Antimicrobial Resistance Of Streptococcus Research Articles

Application of MALDI-TOF MS to Identify and Detect Antimicrobial-Resistant Streptococcus uberis Associated with Bovine Mastitis.

Streptococcus uberis is a common bovine mastitis pathogen in dairy cattle. The rapid identification and characterization of antimicrobial resistance (AMR) in S. uberis plays an important role in its diagnosis, treatment, and prevention. In this study, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to identify S. uberis and screen for potential AMR biomarkers. Streptococcus uberis strains (n = 220) associated with bovine mastitis in northern Thailand were identified using the conventional microbiological methods and compared with the results obtained from MALDI-TOF MS. Streptococcus uberis isolates were also examined for antimicrobial susceptibility using a microdilution method. Principal component analysis (PCA) and the Mann-Whitney U test were used to analyze the MALDI-TOF mass spectrum of S. uberis and determine the difference between antimicrobial-resistant and -susceptible strains. Using MALDI-TOF MS, 73.18% (161/220) of the sampled isolates were identified as S. uberis, which conformed to the identifications obtained using conventional microbiological methods and PCR. Using PCR, antimicrobial-resistant strains could not be distinguished from antimicrobial-susceptible strains for all three antimicrobial agents, i.e., tetracycline, ceftiofur, and erythromycin. The detection of spectral peaks at 7531.20 m/z and 6804.74 m/z was statistically different between tetracycline- and erythromycin-resistant and susceptible strains, respectively. This study demonstrates a proteomic approach for the diagnosis of bovine mastitis and potentially for the surveillance of AMR among bovine mastitis pathogens.

Antimicrobial Resistance in Streptococcus pneumoniae before and after the Introduction of Pneumococcal Conjugate Vaccines in Brazil: A Systematic Review.

Streptococcus pneumoniae causes serious illnesses, such as pneumonia, bacteremia, and meningitis, mainly in immunocompromised individuals and those of extreme ages. Currently, pneumococcal conjugate vaccines (PCVs) are the best allies against pneumococcal diseases. In Brazil, the 10-valent and 13-valent PCVs have been available since 2010, but the threat of antimicrobial resistance persists and has been changing over time. We conducted a systematic review of the literature with works published since 2000, generating a parallel between susceptibility data on isolates recovered from colonization and invasive diseases before and after the implementation of PCVs for routine childhood use in Brazil. This systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines. Despite the inclusion of PCVs at a large scale in the national territory, high frequencies of non-susceptibility to important drugs used in pneumococcal diseases are still observed, especially penicillin, as well as increasing resistance to macrolides. However, there are still drugs for which pneumococci have a comprehensive sensitivity profile.

Antimicrobial resistance in Streptococcus pneumoniae: a retrospective analysis of emerging trends in the United Arab Emirates from 2010 to 2021.

Although pneumococcal conjugate vaccines (PCV) have been effective in reducing the burden of Streptococcus pneumoniae infections, there is a paucity of data on the relationship with antimicrobial resistance (AMR) trends in the Arabian Gulf region. This study was carried out to assess S. pneumoniae resistance trends in the United Arab Emirates (UAE) where PCV-13 vaccination was introduced in 2011. Retrospective analysis of S. pneumoniae demographic and microbiological data collected as part of the national AMR surveillance program from 2010 to 2021 was carried out. A survey of reporting sites and hand searching of annual reports of local health authorities was carried out to identify data on S. pneumoniae serotypes as this is not included in the AMR surveillance database. From 2010 to 2021, 11,242 non-duplicate S. pneumoniae isolates were reported, increasing from 324 in 2010 to 1,115 in 2021. Factoring in annual increment in the number of surveillance sites, the number of isolates per site showed an upward trajectory from 2015 to 2018 and declined in 2020 with the onset of the pandemic. The majority of isolates (n/N = 5,751/11,242; 51.2%) were from respiratory tract specimens with 44.5% (n/N = 2,557/5,751) being nasal colonizers. Up to 11.9% (n/N = 1,337/11,242) were invasive pneumococcal disease (IPD) isolates obtained from sterile site specimens including blood (n = 1,262), cerebrospinal (n = 52), pleural (n = 19) and joint (n = 4) fluid; and were predominantly from pediatric patients. The downward trend for amoxicillin and for penicillin G at the non-meningitis and meningitis as well as oral penicillin breakpoints was statistically significant. In contrast, increasing trends of resistance were seen for levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole and erythromycin. IPD and non-IPD isolates showed similar demographic and AMR trends. None of the surveillance sites carried out S. pneumoniae serotyping and handsearching of annual reports did not yield this information. The increasing trend of pneumococcal disease and AMR with emergence of isolates with MDR phenotype despite is of concern. In the absence of S. pneumoniae serotyping the role of non-vaccine serotypes in driving this pattern remains unknown. There is an urgent need for serotype, genomic and AMR surveillance of S. pneumoniae isolates in the UAE.

