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Schmitz J, van der Linden M, Al-Lahham A, Levina N, Pletz MW, Imöhl M. Fluoroquinolone resistance in Streptococcus pneumoniae isolates in Germany from 2004-2005 to 2014-2015. Int J Med Microbiol 2017; 307:216-222. [PMID: 28506425 DOI: 10.1016/j.ijmm.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae is a major cause of bacterial pneumonia, sepsis and meningitis worldwide. Prevalence of levofloxacin-resistant S. pneumoniae isolates in Germany and associated mutations in the quinolone resistance determining regions (QRDRs), as well as serotype distribution and multi locus sequence types (MLST) are shown. 21,764 invasive S. pneumoniae isolates from Germany, isolated in the epidemiological seasons from 2004/05 to 2014/15 were analyzed at the German National Reference Centre for Streptococci (GNRCS) for their levofloxacin resistance by micro broth dilution method. All resistant (minimal inhibitory concentration (MIC) ≥8μg/ml) and intermediate (MIC >2μg/ml and <8μg/ml) isolates were selected for the present study. Additionally, 29 susceptible isolates were randomly selected. A total of ninety isolates were tested for their levofloxacin-MIC by Etest, their serotype and sequence type, as well as for point-mutations at the QRDRs in the genes parC, parE, gyrA and gyrB. Twenty-five isolates exhibited levofloxacin MICs <2μg/ml (Etest) and no mutations in the QRDRs. Four isolates with MICs=2μg/ml had one mutation in parC; isolates with MICs >2μg/ml all had one or more mutations in the QRDRs. Four of nine intermediate isolates had a mutation in either parC or gyrA, and four isolates had mutations in both parC and gyrB. One isolate had mutations in both parC and gyrA. All isolates with MICs ≥8μg/ml (52) had mutations in both topoisomerase IV and gyrase. Serotypes associated with levofloxacin resistance shifted from a majority of PCV13 serotypes before the introduction of the PCV13 vaccine towards non-PCV serotypes. Resistant isolates were almost exclusively found among adults (98.1%).
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Affiliation(s)
- Julia Schmitz
- Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany.
| | - Mark van der Linden
- Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
| | - Adnan Al-Lahham
- School of Applied Medical Sciences, German Jordanian University, Amman, Jordan
| | - Natalia Levina
- Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Matthias Imöhl
- Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
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Kargar M, Moein Jahromi F, Doosti A, Handali S. Molecular Investigation of Quinolone Resistance of Quinolone Resistance-Determining Region in Streptococcus pneumoniae Strains Isolated from Iran Using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism Method. Osong Public Health Res Perspect 2014; 5:245-50. [PMID: 25389509 PMCID: PMC4225646 DOI: 10.1016/j.phrp.2014.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives The resistance of Streptococcus pneumoniae to the recently available antibiotic treatment has been a growing problem. The aim of the study was to determine the quinolone-resistant strains and detect the presence of mutations in the quinolone resistance-determining regions of the gyrA, parE, and parC genes. Methods In this study, for the first time in Iran, the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) method was used to investigate the presence of mutations at quinolone resistance-determining regions of topoisomerase IV and DNA gyrase on 82 S. pneumoniae strains, among them 45 clinical samples were from patients and 37 from healthy carriers (control group). Results In clinical samples, 34 (75.56%) strains contained mutations in the parC gene, 31 (68.89%) carried mutations in the gyrA gene, and 14 (31.11%) had parE gene mutations. Antibiotic susceptibility test was performed using the CLSI (Clinical and Laboratory Standards Institute) criteria on three different generations of quinolone family, with nalidixic acid (82.22%) showing the highest resistance and levofloxacin (42.22%) the least resistance. Conclusion Results indicated that there is a significant correlation between quinolone resistance development and mutations in the parE gene as well as in the parC and gyrA genes.
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Affiliation(s)
- Mohammad Kargar
- Department of Microbiology, Islamic Azad University, Jahrom Branch, Jahrom, Iran
- Corresponding author.
| | | | - Abbas Doosti
- Biotechnology Research Center, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
| | - Somayeh Handali
- Nanotechnology Research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Rapid detection of a point mutation in the parC gene associated with decreased susceptibility to fluoroquinolones in Mycoplasma bovis. Antimicrob Agents Chemother 2009; 53:4911-4. [PMID: 19721062 DOI: 10.1128/aac.00703-09] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Comparison of the quinolone resistance-determining regions (QRDRs) in 42 Mycoplasma bovis clinical isolates revealed amino acid substitutions at both GyrA (position 83) and ParC (position 84) in 10/11 enrofloxacin-resistant strains. The mutation present in the parC QRDR was discriminative for enrofloxacin resistance by parC PCR-restriction fragment length polymorphism. Comparison of molecular profiles by insertion sequence typing suggests that the currently prevalent enrofloxacin-resistant M. bovis strain evolved by selection under field conditions from one of the susceptible strains.
