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Clinical Characteristics, Antimicrobial Resistance, and Outcomes of Patients with Invasive Pneumococcal Disease in Ningxia Hui Autonomous Region, China, 2013-2021. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:1262884. [PMID: 36545503 PMCID: PMC9763006 DOI: 10.1155/2022/1262884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Objectives This study aimed to analyze the clinical features, antibiotic susceptibility profiles, and outcomes of patients with invasive pneumococcal disease (IPD) at a hospital in Ningxia Hui Autonomous Region, to provide the basis for improving the clinical treatment effect. Methods Patients with IPD were retrospectively collected from 2013 to 2021. Clinical manifestations, laboratory tests, antimicrobial susceptibility, antibiotic treatment, and outcomes of the disease were analyzed. Results In this study, we identified 127 IPD cases, of whom 49 (38.6%) had meningitis and 78 (61.4%) had bacteremia. The median ages of pediatric cases and adult cases were 2 years (IQR: 0-5) and 52.5 years (IQR: 35-62), respectively. There were 27 and 45 males in the pediatric and adult groups, and no significant gender difference in the different age groups (p = 0.584) was found. Of 75 cases with underlying diseases, pneumonia (11%), malignancy (11%), hypertension (9.4%), and hepatic cirrhosis (7.9%) were the most common. The incidence of underlying diseases was even higher in the adult group (67.1%) than in the pediatric group (47.1%) (p = 0.028). The frequency of fever, cough, and seizures was significantly higher in the pediatric group than in the adult group, with p-values of 0.004, 0.004, and 0.001, respectively. The percentage of neutrophils in the blood was significantly higher in the adult cases than in the pediatric cases (p < 0.001). Furthermore, there was a significantly higher WBC count (p < 0.001), percentage of neutrophils (p = 0.012), and protein level (p = 0.019) in the CSF samples in the adult patients compared to pediatric patients. The susceptibility rates of S. pneumoniae isolates to vancomycin, linezolid, and levofloxacin were 100%. The susceptibility rates of penicillin were 98.7% and 34.1% in bacteremia and meningitis patients, respectively. Most isolates were resistant to erythromycin, clindamycin, tetracycline, and azithromycin. The most common antibiotic treatment was β-lactams. Seven (5.5%) patients died during hospitalization, and 38 (29.9%) patients' health deteriorated. Conclusion These results may provide a reference basis for the diagnosis and empiric treatment of IPD in the region.
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Berbel D, González-Díaz A, López de Egea G, Càmara J, Ardanuy C. An Overview of Macrolide Resistance in Streptococci: Prevalence, Mobile Elements and Dynamics. Microorganisms 2022; 10:2316. [PMID: 36557569 PMCID: PMC9783990 DOI: 10.3390/microorganisms10122316] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Streptococcal infections are usually treated with beta-lactam antibiotics, but, in case of allergic patients or reduced antibiotic susceptibility, macrolides and fluoroquinolones are the main alternatives. This work focuses on studying macrolide resistance rates, genetic associated determinants and antibiotic consumption data in Spain, Europe and also on a global scale. Macrolide resistance (MR) determinants, such as ribosomal methylases (erm(B), erm(TR), erm(T)) or active antibiotic efflux pumps and ribosomal protectors (mef(A/E)-mrs(D)), are differently distributed worldwide and associated with different clonal lineages and mobile genetic elements. MR rates vary together depending on clonal dynamics and on antibiotic consumption applying selective pressure. Among Streptococcus, higher MR rates are found in the viridans group, Streptococcus pneumoniae and Streptococcus agalactiae, and lower MR rates are described in Streptococcus pyogenes. When considering different geographic areas, higher resistance rates are usually found in East-Asian countries and milder or lower in the US and Europe. Unfortunately, the availability of data varies also between countries; it is scarce in low- and middle- income countries from Africa and South America. Thus, surveillance studies of macrolide resistance rates and the resistance determinants involved should be promoted to complete global knowledge among macrolide resistance dynamics.