Factors affecting antimicrobial resistance in Streptococcus pneumoniae following vaccination introduction.

Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and septicaemia worldwide. Pneumococcal antimicrobial resistance (AMR) has been highlighted by the WHO as an important public health concern, with emerging serotypes showing resistance to multiple antibiotics. Indeed, although the introduction of pneumococcal conjugate vaccines (PCVs) has been associated with an overall decline in pneumococcal AMR, there have been increases in prevalence of potentially disease-causing AMR serotypes not targeted by vaccination. Here, we discuss a variety of evolutionary mechanisms at the host, pathogen, and environmental levels that may contribute to changes in the prevalence of pneumococcal AMR in the post-vaccination era. The relative importance of these factors may vary by population, pneumococcal lineage, geography, and time, leading to the complex relationship between vaccination, antibiotic use, and AMR.

Antimicrobial resistance of Streptococcus spp. and Staphylococcus spp. isolated from respiratory tract of race horses in Türkiye

As with other animal species, one of the most important challenges encountered in race horse breeding is performance and economic losses caused by infectious diseases. Antibiotics are the most important and common drugs used for protection against infectious diseases. Recently with the occurrence of antibiotic resistance, serious complications have emerged in terms of human and animal health. For this reason, to determine antibiotic resistance in bacteria, many research studies have been carried out in the world and Türkiye. However, in Türkiye no comprehensive study has yet been conducted on antibiotic resistance in race horses. Within the scope of this study, it was aimed to investigate antibacterial susceptibility and resistance in Streptococcus spp. and Staphylococcus spp. agents identified through isolation from tracheal aspiration fluid samples taken from thoroughbred horses brought to 75. Yıl Hippodrome Hospital. Disk Diffusion and Minimum Inhibitory Concentration (MIC) tests were used to determine antibacterial susceptibility. Susceptibility profiles of identified strains against some penicillin, cephalosporin, aminoglycoside, tetracycline, rifamycin and carbapenem group antibacterial drugs were determined. Also, it has been determined that 1 Streptococcus spp. and 10 Staphylococcus spp. agents are sensitive to amoxicillin and ampicillin-sulbactam; moderately sensitive to penicillin and amikacin and resistant to trimethoprim-sulfamethoxazole, kanamycin, gentamicin, enrofloxacin and rifampin.

Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae among Healthy Carrier Children under Five Years Old attended at Outpatient Department of Largest Teaching Hospital in Bangladesh

