Background The aim of the present study was to assess the prevalence and characteristics of S. pneumoniae serotype 19A isolates from invasive and non-invasive pneumococcal disease (IPD) in children, before and after the introduction of pneumococcal conjugate vaccines (PCVs) in Greece.Methods All S. pneumoniae isolates collected between 1986 and 2015 were re-cultured for further testing. Serotyping was performed using the quellung reaction and antibiotic susceptibilities were determined by E-test. The altered pbp genes (pbp2b, pbp2x, and pbp1a) conferring resistance to penicillin and the macrolide-resistant genes [mef(A), mef(E), and erm(B)] were detected by polymerase chain reaction (PCR) using specific primers. The sequence types (ST) and clonal complexes were determined by multilocus sequence typing (MLST).ResultsAmong 1,875 isolates examined, 210(11.2%) (belonged to serotype 19A. The proportion of serotype 19A isolates increased from 4.6% (47/1018) in the pre-PCV7 years (1986–2005) to 19.6% (88/449) in the post-PCV7 years (2006–2010) and to 18.4% (75/408) in the post PCV-10 and PCV13 years (2011–2015).The resistance frequencies to penicillin, cefotaxime, erythromycin, clindamycin, and tetracycline increased significantly after 2005 as compared with the preceding period (1986–2005) from 8.5% to 31.9%, 2.1% to 20.8%, 10.6% to 65.6%, 4.2% to 47.7% and 19.1% to 46.0%, respectively (P < 0.01). Moreover, 94 (57.7%) of 163 isolates after 2005 exhibited multidrug-resistant (MDR) phenotype, whereas only seven (15.9%) of 47 isolates from period 1986–2005 were MDR (P <0.001). All the penicillin non-susceptible isolates examined (N = 136), had altered one or more of the pbp genes. Of 112 erythromycin-resistant isolates, 22 contained the mefE gene, 39 the ermB and 51 both the mefE and ermB genes. MLST analysis of 31 invasive isolates revealed four clonal complexes (CC); CC172 (n = 11), CC199 (n = 8), CC320 (n = 5), and CC276 (n = 3), and four isolates belonged to CC2669, CC177, CC81, and CC63. The CC172 and CC199 were present throughout the study period, whereas the CC320 and CC276 appeared after 2009.Conclusion S. pneumoniae serotype 19A increased significantly after the introduction of PCV7 and a substantial proportion of these isolates exhibited MDR phenotype. The majority of the examined isolates belonged to limited number of CC.Disclosures V. Syriopoulou, Hellenic Center for Disease Control and Prevention: Grant Investigator, Research grant. Pfizer Inc.Pharmaceutical Company: Grant Investigator, Research grant
Read full abstract