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Wambugu P, Shah MM, Nguyen HA, Le KA, Le HH, Vo HM, Toizumi M, Bui MX, Dang DA, Yoshida LM. Molecular Epidemiology of Streptococcus pneumoniae Detected in Hospitalized Pediatric Acute Respiratory Infection Cases in Central Vietnam. Pathogens 2023; 12:943. [PMID: 37513790 PMCID: PMC10385502 DOI: 10.3390/pathogens12070943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Streptococcus pneumoniae is the major bacterial pathogen causing high pneumonia morbidity and mortality in children <5 years of age. This study aimed to determine the molecular epidemiology of S. pneumoniae detected among hospitalized pediatric ARI cases at Khanh Hoa General Hospital, Nha Trang, Vietnam, from October 2015 to September 2016 (pre-PCV). We performed semi-quantitative culture to isolate S. pneumoniae. Serotyping, antimicrobial susceptibility testing, resistance gene detection and multi-locus sequence typing were also performed. During the study period, 1300 cases were enrolled and 413 (31.8%) S. pneumoniae were isolated. School attendance, age <3 years old and prior antibiotic use before admission were positively associated with S. pneumoniae isolation. Major serotypes were 6A/B (35.9%), 19F (23.7%) and 23F (12.7%), which accounted for 80.3% of vaccine-type pneumococci. High resistance to Clarithromycin, Erythromycin and Clindamycin (86.7%, 85%, 78.2%) and the mutant drug-resistant genes pbp1A (98.1%), pbp2b (98.8%), pbp2x (99.6%) ermB (96.6%) and mefA (30.3%) were detected. MLST data showed high genetic diversity among the isolates with dominant ST 320 (21.2%) and ST 13223 (19.3%), which were mainly found in Vietnam. Non-typeables accounted for most of the new STs found in the study. Vaccine-type pneumococcus and macrolide resistance were commonly detected among hospitalized pediatric ARI cases.
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Affiliation(s)
- Peris Wambugu
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi 54840-00200, Kenya
| | - Mohammad-Monir Shah
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Hien-Anh Nguyen
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam
| | - Kim-Anh Le
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam
| | - Huy-Hoang Le
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam
| | - Hien-Minh Vo
- Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang 650000, Vietnam
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
| | - Minh-Xuan Bui
- Khanh Hoa Health Service Department, Nha Trang 650000, Vietnam
| | - Duc-Anh Dang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki 852-8523, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan
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Furuya Y, Yamagishi Y, Okade H, Kadota T, Funatsu T, Eto M, Nomura N, Mitsuyama J, Mikamo H. Impact of the pneumococcal conjugate vaccine on serotype distribution of adult non-invasive Streptococcus pneumoniae isolates in Tokai region, Japan, 2008-2016. J Infect Chemother 2017; 23:394-399. [PMID: 28427991 DOI: 10.1016/j.jiac.2017.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in February 2010 markedly reduced the burden of invasive pneumococcal disease and changed serotype distribution in Japan. In November 2013, PCV7 was replaced by the 13-valent pneumococcal conjugate vaccine (PCV13). We investigated the serotype distribution and susceptibility trends of non-invasive Streptococcus pneumoniae isolates collected from adult patients. A total of 504 pneumococcal isolates were collected during 4 periods between 2008 and 2016 (Period 1; between June 2008 and April 2009, Period 2; between September 2010 and March 2011, Period 3; between October 2011 and March 2012, Period 4; between August 2015 and January 2016). The coverage of PCV7 and PCV13 significantly decreased from 38.6% and 60.5% in Period 1 to 6.6% and 31.1% in Period 4. This change was mainly due to a large decrease in the frequency of serotype 19F, 6B, and 14. Serotype 3 was the most frequently isolated, and gradually increased. Additionally, non-PCV13 serotypes 11A, 33F, and 35B significantly increased. Most of the PCV7 serotypes 19F, 23F, 6B, and 14 had mutations of penicillin-binding protein genes and macrolide resistance genes, and these serotypes showed low susceptibilities to cefdinir and clarithromycin. On the other hand, a significant change in susceptibility to various antimicrobial agents was not observed throughout the study period, except for decreased susceptibility to carbapenems. Continuous surveillance studies of pneumococcal serotype changes and drug susceptibility are necessary in future.
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Affiliation(s)
- Yuri Furuya
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan.
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Hayato Okade
- Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan
| | - Takumi Kadota
- Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan
| | - Tori Funatsu
- Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan
| | - Maki Eto
- Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan
| | - Nobuhiko Nomura
- Toyama Chemical Co., Ltd., 2-4-1 Shimookui, Toyama 930-8508, Japan
| | | | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
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Schroeder MR, Stephens DS. Macrolide Resistance in Streptococcus pneumoniae. Front Cell Infect Microbiol 2016; 6:98. [PMID: 27709102 PMCID: PMC5030221 DOI: 10.3389/fcimb.2016.00098] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Streptococcus pneumoniae is a common commensal and an opportunistic pathogen. Suspected pneumococcal upper respiratory infections and pneumonia are often treated with macrolide antibiotics. Macrolides are bacteriostatic antibiotics and inhibit protein synthesis by binding to the 50S ribosomal subunit. The widespread use of macrolides is associated with increased macrolide resistance in S. pneumoniae, and the treatment of pneumococcal infections with macrolides may be associated with clinical failures. In S. pneumoniae, macrolide resistance is due to ribosomal dimethylation by an enzyme encoded by erm(B), efflux by a two-component efflux pump encoded by mef (E)/mel(msr(D)) and, less commonly, mutations of the ribosomal target site of macrolides. A wide array of genetic elements have emerged that facilitate macrolide resistance in S. pneumoniae; for example erm(B) is found on Tn917, while the mef (E)/mel operon is carried on the 5.4- or 5.5-kb Mega element. The macrolide resistance determinants, erm(B) and mef (E)/mel, are also found on large composite Tn916-like elements most notably Tn6002, Tn2009, and Tn2010. Introductions of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV-7 and PCV-13) have decreased the incidence of macrolide-resistant invasive pneumococcal disease, but serotype replacement and emergence of macrolide resistance remain an important concern.