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Affiliation(s)
- Dàmaris Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Aida González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Guillem López de Egea
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
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Lagoubi Y, Sfar MT, Gomez JA. A cost-effectiveness analysis of PHiD-CV compared to PCV13 in a national immunization program setting in Tunisia. Hum Vaccin Immunother 2022; 18:2079305. [PMID: 35703731 PMCID: PMC9481096 DOI: 10.1080/21645515.2022.2079305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In response to the substantial clinical and economic burden of diseases caused by Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) in Tunisia, the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) was recently introduced into the national immunization program. However, there has yet to be a full-scale health economic analysis comparing currently available pneumococcal conjugate vaccines (PCVs) in Tunisia. Methods A Markov model that simulated the disease processes of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) over a newborn cohort lifetime was used to evaluate the cost-effectiveness/utility of PHiD-CV and the 13-valent pneumococcal conjugate vaccine (PCV13) from payer’s perspective, using 3% discounting. Vaccine effects were considered for up to 9 years of age. Results Vaccination with PHiD-CV or PCV13 was estimated to avert approximately 700 cases of IPD (200 meningitis, 500 bacteremia), and around 5,000 cases of all-cause pneumonia. However, PHiD-CV vaccination was estimated to avert around 4,000 additional AOM cases (18,000) versus PCV13 (14,000). Both PCVs were demonstrated to be cost-effective interventions, but PHiD-CV was estimated to generate additional cost savings of almost $1 million US dollars (USD) with similar levels of clinical benefits. An additional scenario which incorporated serotype-specific vaccine efficacy found no significant change in overall results. Conclusion PCVs are a cost-effective strategy to relieve the burden associated with diseases caused by S.pneumoniae and NTHi in Tunisia. PHiD-CV is more cost-effective than PCV13, generating similar health benefits, at a reduced net cost of almost $1 million USD per vaccinated cohort.
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Affiliation(s)
| | - Mohamed Tahar Sfar
- Department of Paediatrics, Tahar Sfar University Hospital, Mahdia, Tunisia
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Torumkuney D, Hammami A, Mezghani Maalej S, Ayed NB, Revathi G, Zerouali K, Elmdaghri N, Gachii AK, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2015-18 in Tunisia, Kenya and Morocco: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. J Antimicrob Chemother 2021; 75:i2-i18. [PMID: 32337595 DOI: 10.1093/jac/dkaa081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015-18 from Tunisia, Kenya and Morocco. METHODS MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. RESULTS S. pneumoniae isolates from Tunisia (n = 79), Kenya (n = 44) and Morocco (n = 19) and H. influenzae isolates (n = 74) from Tunisia only were collected and analysed. Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, with >90% susceptible only to the fluoroquinolones (all breakpoints), penicillin (CLSI IV and EUCAST high-dose) and ceftriaxone (CLSI, EUCAST high-dose and PK/PD breakpoints). In addition, isolate susceptibility in Kenya was >90% to amoxicillin and amoxicillin/clavulanic acid (CLSI and PK/PD breakpoints). Antibiotic activity was highest in Morocco, where ≥89.5% of pneumococci were susceptible to most antibiotics, excluding trimethoprim/sulfamethoxazole (68.4% by CLSI or PK/PD and 79%-84.2% by EUCAST), macrolides (79%-84.2% by all breakpoints) and cefaclor (0% by EUCAST and 52.6% by PK/PD). The majority (≥86.5%) of H. influenzae isolates from Tunisia were susceptible to most antibiotics by all available breakpoints, except ampicillin and amoxicillin (almost one-third were β-lactamase positive), trimethoprim/sulfamethoxazole (51.4%-56.8%), cefaclor (1.4% by PK/PD), cefuroxime (4.1% by EUCAST), macrolides (1.4%-2.7% by PK/PD) and cefdinir (66.2% by PK/PD). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified. CONCLUSIONS Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, but susceptibility was higher in isolates from Kenya and highest in those from Morocco. H. influenzae from Tunisia were highly susceptible to most antibiotics. These factors are important in decision making for empirical therapy of CA-RTIs.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - A Hammami
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - S Mezghani Maalej
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - N Ben Ayed
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - G Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - K Zerouali
- Laboratory of Bacteriology & Virology and Hygiene, CHU Ibn Rochd, Casablanca, Morocco.,Laboratory of Microbiology, Faculté de Médecine et de Pharmacie, Hassan II University, Casablanca, Morocco
| | - N Elmdaghri
- Laboratory of Bacteriology & Virology and Hygiene, CHU Ibn Rochd, Casablanca, Morocco.,Laboratory of Microbiology, Faculté de Médecine et de Pharmacie, Hassan II University, Casablanca, Morocco
| | - A K Gachii
- Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Bizri AR, Althaqafi A, Kaabi N, Obeidat N, Al Akoury N, Haridy H. The Burden of Invasive Vaccine-Preventable Diseases in Adults in the Middle East and North Africa (MENA) Region. Infect Dis Ther 2021; 10:663-685. [PMID: 33751422 PMCID: PMC7983355 DOI: 10.1007/s40121-021-00420-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Implementing vaccination programmes at the national level is key to managing vaccine-preventable diseases (VPDs) in the overall population. Although paediatric immunization programmes have significantly reduced the burden of VPD, disease burden in adults still poses a substantial challenge, particularly in low- and middle-income countries such as those within the Middle East and North Africa (MENA) region. Invasive bacterial diseases (IBDs) are an important public health concern within this region, although vaccines are available to prevent the three most common causative organisms associated with IBD: Neisseria meningitidis (NM), Streptococcus pneumoniae (SP), and Haemophilus influenzae (HI). For this review, three separate PubMed searches were used to identify English-language publications describing the epidemiology of NM, SP, and HI in adults within the MENA region. Of the 161 total publications retrieved among all 3 literature searches, 39 were included in this review (NM: 8 publications; SP: 27 publications; HI: 4 publications). Publications describing epidemiology in paediatric or overall populations were excluded. Overall, these studies generally observed a high burden of IBD among adults in this region. Although NM, SP, and HI are communicable diseases in several countries, the surveillance systems in the MENA region are largely inadequate, resulting in poor responses to outbreaks and hindering improvement in outcomes of communicable diseases. Improving IBD surveillance would provide necessary estimates of disease burden, resulting in better vaccination strategies and improved outcomes. In conclusion, the present review provides a summary of the available information on the epidemiology of vaccine-preventable IBD in adults within the MENA region and highlights the need for increased disease surveillance and preventive strategies in these countries.
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Affiliation(s)
| | - Abdulhakeem Althaqafi
- Department of Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.
| | - Nawal Kaabi
- Abu Dhabi Health Services Company, Abu Dhabi, United Arab Emirates
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Midouni Ayadi B, Mehiri E, Draoui H, Ghariani A, Essalah L, Raoult D, Fournier PE, Slim-Saidi LN. Phenotypic and molecular characterization of macrolide resistance mechanisms among Streptococcus pneumoniae isolated in Tunisia. J Med Microbiol 2020; 69:505-520. [PMID: 32159507 DOI: 10.1099/jmm.0.001151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction. Streptococcus pneumoniae is responsible for many community infections, with the main ones being pneumonia and meningitis. Pneumococcus has developed increased resistance to multiple classes of antibiotics. The evolution of antibiotic resistance in pneumococcus was influenced by changes in serotype distribution under vaccine selection pressure.Aim. The aim of this study was to determine the genes involved in macrolide resistance, the antimicrobial susceptibility, the serotype distribution and the spread of international antibiotic-resistant clones among clinical isolates of S. pneumoniae.Methodology. We investigated 86 erythromycin-resistant S. pneumoniae strains isolated from respiratory (n=74) or non-respiratory (n=12) samples in Tunisia. Antimicrobial susceptibility was tested using the disk diffusion method. Macrolide-resistant strains were analysed by polymerase chain reaction (PCR) for ermA, ermB, mefA and msrD. We also investigated the macrolide resistance mechanisms in eight isolates (9.3%) by sequencing the L4 and L22 riboprotein-coding genes, plus relevant segments of the three 23S rRNA genes. Capsular serotypes were detected by multiplex PCR. Sequence types (STs) were explored using multilocus sequence typing (MLST).Results. Among the 86 studied strains, 70 (81.4 %) were resistant to penicillin G. The prevalent serotypes were 19F, 14, 19A and 23F. We observed that the cMLSB phenotype (66/86, 76.7%) was the most common in these pneumococci. In addition, ermB was the most frequent resistance gene. No mutation in ribosomal protein L22 or L4 or 23S rRNA was detected. Overall, 44 STs were identified in this study, including 16 that were described for the first time. Resistance to lincomycin, tetracycline and trimethoprim/sulfamethoxazole was observed in 55 (64 %), 34 (39.5 %) and 31 (36 %) isolates, respectively. Furthermore, an increase in fluoroquinolone use in particular may lead to the emergence of levofloxacin-resistant strains. Multidrug resistance was observed in 83 isolates (96.5%). Three global antibiotic-resistant clones were identified: Denmark14 ST230, Portugal19F ST177 and Spain9V ST156.Conclusion. This study shows that macrolide resistance among S. pneumoniae isolated in Tunisia is mainly related to target site modification. Our observations demonstrate a high degree of genetic diversity and capsular types among strains resistant to macrolides.
