3201/eid2402.171268

Cited by 37 publications

(48 citation statements)

References 33 publications

(41 reference statements)

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“…Considering that ST3111 did not have any alleles in common with ST199 and ST320, which represent sequence types in serotype 19A that have been prevalent after the introduction of PCV7, this clone should be highly specific to Japan. In Japan, the number of cases attributable to non-meropenem-susceptible serotype 15A-ST63 pneumococci increased after the introduction of PCV7 and PCV13 (8,20). A previous study demonstrated that this resistance was caused by recombination in the pbp1a region, which resulted in the insertion of pbp1a-13 (20).…”

Section: Discussionmentioning

confidence: 99%

“…In Japan, the number of cases attributable to non-meropenem-susceptible serotype 15A-ST63 pneumococci increased after the introduction of PCV7 and PCV13 (8,20). A previous study demonstrated that this resistance was caused by recombination in the pbp1a region, which resulted in the insertion of pbp1a-13 (20). This pbp1a-13 allele was identified in serotype 19A-ST320 isolates in the United States (9); however, this clone was not prevalent in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…Whole-genome sequencing. Of the 119 serotype 19A-CC3111 isolates described above, wholegenome sequencing data for seven isolates were obtained in the previous study (20). The sequencing data for the remaining 112 isolates were newly obtained in this study.…”

Section: Methodsmentioning

confidence: 99%

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Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Nakano

Fujisawa

Ito

et al. 2019

Antimicrob Agents Chemother

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Since the introduction of pneumococcal conjugate vaccines, the prevalence of non-meropenem-susceptible pneumococci has been increasing in Japan. In an earlier study, we demonstrated that multidrug-resistant serotype 15A-ST63 in Japan has a specific pbp1a sequence (pbp1a-13) that could promote meropenem resistance. To trace the origin of pbp1a, we analyzed isolates of serotype 19A-CC3111, which is the most prevalent non-meropenem-susceptible clone in Japan. We analyzed a total of 119 serotype 19A-CC3111 strains recovered in Japan using whole-genome sequencing. Of the 119 isolates, 53 (44.5%) harbored pbp1a-13, indicating that the clone may be the primary reservoir of the pbp1a type and that the pbp1a region may be horizontally transferred between different serotype strains. The single acquisition of pbp1a-13 seemed to cause only penicillin resistance and not multidrug resistance; a combination of penicillin-binding protein (PBP) recombination in the pbp2b and/or pbp2x region(s) with acquisition of pbp1a-13 caused multidrug resistance. Conserved amino acid motif analysis suggested that the pbp1a 370SXXK, pbp2b 448SXN, and pbp2x 337SXXN motifs were the candidates for amino acid substitutions increasing the MICs of meropenem, cefotaxime, and penicillin. We identified a specific clone that was correlated with multidrug resistance, although no correlation was observed between phylogenetic trees generated using core genomes and those generated with only the cps locus. All tested isolates were highly erythromycin resistant, and most harbored mefE within macrolide efflux genetic assembly (MEGA) elements and ermB within Tn917, which was inserted within Tn916 and exhibited a structure identical to that of Tn2017.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Nakano

Fujisawa

Ito

et al. 2019

Antimicrob Agents Chemother

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“…We separated the resulting PCR products by using 1% agarose gel electrophoresis and extracted DNA for Sanger sequencing. We used BLAST 2.10.0 (https://blast.ncbi.nlm.nih.gov/Blast.cgi) to compare the nucleotide sequences of each PBP transpeptidase region to the PBP sequences in the US Centers for Disease Control and Prevention database (15) and in previous studies (3,11,16,17).…”

Section: Pbp Profilesmentioning

confidence: 99%

“…(PMEN) standardized nomenclature of prevalent multidrug-resistant international clones causing most invasive diseases, including Spain 23F-ST81 (PMEN1), Taiwan 19F-ST236 (PMEN14), Taiwan 23F -ST242 (PMEN15), and 19A-ST320 (9,10). These clones usually harbored PBPs that are not susceptible to penicillins, third-generation cephalosporins, and meropenem (3,11). Because S. pneumoniae is highly recombinogenic, continued circulation of these highly β-lactam-resistant PBP determinants is of concern in the era of PCV13.…”

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confidence: 99%

Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain^23F-ST81, Taiwan

Chen¹,

Hsieh²,

Gong³

et al. 2020

Emerg. Infect. Dis.

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S treptococcus pneumoniae is a major human pathogen that causes bacteremia, meningitis, pneumonia, and sepsis (1). Although the use of pneumococcal conjugate vaccines (PCVs) has dramatically decreased incidence rates of diseases caused by vaccine-targeted serotypes in children (2), the rates of pneumococcal disease caused by non-PCV serotypes have risen, including as 35B in the United States; 8, 12F, and 9N in the United Kingdom; 24F in France; 12F in Israel; and 15A in Japan (3,4). Of note, 35B and 15A have high-level β-lactam resistance (3,4). Taiwan launched a national vaccination catch-up program in 2013, in which 1 dose of 13-valent PCV (PCV13) was administered to children 24-60 months of age. In 2014, the program was expanded to include 2 doses at 12-23 months of age, and in 2015, a 2+1 national infant immunization program was implemented (5). Since 2015, PCV13 coverage has been >90%, and the incidence of invasive pneumococcal disease (IPD) in children <5 years of age was reduced by 70%, from 18.9/100,000 children during 2010-2012 to 6.3/100,000 children during 2015-2017 (6). Surveillance data from the Taiwan Centers for Disease Control (Taiwan CDC) demonstrated that serogroup 15 isolates caused most IPD in children <5 years of age during 2015-2017, which increased from 0.67/100,000 children in 2010 to 2.61/100,000 children in 2017 (6). In Japan, serotype 15A sequence type (ST) 63 (15A-ST63) was highly associated with resistance to penicillin (MIC >2 mg/L) and meropenem (MIC >0.5 mg/L) (3). Meropenem is a broad-spectrum carbapenem antimicrobial drug recommended for initial empirical therapy in some countries and is indicated for treating bacterial meningitis caused by S. pneumoniae in children >3 months of age (7,8). Meropenem resistance seen in the S. pneumoniae 15A-ST63 clone in Japan was thought to be due to acquisition of penicillin-binding protein (PBP) 1a (type 13) via recombination with a formerly predominant global serotype 19A-ST320 vaccine strain (3).

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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Spread of Meropenem-ResistantStreptococcus pneumoniaeSerotype 15A-ST63 Clone in Japan, 2012–2014

Cited by 37 publications

References 33 publications

Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain^23F-ST81, Taiwan

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

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Spread of Meropenem-ResistantStreptococcus pneumoniaeSerotype 15A-ST63 Clone in Japan, 2012–2014

Cited by 37 publications

References 33 publications

Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Penicillin-Binding Protein Typing, Antibiotic Resistance Gene Identification, and Molecular Phylogenetic Analysis of Meropenem-Resistant Streptococcus pneumoniae Serotype 19A-CC3111 Strains in Japan

Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain23F-ST81, Taiwan

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Contact Info

Product

Resources

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Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain^23F-ST81, Taiwan