Background: Over the past several decades, antimicrobial resistance in Streptococcus pneumoniae has dramatically increased worldwide.
 Objectives: The purpose of the present study was to detect and monitor the antibiotic susceptibility pattern of Streptococcus pneumoniae among under five years old children as carrier.
 Methodology: The cross-sectional study was conducted in the Department of Microbiology of Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2017 Data were collected among 200 under five children from Pediatric OPD of Dhaka Medical College Hospital. Streptococcus pneumoniae were isolated and identified by culture, Gram staining and biochemical test. Antimicrobial susceptibility test for S. pneumoniae was performed by disc-diffusion method.
 Results: Out of 200 nasopharyngeal swabs, 67(33.50%) isolates were positive by culture. Among 67 isolated Streptococcus pneumoniae, all the isolates were susceptible to penicillins, cephalosporins, glycopeptides and carbapenems. Among the isolated Streptococcus pneumoniae, 92.53% isolates were susceptible to ciprofloxacin, 52.16% isolates were susceptible to erythromycin and azithromycin. Streptococcus pneumoniae showed very low susceptibility to gentamicin (11.94%) and co-trimoxazole (23.88%).
 Conclusion: This study has shown the antimicrobial susceptibility pattern of Streptococcus pneumoniae in children as carriers.
 Bangladesh Journal of Infectious Diseases June 2021;8(1):12-17

Burden of Pneumococcal Meningitis and Bacteremia, Serotype Distribution and Antibiotic Resistance in Healthy Children After Conjugated Pneumococcal Vaccine Implementation: Single Center Experience

In Turkey, the seven-valent pneumococcal conjugated vaccine (PCV7) was included in the childhood national immunization programme in April 2008 and was replaced by the 13-valent pneumococcal conjugated vaccine (PCV13) in April 2011. In this retrospective, single-center study, it was aimed to determine the serotype distribution and antimicrobial resistance in Streptococcus pneumoniae isolates of pediatric patients with invasive pneumococcal disease (IPD) after the introduction of PVC7 and PVC13. Fifty pediatric patients diagnosed with meningitis and sepsis/bacteremia between October 2009 and October 2019 were included in the study. The pediatric patient group consisted of previously healthy patients diagnosed with meningitis and sepsis/bacteremia with S.pneumoniae isolated in their blood or cerebrospinal fluids. Patients with pneumonia-associated bacteremia and empyema were not included in the study. Serotyping of the isolates was performed by Quellung reaction using specific antisera (Statens Serum Institute, Denmark) and antibiotic (penicillin and ceftriaxone) susceptibility was determined by antibiotic gradient method based on Clinical Laboratory Standards Institute (CLSI) criteria. Of the children, 29 (58%) were boys and 21 (42%) were girls. The median age of the patients was 19 months (1 month-18 year). When the children under the age of five were evaluated, it was found that 30 (79%) patients were diagnosed with occult bacteremia/sepsis and 8 (21%) with meningitis. The overall annual incidence rate of IPD among the healthy children aged <5 years decreased significantly from 9.35/100000 to 0.83/100000 (p< 0.001). Serotype identification was determined for 44 of 50 pneumococcal isolates . However, since six patients with underlying disease were not included in the evaluation, the remaining 38 isolates were found to be one of the serotypes included in PCV7 and PCV13 at a rate of 28.9% (n= 11) and 44.7% (n= 17), respectively. While the rate of PCV13 serotypes seen in the PCV7 period was 81.8%, this rate decreased to 29.6% within eight years after PCV13 administration. The rate of non-vaccine serotypes was determined as 54.5% in PCV7 period and 70.3% in PCV13 period. The rate of non-vaccine serotypes in patients under 5 years was 60% in the period of PCV7 and 75% in the period of PCV13. The proportion of non-vaccine serotypes has increased over time. However, this difference was not statistically significant (p> 0.05). The most common serotypes detected in isolates were 19F, 23F, 7F, 31 and 24B. According to the minimum inhibitory concentration values of the isolates recovered from patients with meningitis, penicillin and ceftriaxone resistance rates were found as 43.9% and 9.8%, respectively. In conclusion, our study showed that there was a 91.1% decrease in the incidence of IPD in healthy children aged under five years after the implementation of PCV7 and PCV13. It was determined that while the rate of serotypes in vaccine content decreased, there was an increase in non-vaccine serotypes. In addition no significant change was observed in antibiotic resistance rates over the years.

Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in the Philippines, 2012–2018

Objective: Data are scarce on the prevailing Streptococcus pneumoniae serotypes in the Philippines, including the relative antimicrobial resistance (AMR) of these bacteria. This study is designed to fill that gap by describing the serotype distribution and AMR of S. pneumoniae in the Philippines from 2012 to 2018. Methodology: S. pneumoniae isolates from clinical specimens were collected through the Philippine Department of Health Antimicrobial Resistance Surveillance Program from 1 January 2012 to 31 December 2018. Identification and antimicrobial susceptibility testing (AST) were performed using conventional and automated methods (Vitek2 Compact Automated Machine). AST for penicillin, erythromycin, co-trimoxazole, ceftriaxone and levofloxacin was done following the Clinical and Laboratory Standard Institute recommendations. Serotyping was done through slide agglutination following the Denka Seiken slide agglutination method. Results: From a total of 307 isolates of S. pneumoniae, 32 serotypes were identified; the most frequently occurring were serotypes 1, 3, 5, 4, 18, 19A, 6B, 15 and 14. Many (n=113, 36.53%) of the isolates were from those aged &lt;5 years. Pneumococcal conjugate vaccine (PCV) coverage was as follows: PCV7 (32.69%), PCV10 (54.16%) and PCV13 (69.23%). The overall AMR of invasive S. pneumoniae isolates was low. Penicillin-resistant serotypes were 14, 19, 24, 4, 5, 1, 15, 6 and 32. Discussion: With the inclusion of PCV13 in the National Immunization Program, continued monitoring of the prevailing serotypes of S. pneumoniae isolates in the Philippines is needed to guide disease and AMR control measures.

Is Hinokitiol Efficacious Against an Antimicrobial-Resistant Strain of Streptococcus pyogenes? A Research Protocol

Introduction: Streptococcus pyogenes, a highly infectious and deadly gram-positive bacterium in the Group A Streptococcus family, that causes respiratory and skin infections. Treatments include oral penicillin and macrolides; however, penicillin and macrolide-resistant Streptococcus pyogenes (e.g., A458) are emerging. Hinokitiol, beta-thujaplicin, has been thought to be an alternative solution to help fight against antimicrobial resistant strains of S. pyogenes as several studies have highlighted its bactericidal effects. These effects in turn, inhibit the production of bacterial adenosine triphosphate and bacteriostatic effects (growth inhibition) of hinokitiol on a related bacterium, Streptococcus pneumoniae and a variant of Streptococcus pyogenes, SSI-9. Furthermore, hinokitiol was found to be very efficacious against a penicillin and macrolide resistant gram-positive bacterium, indicating that penicillin and macrolides likely have a different mechanism of action from hinokitiol. This suggests that microbes are likely not resistant to hinokitiol. Therefore, by extrapolating this data, it is thought that hinokitiol may be efficacious in combatting A458, a concerning antimicrobial resistant strain of Streptococcus pyogenes. Methods: Every step would be performed under triple-blind conditions. Using a solvent control, penicillin G, streptomycin, and hinokitiol, an efficacy trial would be undertaken to evaluate the bactericidal/inhibitory effects of each drug and determine whether hinokitiol is superior to the current gold-standards. A two-way analysis of variance and multiple repeated-measures analysis of variance will be used to evaluate efficacy. Results: It is expected that hinokitiol is efficacious against the resistant strain of Streptococcus pyogenes, A458 unlike streptomycin. Discussion: The strengths of this study are that a novel treatment was used and the experiment was conducted as a triple-blinded experiment. The limitations include its efficiency and the lack of knowledge of the treatment. The statistical test conducted for this study would evaluate whether hinokitiol has a statistically significant effect on a resistant strain of Streptococcus pyogenes. Conclusion: It is likely that hinokitiol will show a resistance-free effect on the two strains of Streptococcus pyogenes. This is a significant undertaking due to the dangers of antimicrobial-resistant Streptococcus pyogenes. However, further experiments need to be conducted to support this hypothesis.

