Drug-resistant Streptococcus pneumoniae in the Lebanon: implications for presumptive therapy

Virtual Screening of compounds from Tabernaemontana divaricata for potential anti-bacterial activity

Virtual Screening and Molecular Docking analysis for Tabernaemontana divaricata derived 66 Law Molecular Weight Compounds (LMW) was conducted and to identified and predicted novel molecules as a inhibitor of Streptococcus pneumonia. The investigation has revealed several compounds with optimum binding towards Penicillin-binding proteins, Sialidases, Aspartate betasemialdehide dehydrogenase cell membrane protein of Streptococcus pneumonia. Docking results were computed in term of binding energy, ligand efficiency and number of hydrogen bonding. Apparicine (-5.14), 5-Hydroxyvoaphylline (-4.78), Voacangine (-4.7), 19-Hydroxycoronaridine (-4.44) and Coronaridine (-4.72) are identified as most suitable to bind with N-acetylglucosamine-1- phosphate uridyltransferase receptor. Ervaticine (-6.33), Ibogamine (-6.15), Methylvoaphylline (-5.74) and Coronaridine hydroxyindolenine (-5.32) has showed novel binding against the penicillin-binding proteins. Ervaticine (-6.42), 5-oxo-11-hydroxy voaphylline (-6.18), Conolobine B (-6.02) has found optimum binding against the active site of NanB sialidase of Streptococcus pneumonia. The compounds 3S-Cyanocoronaridine (-6.71), 19-Epivoacristine (-5.48) and Ervaticine(-5.45) interacting with aspartate beta-semialdehide and found suitable with least docking score.

Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: a report of three cases

The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. We report the first three cases of levofloxacin resistant S. pneumoniae isolates in a tertiary medical center in Beirut, Lebanon. Judicious use of antimicrobial agents is imperative to limit the spread of such resistant strains.

Prevalence of penicillin-resistant Streptococcus pneumoniae in Kuwait

The worldwide incidence of penicillin-resistant Streptococcus pneumoniae has increased at an alarming rate during the past decade. However, there has been little published data about the extent of this problem in Kuwait. The present study was undertaken to ascertain the preponderance of S. pneumoniae, either resistant or intermediate-resistant to penicillin, other beta-lactams and non-beta-lactam antimicrobials in Kuwait. Two hundred and fifty fresh isolates from as many patients suffering from different clinical conditions were collected from all clinics and hospitals in Kuwait. Optochin sensitivity and bile solubility tests reconfirmed these. Susceptibility testing to penicillin, ampicillin, cefuroxime, ceftriaxone, cefotaxime, imipenem, erythromycin, chloramphenicol, ciprofloxacin and vancomycin was done using E-test strips and to oxacillin, tetracycline, trimethoprim and amoxicillin-clavulanate by disc diffusion technique. Full and intermediate resistance to penicillin was observed in 1.6% and 52.8% of the isolates respectively. Full resistance to third-generation cephalosporins ranged from 0.4% to 3.2%, however, intermediate resistance to these antibiotics varied between 18.8% and 21.2%. Ampicillin resistance was noted in 0.8%, but 40.4% of isolates were intermediately resistant. However, only 0.4% of the isolates showed either intermediate or full resistance to amoxicillin-clavulanate. Resistance to imipenem was observed in 0.4% and intermediate to 13.6% of the organisms. The rates of S. pneumoniae resistant to chloramphenicol, erythromycin, tetracycline and trimethoprim were between 8.4% and 37.6% and intermediate resistance between 1.2% and 17.6% while only 0.4% showed resistance to ciprofloxacin and none to vancomycin. Multiresistance to both beta-lactam and non-beta-lactam antibiotics was observed in 52% of the penicillin-resistant isolates.

Antibiotic resistance in Streptococcus pneumoniae

Resistance to penicillin and other antibiotics in Streptococcus pneumoniae has emerged in Australia and around the world in the past decade, and appears to be worsening (e.g., rates of penicillin resistance in Australia rose from 1% in 1989 to 25% in 1997). In Australia, the only oral antibiotic able to treat respiratory infections caused by some multiresistant strains is high-dose amoxycillin. If these strains increase in prevalence, then treatment failures for relatively minor infections (e.g., otitis media) are likely to become common, resulting in repeat antibiotic courses or hospitalisation for parenteral therapy. Therapy for meningitis caused by penicillin-sensitive pneumococcal strains remains high-dose benzylpenicillin, but empirical treatment while awaiting culture and sensitivity results is problematic; neither penicillin nor third-generation cephalosporins cover all strains. Therefore, many authorities recommend vancomycin, usually combined with a third-generation cephalosporin, for treating presumptive or proven pneumococcal meningitis pending penicillin-susceptibility results. As almost all readily available oral antibiotics in Australia select for resistant strains of pneumococci, multiresistant strains will increase in prevalence unless unnecessary antibiotic use and prescription volumes are reduced substantially in the next few years.