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De Vecchi E, Nicola L, Ossola F, Drago L. In vitro selection of resistance in Streptococcus pneumoniae at in vivo fluoroquinolone concentrations. J Antimicrob Chemother 2009; 63:721-7. [PMID: 19218275 DOI: 10.1093/jac/dkp020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare the ability to select for resistance in Streptococcus pneumoniae of levofloxacin, moxifloxacin, ciprofloxacin and prulifloxacin. METHODS Twenty strains of S. pneumoniae susceptible to fluoroquinolones were used. The frequencies of spontaneous single-step mutations at plasma and epithelial lining fluid (ELF) peak and trough antibiotic concentrations were calculated. Multi-step selection of resistance was evaluated by performing 10 serial subcultures on agar plates containing a linear gradient from peak to trough antimicrobial concentrations, followed by 10 subcultures on antibiotic-free agar. Resistant strains selected after multi-step selection were characterized for DNA mutations by sequencing gyrA, gyrB, parC and parE genes. RESULTS Levofloxacin and moxifloxacin showed the lowest frequencies of mutations (median <10(-11)) at plasma peak and at ELF concentrations, while medians ranging from 10(-8) to 10(-6) were observed for ciprofloxacin and prulifloxacin. In a multi-step selection assay, ciprofloxacin and prulifloxacin selected for the highest number of resistant strains (19 and 31, respectively). No selection of resistance was observed for levofloxacin at ELF concentrations and for moxifloxacin at plasma and ELF concentrations. Mutations in parC, parE and gyrA genes were found in ciprofloxacin- and prulifloxacin-resistant strains, while only parC mutations were found for levofloxacin. CONCLUSIONS Levofloxacin and moxifloxacin are characterized by a lower propensity to select in vitro for resistance in S. pneumoniae than ciprofloxacin and prulifloxacin, when tested at plasma and lung concentrations.
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Affiliation(s)
- E De Vecchi
- Laboratory of Microbiology, Department of Preclinical Sciences LITA Vialba, University of Milan, Milan, Italy
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Savini V, Favaro M, Fontana C, Consilvio NP, Manna A, Talia M, Catavitello C, Balbinot A, Febbo F, Di Bonaventura G, Di Giuseppe N, D'Antonio D. A case of pharyngitis caused by Streptococcus pneumoniae. J Med Microbiol 2008; 57:674-675. [PMID: 18436606 DOI: 10.1099/jmm.0.47641-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Throat cultures from an adult pharyngitis patient yielded Streptococcus pneumoniae as a single organism, with a very high bacterial count. The isolate was found to be macrolide and fluoroquinolone resistant, and the same strain was cultured from the patient's denture washing solution. Ceftriaxone therapy, a gradual reduction in the bacterial count and progressive clinical improvement proceeded at the same pace, so we labelled this clinical case as a pneumococcal pharyngitis.
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Affiliation(s)
- Vincenzo Savini
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Marco Favaro
- Dipartimento di Microbiologia Clinica, Policlinico Torvergata, Roma, Italy
| | - Carla Fontana
- Dipartimento di Microbiologia Clinica, Policlinico Torvergata, Roma, Italy
| | | | - Assunta Manna
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Marzia Talia
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Chiara Catavitello
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Andrea Balbinot
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Fabio Febbo
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Giovanni Di Bonaventura
- Laboratorio di Microbiologia Clinica, Centro Studi Invecchiamento (Ce.S.I.), Università Degli Studi Gabriele D'Annunzio, Chieti, Italy
| | - Nicola Di Giuseppe
- Dipartimento di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Domenico D'Antonio
- Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Pescara, Italy
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Ip M, Chau SSL, Chi F, Tang J, Chan PK. Fluoroquinolone resistance in atypical pneumococci and oral streptococci: evidence of horizontal gene transfer of fluoroquinolone resistance determinants from Streptococcus pneumoniae. Antimicrob Agents Chemother 2007; 51:2690-700. [PMID: 17548487 PMCID: PMC1932522 DOI: 10.1128/aac.00258-07] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atypical strains, presumed to be pneumococcus, with ciprofloxacin MICs of > or =4.0 microg/ml and unique sequence variations within the quinolone resistance-determining regions (QRDRs) of the gyrase and topoisomerase genes in comparison with the Streptococcus pneumoniae R6 strain, were examined. These strains were reidentified using phenotypic methods, including detection of optochin susceptibility, bile solubility, and agglutination by serotype-specific antisera, and genotypic methods, including detection of pneumolysin and autolysin genes by PCR, 16S rRNA sequencing, and multilocus sequence typing (MLST). The analysis based on concatenated sequences of the six MLST loci distinguished the "atypical" strains from pneumococci, and these strains clustered closely with S. mitis. However, all these strains and five of nine strains from the viridans streptococcal group possessed one to three gyrA, gyrB, parC, and parE genes whose QRDR sequences clustered with those of S. pneumoniae, providing evidence of horizontal transfer of the QRDRs of the gyrase and topoisomerase genes from pneumococci into viridans streptococci. These genes also conferred fluoroquinolone resistance to viridans streptococci. In addition, the fluoroquinolone resistance determinants of 32 well-characterized Streptococcus mitis and Streptococcus oralis strains from bacteremic patients were also compared. These strains have unique amino acid substitutions in GyrA and ParC that were distinguishable from those in fluoroquinolone-resistant pneumococci and the "atypical" isolates. Both recombinational events and de novo mutations play an important role in the development of fluoroquinolone resistance.
