Abstract
In Latin America and the Caribbean, pneumococcal infections are estimated to account for 12000-18000 deaths, 327000 pneumonia cases, 4000 meningitis cases and 1229 sepsis cases each year in children under five years old. Pneumococcal antimicrobial resistance has evolved into a worldwide health problem in the last few decades. This study aimed to determine the antimicrobial susceptibility profiles of pneumococcal isolates collected in Trinidad and Tobago and their associated genetic determinants. Whole-genome sequences were obtained from 98 pneumococcal isolates recovered at several regional hospitals, including 83 invasive and 15 non-invasive strains, recovered before (n=25) and after (n=73) introduction of pneumococcal conjugate vaccines (PCVs). A bioinformatics pipeline was used to identify core genomic and accessory elements conferring antimicrobial resistance phenotypes, including β-lactam non-susceptibility. Forty-one isolates (41.8%) were predicted as resistant to at least one antimicrobial class, including 13 (13.3%) resistant to at least three classes. The most common serotypes associated with antimicrobial resistance were 23F (n=10), 19F (n=8), 6B (n=6) and 14 (n=5). The most common serotypes associated with penicillin non-susceptibility were 19F (n=7) and 14 (n=5). Thirty-nine isolates (39.8%) were positive for PI-1 or PI-2 type pili: 30 (76.9%) were PI-1+, 4 (10.3%) were PI-2+ and 5 (12.8%) were positive for both PI-1 and PI-2. Of the 13 multidrug-resistant isolates, 10 belonged to globally distributed clones PMEN3 and PMEN14 and were isolated in the post-PCV period, suggesting clonal expansion.
Highlights
Infections caused by Streptococcus pneumoniae include diseases such as meningitis, bacteraemia and pneumonia as well as less severe conditions such as sinusitis and otitis media
In Latin America and the Caribbean, pneumococcal infections were estimated to account for 12 000–18 000 deaths, 327 000 cases of pneumonia, 4000 cases of meningitis and 1229 cases of sepsis each year in children under five years old [2]
Non-susceptibility to b-lactams was predicted based on three key penicillinbinding protein (PBP) transpeptidase domain sequences or PBP types [13,14], which correlate with recorded Minimum inhibitory concentrations (MICs) for each of the six b-lactams
Summary
Infections caused by Streptococcus pneumoniae include diseases such as meningitis, bacteraemia and pneumonia as well as less severe conditions such as sinusitis and otitis media. The World Health Organization (WHO) estimated that pneumococcal infections caused 476 000 (5%) deaths globally among human immunodeficiency virus (HIV)-negative children under 5 years of. In Latin America and the Caribbean, pneumococcal infections were estimated to account for 12 000–18 000 deaths, 327 000 cases of pneumonia, 4000 cases of meningitis and 1229 cases of sepsis each year in children under five years old [2]. Resistance of pneumococci to a variety of antimicrobials has evolved into a worldwide health problem [7]. In the Caribbean region, infections due to penicillin-resistant pneumococci have been reported in hospitals and community settings, but limited data are available to estimate patterns of drug resistance [9]. The aim of this study was to determine the antimicrobial susceptibility profiles of 98 pneumococcal isolates collected in Trinidad and Tobago from invasive and non-invasive sites and their associated genetic determinants
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