Prevalence of antimicrobial-resistant Streptococcus species among respiratory patients and meat products, and antibacterial effects of oregano oil nanoemulsion

Background and Aim: Antimicrobial-resistant Streptococcus species causes several diseases in humans with infection recurrence in some cases. Handling of food under unhygienic conditions resulted in transmission of pathogens to food leading to risks for consumers' health. This work studies the possible role of humans in transmission of human pathogens to food products. In this study, we focused on the presence of antimicrobial resistance Streptococcus pyogenes, Streptococcus mitis, and Streptococcus pneumoniae found in respiratory patients and in some meat products. We detected the risk factors for patient's infection and examined the antibacterial effect of oregano oil nanoemulsion (ONE) at different concentrations against the multi-drug resistance strains of streptococci. Materials and Methods: Microbiological culture and polymerase chain reaction were used to identify S. pyogenes, S. mitis, and S. pneumoniae in 120 throat swab samples and 200 meat products. The disk diffusion method was used for investigating the prevalence of resistance against 10 antimicrobials that are commonly used in the treatment of humans and animals. ONE at four concentrations (0.5%, 1.0%, 2.0%, and 3.0%) with an average particle size of 45.4 nm was identified using transmission electron microscopy. The effect of ONE on Streptococcus species isolates was examined using the well diffusion method. Risk factors for human infection were detected using statistical analysis. Results: S. pyogenes, S. mitis, and S. pneumoniae were detected in 14 (11.7%), 9 (7.5%), and 7 (5.8%), respectively, of 120 throat swabs of patients. These bacteria were also detected in 11 (5.5%), 8 (4%), and 6 (3%), respectively, of 200 meat products samples. Beef luncheon had the highest infection rate for the three species of streptococci. The majority of these isolates showed resistance to antimicrobials such as tetracycline and amoxicillin/clavulanic acid. ONE had an inhibitory effect on the growth of S. pyogenes, S. mitis, and S. pneumoniae, and its effect was significantly increased at a high concentration (3%), with a mean inhibition zone of 36.45±0.302 mm. Very young and old patients, those with chronic diseases, and those exposed to the infection several times were most susceptible to infection. Conclusion: ONE may be used as a therapeutic agent at safe and specific doses, and also in the food industry, to prevent the spoilage of food and protect human health.

Effective Antibacterial and Antihemolysin Activities of Ellipticine Hydrochloride against Streptococcus suis in a Mouse Model.

Streptococcal toxic shock-like syndrome (STSLS) caused by the epidemic strain of Streptococcus suis leads to severe inflammation and high mortality. The life and health of humans and animals are also threatened by the increasingly severe antimicrobial resistance in Streptococcus suis There is an urgent need to discover novel strategies for the treatment of S. suis infection. Suilysin (SLY) is considered to be an important virulence factor in the pathogenesis of S. suis In this study, ellipticine hydrochloride (EH) was reported as a compound that antagonizes the hemolytic activity of SLY. In vitro, EH was found to effectively inhibit SLY-mediated hemolytic activity. Furthermore, EH had a strong affinity for SLY, thereby directly binding to SLY to interfere with the hemolytic activity. Meanwhile, it was worth noting that EH was also found to have a significant antibacterial activity. In vivo, compared with traditional ampicillin, EH not only significantly improved the survival rate of mice infected with S. suis 2 strain Sc19 but also relieved lung pathological damage. Furthermore, EH effectively decreased the levels of inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and blood biochemistry enzymes (alanine transaminase [ALT], aspartate transaminase [AST], creatine kinase [CK]) in Sc19-infected mice. Additionally, EH markedly reduced the bacterial load of tissues in Sc19-infected mice. In conclusion, our findings suggest that EH can be a potential compound for treating S. suis infection in view of its antibacterial and antihemolysin activity.IMPORTANCE In recent years, the inappropriate use of antibiotics has unnecessarily caused the continuous emergence of resistant bacteria. The antimicrobial resistance of Streptococcus suis has also become an increasingly serious problem. Targeting virulence can reduce the selective pressure of bacteria on antibiotics, thereby alleviating the development of bacterial resistance to a certain extent. Meanwhile, the excessive inflammatory response caused by S. suis infection is considered the primary cause of acute death. Here, we found that ellipticine hydrochloride (EH) exhibited effective antibacterial and antihemolysin activities against S. suisin vitroIn vivo, compared with ampicillin, EH had a significant protective effect on S. suis serotype 2 strain Sc19-infected mice. Our results indicated that EH, with dual antibacterial and antivirulence effects, will contribute to treating S. suis infections and alleviating the antimicrobial resistance of S. suis to a certain extent. More importantly, EH may develop into a promising drug for the prevention of acute death caused by excessive inflammation.