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Affiliation(s)
- B Midouni Ayadi
- Aix Marseille University, IRD, SSA, Vitrome, IHU Mediterranee Infection, 19-21 Bd Jean Moulin, 13005 Marseille, France.,Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia.,Faculty of Sciences of Tunis - University of Tunis El Manar, Ariana, Tunisia
| | - E Mehiri
- Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia
| | - H Draoui
- Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia
| | - A Ghariani
- Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia
| | - L Essalah
- Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia
| | - D Raoult
- Aix Marseille University, IRD, Mephi, IHU Mediterranee Infection, 19-21 Bd Jean Moulin, 13005 Marseille, France
| | - P E Fournier
- Aix Marseille University, IRD, SSA, Vitrome, IHU Mediterranee Infection, 19-21 Bd Jean Moulin, 13005 Marseille, France
| | - L N Slim-Saidi
- Microbiology Laboratory, A. Mami Hospital of Pneumology, UR12/SP18, Ariana, Tunisia
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Midouni B, Mehiri E, Ghariani A, Draoui H, Essalah L, Bouzouita I, Raoult D, Slim-Saidi L, Fournier P. Genetic diversity of Streptococcus pneumoniae in Tunisia. Int J Antimicrob Agents 2019; 53:63-69. [DOI: 10.1016/j.ijantimicag.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/26/2018] [Accepted: 09/29/2018] [Indexed: 12/16/2022]
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Moghnieh RA, Kanafani ZA, Tabaja HZ, Sharara SL, Awad LS, Kanj SS. Epidemiology of common resistant bacterial pathogens in the countries of the Arab League. THE LANCET. INFECTIOUS DISEASES 2018; 18:e379-e394. [PMID: 30292478 DOI: 10.1016/s1473-3099(18)30414-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 06/03/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
No uniformly organised collection of data regarding antimicrobial resistance has occurred in the countries of the Arab League. 19 countries of the Arab League have published data for antimicrobial susceptibility for the WHO priority organisms, and seven of 14 of these organisms are included in this Review (Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa, Acinetobacter baumannii, Salmonella spp, Staphylococcus aureus, and Streptococcus pneumoniae). Although E coli and Klebsiella spp resistance to third-generation cephalosporins is common in all countries, with prevalence reaching more than 50% in Egypt and Syria, carbapenem resistance is emerging, albeit with a prevalence of less than 10%. Conversely, a large amount of carbapenem resistance has been reported for P aeruginosa and A baumannii across the Arab League, reaching 50% and 88% of isolates in some countries. As for Salmonella spp, the prevalence of fluoroquinolone resistance has exceeded 30% in several areas. With regards to the Gram-positive pathogens, the prevalence of meticillin resistance in S aureus is reported to be between 20% and 30% in most countries, but exceeds 60% in Egypt and Iraq. The prevalence of penicillin non-susceptibility among pneumococci has reached more than 20% in Algeria, Egypt, Morocco, Saudi Arabia, and Tunisia. These findings highlight the need for structured national plans in the region to target infection prevention and antimicrobial stewardship.