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Affiliation(s)
- Margaret Ip
- Department of Microbiology, Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong.
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Ip M, Chau SSL, Chi F, Cheuk ESC, Ma H, Lai RWM, Chan PK. Longitudinally tracking fluoroquinolone resistance and its determinants in penicillin-susceptible and -nonsusceptible Streptococcus pneumoniae isolates in Hong Kong, 2000 to 2005. Antimicrob Agents Chemother 2007; 51:2192-4. [PMID: 17371818 PMCID: PMC1891361 DOI: 10.1128/aac.00139-07] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Of 1,388 Streptococcus pneumoniae isolates collected from 2000 to 2005, 10.5% had a ciprofloxacin MIC of >/=4.0 mug/ml and 1.6% (range, 0.8% to 4.3% per year) had a levofloxacin MIC of >/=4.0 mug/ml. Molecular characterization indicated that fluoroquinolone resistance occurred independently in our prevalent Spain(23F)-1 clone, expressing serotypes 23F, 19F, and 14. Rates of resistance to levofloxacin in S. pneumoniae have remained stable at a Hong Kong hospital.
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Affiliation(s)
- Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
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Hathaway LJ, Brugger S, Martynova A, Aebi S, Mühlemann K. Use of the Agilent 2100 bioanalyzer for rapid and reproducible molecular typing of Streptococcus pneumoniae. J Clin Microbiol 2007; 45:803-9. [PMID: 17202282 PMCID: PMC1829109 DOI: 10.1128/jcm.02169-06] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Restriction fragment length polymorphism (RFLP) analysis is an economic and fast technique for molecular typing but has the drawback of difficulties in accurately sizing DNA fragments and comparing banding patterns on agarose gels. We aimed to improve RFLP for typing of the important human pathogen Streptococcus pneumoniae and to compare the results with the commonly used typing techniques of pulsed-field gel electrophoresis and multilocus sequence typing. We designed primers to amplify a noncoding region adjacent to the pneumolysin gene. The PCR product was digested separately with six restriction endonucleases, and the DNA fragments were analyzed using an Agilent 2100 bioanalyzer for accurate sizing. The combined RFLP results for all enzymes allowed us to assign each of the 47 clinical isolates of S. pneumoniae tested to one of 33 RFLP types. RFLP analyzed using the bioanalyzer allowed discrimination between strains similar to that obtained by the more commonly used techniques of pulsed-field gel electrophoresis, which discriminated between 34 types, and multilocus sequence typing, which discriminated between 35 types, but more quickly and with less expense. RFLP of a noncoding region using the Agilent 2100 bioanalyzer could be a useful addition to the molecular typing techniques in current use for S. pneumoniae, especially as a first screen of a local population.
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Affiliation(s)
- Lucy J Hathaway
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland
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Fukushima KY, Hirakata Y, Sugahara K, Yanagihara K, Kondo A, Kohno S, Kamihira S. Rapid screening of topoisomerase gene mutations by a novel melting curve analysis method for early warning of fluoroquinolone-resistant Streptococcus pneumoniae emergence. J Clin Microbiol 2006; 44:4553-8. [PMID: 17021062 PMCID: PMC1698396 DOI: 10.1128/jcm.01887-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed a real-time PCR assay combined with melting curve analysis for rapidly genotyping quinolone resistance-determining regions (QRDR) of topoisomerase genes in Streptococcus pneumoniae. This assay was not only accurate for the screening of fluoroquinolone (FQ) resistance but also relevant as an early warning system for detecting preexisting single QRDR mutations.
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Affiliation(s)
- Kazuko Y Fukushima
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City 852-8501, Japan
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