Nasopharyngeal Carriage of Streptococcus pneumoniae and Associated Factors among Children in Southwest Ethiopia

Background: In Ethiopia, Streptococcus pneumoniae is the predominant causative agent of pneumonia. About, 95% of bacterial pneumonia cases in under five years of children are caused by pneumococci. Objective: To assess the nasopharyngeal carriage of Streptococcus pneumoniae, its antibiotic susceptibility pattern, and associated factors among children in Southwest Ethiopia. Methods: A cross-sectional study was conducted from October 01, 2018, to December 30, 2018. A total of 293 children aged ≤15 years were included in the study using a systematic random sampling technique. A nasopharyngeal swab was collected using a sterile cotton swab and cultured on blood agar supplemented with 5μg/ml gentamicin. The antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion technique. Results: The ages of participants ranged from 5 months to 14 years. The carriage rate of Streptococcus pneumoniae was 74/293 (25.3%). Being within the age group &lt;3 years, the habit of sleeping with parent(s)/guardians and numbers of rooms per household were significantly associated with pneumococcal carriage. Streptococcus pneumoniae showed the highest resistance to Tetracycline, 36 (48.65%), and Trimethoprim/sulfamethoxazole, 29 (39.2%), and was found to be susceptible to Chloramphenicol, 54 (77%), and Erythromycin, 38 (51.4%). Conclusion: The nasopharyngeal carriage rate of Streptococcus pneumoniae is considerably high. High antimicrobial resistance of Streptococcus pneumoniae against Tetracycline and Trimethoprim/sulfamethoxazole was observed. Living in a house with a single room, children’s habit of sleeping with parents/guardians and age are associated factors of high pneumococcal carriage. Strategies need to be designed to address the modifiable associated factors and the bacterium antibiotic resistance pattern should be monitored regularly.

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

Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013–2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain23F-ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure.

Serotypes of Streptococcus pneumoniae in Egyptian children: are they covered by pneumococcal conjugate vaccines?

In Egypt, pneumococcal vaccines have not yet been introduced as being compulsory. Identification of the circulating serotypes in Egypt is mandatory to determine whether or not the pneumococcal vaccines will be beneficial. The current study aims to identify the serotypes, vaccine coverage, and antimicrobial resistance of Streptococcus pneumoniae colonizing the nasopharynx of Egyptian children younger than 5years old. The study was conducted in two successive winter seasons (December 2012-February 2013 and December 2013-February 2014). Two hundred children were enrolled, aged from 6months to 5years, excluding those with fever, signs of infection, history of antibiotic intake, and hospitalization in the preceding month. Nasopharyngeal (NP) secretions were collected, subjected to culture, and underwent antibiotic susceptibility testing if positive for pneumococci. Real-time polymerase chain reaction (PCR) and serotyping by sequential multiplex PCR for positive cases were included as well. Streptococcus pneumoniae was isolated from 62 subjects. All isolates were sensitive to vancomycin and levofloxacin, but the majority showed resistance to multiple antibiotics. PCR was positive for pneumococci in 113 subjects (56.5%). The most commonly detected serotypes (st) were 6A6B6C (n=21, 20.8%), 19F (n=19, 18.8%), 1 (n=11, 10.9%), 34 (n=8, 7.9%), and 19A (n=6, 5.9%). The theoretical coverage of the PCV13 vaccine for the detected serotypes was 72.4%, while that of PCV10 was 65.5%. Based on these percentages, we recommend including pneumococcal conjugate vaccines in the Egyptian national vaccination program.

Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Invasive Isolates Collected at the Italian Hospital of Desio, Lombardy, from 2008 to 2016.

Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Invasive Isolates Collected at the Italian Hospital of Desio, Lombardy, from 2008 to 2016.

Prediction of the temperature response to antibiotic treatment in children with pneumonia

Nielsen et al. [1] present in this issue an innovative retrospective study that attempts to define the population of children with pneumonia who will respond to antimicrobilal therapy. This was done by correlating the clinical, laboratory and radiological variables available at the time of admission to the hospital with the temperature response to intravenous antibiotic (mainly penicillin) treatment. Since typical and atypical bacterial and viral cultures as well as other methods of diagnosis were not routinely performed, a rapid reduction in fever following initiation of therapy signified in this study the presence of bacterial infection. What allows such an analysis, according to the authors, is that antimicrobial resistance of Streptococcus pneumoniae and of Haemophilus influenzae is practically nonexistent in Denmark. However, the absence of conclusive identifications of the pathogens reduces the significance of these conclusions. What also detracts from the validity of the analysis is that atypical pathogens (i.e. Mycoplasma, Chlamydia) are not susceptible to penicillin. Furthermore, penicillin is not the most effective antimicrobial even against non-beta lactamase producing Haemophilus influenzae. What also con-

Носоглоточное носительство Streptococcus pneumoniae у воспитанников детских домов, дошкольных учреждений и неорганизованных детей младше 5 лет

Nasopharyngeal colonization with Streptococcus pneumoniae is a source of respiratory mucosal and invasive infections. For effective vaccine prophylaxis of these diseases the national monitoring of the circulating serotypes and antimicrobial resistance of Streptococcus pneumoniae is required. Objective : To analyze serotype diversity and antimicrobial resistance of S. pneumoniae in the nasopharyngeal carriage in children under 5 years. Methods and patients : The study included orphanage, nursery and children not attending preschool institutions (unorganized children) without respiratory infections and not receiving antibiotic therapy. Conducted microbiological analysis of nasopharyngeal flora, serotyping of pneumococcus, assess their sensitivity to antibiotics. Results : Nasopharyngeal carriage of S. pneumoniae was found in 23%, Moraxella catarrhalis - in 23%, Haemophilus influenzae - 16% of the 246 children included in the study. Serotype was determined in 54 pneumococcal isolates: predominant serotypes 19F (21%), 6B (15%), 23F (14%), 14 (8%). The coincidence of the spectrum obtained with serotypes members of the PCV7 pneumococcal conjugate vaccines and PKV10, was 81% in PKV13 - 90%. The proportion of strains sensitive to clindamycin, 31%, to macrolides - 40% to trimethoprim / sulfamethoxazole - 60%. Multiple resistance was observed in 37% of the identified pneumococcal serotypes. In erythromycin-resistant strains resistance was caused by the presence of ermB-gene (in 74% of cases) or mef-dependent efflux pump as the sole determinant (9%), in 17% of cases – with its association. Maximum antibiotic resistance is observed in pneumococcal vaccine serotypes. Conclusions : The results of the study comparing with previously obtained data shows stability over the past decades the spectrum of pneumococci circulating in the Russian population of children. A substantial increase in pneumococcal resistance to (especially vaccine serotypes) antibiotic penicillin, macrolides, clindamycin is observed.

Changes in drug resistance and distribution of Streptococcus pneumonia infection from 2001 to 2011 in Shenyang area