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Affiliation(s)
- Rima A Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Zeina A Kanafani
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussam Z Tabaja
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sima L Sharara
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lyn S Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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High prevalence of multidrug-resistant international clones among macrolide-resistant Streptococcus pneumoniae isolates in immunocompromised patients in Tunisia. Int J Antimicrob Agents 2018; 52:893-897. [PMID: 29698665 DOI: 10.1016/j.ijantimicag.2018.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/12/2018] [Accepted: 04/14/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Macrolide-resistant Streptococcus pneumoniae isolates have increased considerably in the last decade, with important geographical variations in involved phenotypes and genotypes. The aim of this study was to investigate phenotypes, genotypes, serotypes and genetic relatedness of macrolide-resistant S. pneumoniae isolated from immunocompromised patients in Tunisia. METHODS Antibiotic susceptibility was determined by disk diffusion, and MICs of erythromycin and clindamycin were determined for macrolide-resistant isolates by Etest. Macrolide-resistant isolates were analysed by PCR for ermB, mefA, tetM, tetO and Int-Tn1545. Serotyping was done by multiplex PCR and the Quellung reaction. Multilocus sequence typing (MLST) was performed for molecular typing. RESULTS Macrolide resistance was observed in 41 (69.5%) of 59 isolates. Of the 41 isolates, 37 (90.2%) had a macrolide-lincosamide-streptogramin B (MLSB) resistance phenotype, with a predominance of high-level inducible MLSB phenotype, and harboured the ermB gene. All isolates with high-level inducible MLSB phenotype were highly resistant to erythromycin and clindamycin. Four isolates (9.8%) had a macrolide (M) resistance phenotype and harboured the mefA gene. Erythromycin-resistant isolates were multidrug-resistant (MDR) in 97.5% of cases and extensively drug-resistant in 12.2%. The isolates belonged essentially to four serotypes (19F, 23F, 14 and 6B). They were mainly assigned to three sequence types (ST81, ST2918 and ST386). Also, 65.9% of the isolates were grouped in three clonal complexes (CC81, CC838 and CC386). CONCLUSIONS These data indicate a high prevalence of Tn1545 transposon and of three MDR international clones contributing to the high frequency of multidrug resistance among S. pneumoniae isolates in our centre.
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Shi W, Liu Y, Meng Q, Yuan L, Gao W, Yao K. Antimicrobial susceptibility and fluctuations in clonal complexes of serogroup 6 Streptococcus pneumoniae isolates collected from children in Beijing, China, between 1997 and 2016. Braz J Microbiol 2018; 49:891-899. [PMID: 29606509 PMCID: PMC6175703 DOI: 10.1016/j.bjm.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/09/2018] [Accepted: 02/10/2018] [Indexed: 12/05/2022] Open
Abstract
This study examined the antimicrobial susceptibility patterns and clonal complex (CC) characteristics of serogroup 6 Streptococcus pneumoniae isolates collected from children in Beijing, China, between 1997 and 2016. Serotypes were determined using the Quellung reaction, and the antimicrobial susceptibility profiles of the isolates were determined using the disc-diffusion method or by E-test. Sequence types (STs) were assigned based on multilocus sequence typing. A total of 250 isolates were examined, with 55.2%, 30.0%, 12.8%, and 2.0% of isolates identified as serotypes 6A, 6B, 6C, and 6D, respectively. All of the isolates were susceptible to levofloxacin and vancomycin, and the non-suceptibitility rate to penicillin was 41.6%. Eighty-two distinct STs, assigned to 13 CCs and 28 singletons, were identified. CC982 was the most prevalent CC amongst serotype 6A isolates (34%), followed by CC9789 and CC3173. Amongst serotype 6B isolates, CC90 and CC4542 were the most common, accounting for 25.3% and 14.7% of isolates respectively. Over the study period, the prevalence of CC982, CC4542, and CC4536 isolates showing susceptibility to penicillin and cefuroxime decreased, and the proportion of CC3173, CC9789, CC855, and CC902 isolates showing non-susceptibility to these two antibiotics increased.
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Affiliation(s)
- Wei Shi
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China
| | - Ying Liu
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China
| | - Qinghong Meng
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China
| | - Lin Yuan
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China
| | - Wei Gao
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China
| | - Kaihu Yao
- Capital Medical University, National Center for Children's Health, Beijing Children's Hospital, Beijing Pediatric Research Institute, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing, China.
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Streptococcus pneumoniae Serotyping by a Single Polymerase Chain Reaction–Based Multiplex Assay. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Raddaoui A, Ben Tanfous F, Achour W, Baaboura R, Ben Hassen A. Description of a novel mutation in the atpC gene in optochin-resistant Streptococcus pneumoniae strains isolates from Tunisia. Int J Antimicrob Agents 2018; 51:803-805. [PMID: 29305958 DOI: 10.1016/j.ijantimicag.2017.12.029] [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: 09/24/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 11/25/2022]
Abstract
Identification of Streptococcus pneumoniae among other α-haemolytic streptococci is based on phenotypic or genotypic characteristics such as colony morphology, bile solubility and optochin susceptibility. This study reports three optochin-resistant S. pneumoniae strains isolated from immunocompromised patients in Tunisia. The three isolates were positive for the bile solubility test. Biochemical identification with API® 20 Strep was not discriminatory for two strains. The three strains had different serotypes (6C, 19F and 23F) and three different sequence types (ST386, ST320 and ST326). Sequencing of the atpA and atpC genes for each strain showed only modification in atpC. The mutations Met13→Val or Val48→Ile were observed in two strains. However, in the third strain a novel type of mutation (Val15→Ile) was identified.