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Affiliation(s)
| | - David S Stephens
- Departments of Medicine, Emory UniversityAtlanta, GA, USA; Departments of Microbiology and Immunology, Emory UniversityAtlanta, GA, USA; Departments of Epidemiology, Emory UniversityAtlanta, GA, USA
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Kawaguchiya M, Urushibara N, Aung MS, Morimoto S, Ito M, Kudo K, Sumi A, Kobayashi N. Emerging non-PCV13 serotypes of noninvasive Streptococcus pneumoniae with macrolide resistance genes in northern Japan. New Microbes New Infect 2015; 9:66-72. [PMID: 26909157 PMCID: PMC4735479 DOI: 10.1016/j.nmni.2015.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 01/20/2023] Open
Abstract
In Japan, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to the nation's routine immunization program in April 2013 and was replaced by the 13-valent pneumococcal conjugate vaccine (PCV13) in November 2013. Distribution of serotypes and macrolide resistance genotypes was investigated for a total of 1097 (975 children, 122 adults) and 960 (873 children, 87 adults) clinical isolates of Streptococcus pneumoniae from noninvasive infections in Hokkaido (northern main island of Japan) in the routine immunization periods for PCV7 and PCV13 (April–October 2013 and November 2013–November 2014, respectively). Serotype was determined by sequential multiplex PCR and additional genetic analyses. Macrolide resistance genes erm(B) and mef(A/E) were detected by multiplex PCR. Although the most prevalent serotypes in children were 23A and 6C in the PCV7 period, after replacement with PCV13, 19A became the most common, followed by 6C, 15A and 23A. Among adults, serotype 3 was consistently the most frequent throughout the study periods. Compared with values from the pre-PCV7 routine immunization period, PCV7 serotypes decreased from 48.3 to 3.3% in the PCV13 period among children, while the rates of non-PCV13 serotypes (particularly 15A, 23A, 11A, 10A and 35B) increased from 39.7 to 75.1% (p < 0.001). In the PCV13 period, erm(B), mef(A/E) and both of these genes were detected in 75.8, 31.6 and 11.3% of all isolates, respectively. Serotype 19A accounted for 76.9% of the isolates with both the macrolide resistance genes, and emerging non-PCV13 serotypes 15A, 15C and 23A mostly harboured erm(B).
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Affiliation(s)
- M Kawaguchiya
- Department of Hygiene, Sapporo Medical University School of Medicine, Japan
| | - N Urushibara
- Department of Hygiene, Sapporo Medical University School of Medicine, Japan
| | - M S Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Japan
| | - S Morimoto
- Sapporo Clinical Laboratory Inc., Sapporo, Hokkaido, Japan
| | - M Ito
- Sapporo Clinical Laboratory Inc., Sapporo, Hokkaido, Japan
| | - K Kudo
- Sapporo Clinical Laboratory Inc., Sapporo, Hokkaido, Japan
| | - A Sumi
- Department of Hygiene, Sapporo Medical University School of Medicine, Japan
| | - N Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Japan
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Wei SH, Chiang CS, Chen CL, Chiu CH. Pneumococcal disease and use of pneumococcal vaccines in Taiwan. Clin Exp Vaccine Res 2015; 4:121-9. [PMID: 26273570 PMCID: PMC4524896 DOI: 10.7774/cevr.2015.4.2.121] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022] Open
Abstract
The use of pneumococcal vaccine plays an important role for prevention of invasive pneumococcal disease (IPD). However, introducing the pneumococcal vaccine into the national immunization program (NIP) is complex and costly. The strategy of progressively integrating the pneumococcal conjugate vaccine (PCV) into the NIP in Taiwan provides valuable experience for policy makers. The 7-valent PCV (PCV7) was first available in Taiwan in late 2005. PCV7 was first provided free to children with underlying diseases, those in vulnerable socioeconomic status, and those with inadequate health care resources. The catch-up immunization program with the 13-valent PCV was launched in 2013 and the national pneumococcal immunization program was implemented in 2015. Children aged 2-5 years had the highest incidence of IPD among pediatric population in Taiwan. Although the incidence of IPD caused by PCV7 serotypes has declined, the overall incidence of IPD remained high in the context of PCV7 use in the private sector. A surge of IPD caused by serotype 19A occurred, accounting for 53.6% of IPD cases among children aged ≤ 5 years in 2011-2012. After the implementation of the national pneumococcal immunization program, serogroup 15 has become the leading serogroup for IPD in children. Continued surveillance is necessary to monitor the serotype epidemiology in Taiwan.
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Affiliation(s)
- Sung-Hsi Wei
- Central Regional Center, Centers for Disease Control, Taichung, Taiwan. ; Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chuen-Sheue Chiang
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan. ; Center of General Education, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. ; Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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