Abstract
Concurrent analysis of antibiotic resistance of colonising and invasive Streptococcus pneumoniae gives a more accurate picture than looking at either of them separately. Therefore, we analysed 2,129 non-invasive and 10,996 invasive pneumococcal isolates from Switzerland from 2004 to 2014, which spans the time before and after the introduction of the heptavalent (PCV7) and 13-valent (PCV13) conjugated pneumococcal polysaccharide vaccines. Serotype/serogroup information was linked with all antibiotic resistance profiles. During the study period, the proportion of non-susceptible non-invasive and invasive isolates significantly decreased for penicillin, ceftriaxone, erythromycin and trimethoprim/sulfamethoxazole (TMP-SMX). This was most apparent in non-invasive isolates from study subjects younger than five years (penicillin (p = 0.006), erythromycin (p = 0.01) and TMP-SMX (p = 0.002)). Resistant serotypes/serogroups included in PCV7 and/or PCV13 decreased and were replaced by non-PCV13 serotypes (6C and 15B/C). Serotype/serogroup-specific antibiotic resistance rates were comparable between invasive and non-invasive isolates. Adjusted odds ratios of serotype/serogroup-specific penicillin resistance were significantly higher in the west of Switzerland for serotype 6B (1.8; 95% confidence interval (CI): 1.4-4.8), 9V (3.4; 95% CI: 2.0-5.7), 14 (5.3; 95% CI: 3.8-7.5), 19A (2.2; 95% CI: 1.6-3.1) and 19F (3.1; 95% CI: 2.1-4.6), probably due to variations in the antibiotic consumption.
Highlights
Antibiotic resistance in Streptococcus pneumoniae is a worldwide concern and can lead to treatment failures with increase in morbidity and mortality, augmented treatment cost and use of more toxic reserve antimicrobials [1,2]
Differences were noted for the PCV13 minus PCV7 and non-PCV13 serotypes/serogroups
The main findings of this study were (i) that antibiotic resistance of pneumococci decreased after the vaccination recommendation of PCV7 and PCV13 and (ii) that patient age and geographical origin of samples had a greater influence on the epidemiology of antibiotic resistance of pneumococci than the site of isolation
Summary
Antibiotic resistance in Streptococcus pneumoniae is a worldwide concern and can lead to treatment failures with increase in morbidity and mortality, augmented treatment cost and use of more toxic reserve antimicrobials [1,2]. In this context, surveillance of antibiotic resistance in S. pneumoniae is important for the appropriate choice of empirical therapy, to detect new resistance developments in a timely manner and to monitor the effect of interventions such as antibiotic stewardship campaigns or vaccines on resistance rates and serotype distribution [3]. In Switzerland, antibiotic resistance in S. pneumoniae has only been analysed in the pre-PCV7 era from 2001 to 2004 [6]
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