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Affiliation(s)
- Anis Raddaoui
- Université de Carthage, Faculté des Sciences de Bizerte, Jarzouna 7021, Tunisia; Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, UR 12ES02, Tunis 1007, Tunisia.
| | - Farah Ben Tanfous
- Université de Carthage, Faculté des Sciences de Bizerte, Jarzouna 7021, Tunisia; Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, UR 12ES02, Tunis 1007, Tunisia
| | - Wafa Achour
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, UR 12ES02, Tunis 1007, Tunisia
| | - Rekaya Baaboura
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, UR 12ES02, Tunis 1007, Tunisia
| | - Assia Ben Hassen
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, UR 12ES02, Tunis 1007, Tunisia
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Shi W, Zhou K, Yuan L, Meng Q, Dong F, Gao W, Chen C, Wen D, Yao K. Serotype distribution, antibiotic resistance patterns and molecular characteristics of serogroup 6 Streptococcus pneumoniae isolates collected from Chinese children before the introduction of PCV13. J Glob Antimicrob Resist 2017; 14:23-28. [PMID: 29274470 DOI: 10.1016/j.jgar.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Streptococcus pneumoniae is an important pathogen in infectious diseases worldwide, and serogroup 6 S. pneumoniae strains are very common in China. This study investigated the serotype distribution, antibiotic resistance patterns and molecular characteristics of 215 serogroup 6 S. pneumoniae isolates collected from hospitalised children in China during 2013-2016. METHODS Serotypes were determined using the Quellung reaction with antisera. Antibiotic resistance against 11 antimicrobials was tested by Etest or the disk diffusion method. Sequence types (STs) were assigned using multilocus sequence typing (MLST). Data analysis was performed with WHONET 5.6 software. RESULTS The percentages of serotype 6A, 6B, 6C and 6D among the 215 serogroup 6 isolates were 50.7% (109/215), 36.3% (78/215), 12.6% (27/215) and 0.5% (1/215), respectively. All isolates were susceptible to levofloxacin and were resistant to erythromycin. No isolate was resistant to parenteral penicillin, but the intermediate and resistant rates reached 72.6% (156/215) and 5.1% (11/215), respectively, based on the oral breakpoint. Sixty-seven STs were detected, with 14 STs being newly assigned. The most common clonal complexes (CCs) were CC3173 (26.5%; 57/215), CC9789 (13.5%; 29/215), CC90 (13.0%; 28/215) and CC902 (8.8%; 19/215), and the non-susceptibility rates of these four CCs against penicillin and cefuroxime (penicillin, 98.2%, 100%, 100% and 100%, respectively; cefuroxime, 98.2%, 100%, 96.4% and 94.7%, respectively) were higher than the overall level of serogroup 6 isolates (penicillin, 77.7%; cefuroxime, 70.2%). CONCLUSIONS Serotype 6A is the most common serotype of serogroup 6 S. pneumoniae strains in Chinese children, and different CCs/STs express diverse antibiotic resistance patterns.
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Affiliation(s)
- Wei Shi
- Key Laboratory of Major Diseases in Children, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China
| | - Kai Zhou
- Infective Department, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Lin Yuan
- Key Laboratory of Major Diseases in Children, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China
| | - Qinghong Meng
- Key Laboratory of Major Diseases in Children, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China
| | - Fang Dong
- Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China
| | - Wei Gao
- Key Laboratory of Major Diseases in Children, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China
| | - Changhui Chen
- Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University, People's Hospital of Chongqing Youyang County, 102 Tao-hua-yuan Road, 409899 Youyang, Chongqing, China
| | - Denian Wen
- People's Hospital of Zhongjiang County, 96 Da-bei Street, 618100 Zhongjiang, Sichuan, China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, 100045 Beijing, China.