Objective To investigate the dynamic changes of infectious distribution,current resistant situation of Streptococcus pneumoniae(SP) and resistant to penicillin and other 10 kinds of antibiotics for the guidance of clinical therapy of SP.Methods Bacteria were identified by French BioMerieux API identification system,VITEK 2-COMPACT identification system and Optochin test,bile solubility test.In vitro,drug susceptibility test to penicillin,cefotaxime,and other 10 kinds of antibiotics were conducted with K-B disk diffusion method combined with the concentration gradient method.Drug susceptibility results were analyzed from 2001 to 2011.Results In recent 11 years,SP antimicrobial resistance rate had increased year after year,especially rates of penicillin-resistant and penicillin not-sensitive had increased significantly,rising from 8.3％( in 2001 ) to 72.7％ ( in 2011 ) ( meningitis 86.4％,non-meningitis 59.0％ ).Resistance rate of cefotaxime,belonging to third-generation cephalosporin had already accounted for 54.0％ ( meningitis 64.0％,non-meningitis 44.0％ ) ;and the resistance rate of macrolide antimicrobial was 100％ ; vancomycin-resistant strains and linezolid-resistant strains had not been detected.Conclusion Penicillin non-susceptible SP has accounted for a high percentage,antimicrobial resistance of Streptococcus pneumoniae penicillin,cephalosporins,macrolides are in serious condition.Vancomycin and linezolid should be preferred or the right antibiotics be chosen according to vitro susceptibility results of isolates in clinical treatment of severe infections caused by SP. Key words: Streptococcus pneumoniae; Antimicrobial drugs; Drug resistance; Surveillance

Risk Factors for Drug‐resistant Streptococcus pneumoniae and Antibiotic Prescribing Practices in Outpatient Community‐acquired Pneumonia

Due to antimicrobial resistance in Streptococcus pneumoniae, national guidelines recommend a respiratory fluoroquinolone or combination antimicrobial therapy for outpatient treatment of community-acquired pneumonia (CAP) associated with risk factors for drug-resistant S. pneumoniae (DRSP). The objectives of this study were to assess the prevalence of these risk factors and antibiotic prescribing practices in cases of outpatient CAP treated in the acute care setting. This was a retrospective cohort study of adult outpatients treated for CAP in the emergency department (ED) or urgent care center of an urban, academic medical center from May 1, 2009, through October 31, 2009, and comparison of antibiotic therapy in cases with and without DRSP risk factors. Of 175 patients, 90 (51%) had at least one DRSP risk factor, most commonly asthma (n = 28, 16%), alcohol abuse (n = 24, 14%), diabetes mellitus (n = 18, 10%), chronic obstructive pulmonary disease (n = 16, 9%), age > 65 years (n = 16, 9%), and use of antibiotics within 3 months (15, 9%). Antibiotic prescriptions were similar among cases with and without DRSP risk factors: a macrolide (62% vs. 59%, respectively, p = 0.65), doxycycline (27% vs. 28%, p = 0.82), or a respiratory fluoroquinolone (9% vs. 9%, p = 0.90). Concordance with national guideline treatment recommendations was significantly lower in cases with DRSP risk factors (9% vs. 87%, p < 0.0001). DRSP risk factors were present in approximately half of outpatient CAP cases treated in the acute care setting; however, guideline-concordant antibiotic therapy was infrequent. Strict adherence to current guidelines would substantially increase use of fluoroquinolones or combination therapy. Whether the potential risks associated with these broad-spectrum regimens are justified by improved clinical outcomes requires further study.

Pneumococcal serotype distribution and antimicrobial resistance in Chinese children hospitalized for pneumonia

A prospective study was performed to determine serotype distribution and antimicrobial resistance in Streptococcus pneumoniae ( S. pneumoniae) from Chinese children <5 years old meeting pneumonia criteria. A total of 3865 children were enrolled and 338 S. pneumoniae isolates were obtained. The most frequent serotypes were 19F (55.6%), 19A (13.9%), 23F (10.1%), 6B (4.7%), and 14 (3.6%). The 7-, 10- and 13-valent conjugate vaccines, respectively, covered 76.3%, 76.9%, and 92.3% of isolates. Out of the isolates, six (1.8%) were penicillin resistant. All except 1 of the isolates were resistant to erythromycin. Serotype 19A showed the highest drug resistance. The use of PCV7 has the potential to prevent a substantial number of pneumococcal infections. However, PCV13 is likely to prevent more episodes of pneumococcal disease in China because of the high rates of 19A.