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Ktari S, Jmal I, Mroua M, Maalej S, Ben Ayed NE, Mnif B, Rhimi F, Hammami A. Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae strains in the south of Tunisia: A five-year study (2012–2016) of pediatric and adult populations. Int J Infect Dis 2017; 65:110-115. [DOI: 10.1016/j.ijid.2017.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022] Open
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Zhou H, Guo J, Qin T, Ren H, Xu Y, Wang C, Xu X. Serotype and MLST-based inference of population structure of clinical Streptococcus pneumoniae from invasive and noninvasive pneumococcal disease. INFECTION GENETICS AND EVOLUTION 2017; 55:104-111. [PMID: 28867594 DOI: 10.1016/j.meegid.2017.08.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
Streptococcus pneumoniae is an important human pathogen causing various diseases. In this study, S. pneumoniae from invasive (IPD) and noninvasive pneumococcal disease (NIPD) were studied by serotype and multilocus sequence typing (MLST) for population structure characteristics. A total of 169 clinical S. pneumoniae, containing 63 IPD and 106 NIPD strains, were analyzed. 19F, 19A, 6A, 6B, 1, 14 and 23F were the dominant serotypes in both IPD and NIPD strains. By MLST, 169 strains were divided into 85 sequence types (STs) with an index of discrimination (IOD) value of 0.9606. The seven predominant STs were ST271, ST320, ST876, ST3173, ST236, ST81 and ST342, which were mainly associated with serotypes 19F, 19A, 14, 6A, 19F, 1, and 1/23F, respectively. The 63 IPD strains were divided into 20 serotypes (IOD=0.9135) and 44 STs (IOD=0.9795); the 106 NIPD strains were divided into 16 serotypes (IOD=0.8334) and 49 STs (IOD=0.9430). In conclusion, the serotypes and ST distribution of IPD and NIPD strains analyzed in this study are similar to the profiles observed in other cities of China, suggesting that the clinical S. pneumoniae isolates were derived from clones generally circulating in China. The strains showed a variety of serotypes and STs, and the IPD strains showed higher serotype and genetic diversity than NIPD strains.
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Affiliation(s)
- Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, PR China
| | - Jiayin Guo
- Changning District Center for Disease Control and Prevention, Shanghai, PR China
| | - Tian Qin
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, PR China
| | - Hongyu Ren
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Yang Xu
- Changning District Center for Disease Control and Prevention, Shanghai, PR China
| | - Chuanqing Wang
- Children's Hospital of Fudan University, Shanghai, PR China.
| | - Xuebin Xu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, PR China.
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Talebi M, Azadegan A, Sadeghi J, Ahmadi A, Ghanei M, Katouli M, Owlia P, Pourshafie MR. Determination of Characteristics of Erythromycin Resistant Streptococcus pneumoniae with Preferred PCV Usage in Iran. PLoS One 2016; 11:e0167803. [PMID: 28033345 PMCID: PMC5199012 DOI: 10.1371/journal.pone.0167803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022] Open
Abstract
Amongst 100 Streptococcus pneumoniae isolated from clinical cases and nasopharynx of healthy individuals, 60 erythromycin resistant strains were isolated and characterized using MLST, PFGE, transposon analysis and Quellung reaction. Most of the S. pneumoniae erythromycin resistant (80%) were found to be attributable to the ermB-edncoded ribosome methylase activity which differs from the dominant mechanism of macrolide resistance seen in North America. The most predominant transposons were; Tn1545/6003 (27%), Tn6002 (22%), Tn2009 (20%), Tn2010 (17%). Number of the clinical isolates carrying Tn2010 was more significant than the normal flora. The serotypes found were; 14 (33%), 3 (22%), 23F (15%), 19F (15%), 19A (7%), 6A (3%), 9V (3%) and 6B (2%). The most prevalent serotypes among the clinical (n = 28) and normal flora (n = 32) isolates were serotypes 14 (46%) and 3 (31%), respectively. The most prevalent vaccine serotypes amongst the clinical isolates and the healthy individuals were pneumococcal conjugate vaccines (PCV) 13 and PCV10, respectively. PFGE revealed 34 pulsotypes with 9 common and 25 single types. Significant number of the normal isolates belonged to CT5 and CT6. On the other hand, significant number of clinical isolates belonged to CT8 as compared to the normal flora isolates. MLST showed 2 dominant sequence types. ST3130 (23%) and ST180 (22%) were the most predominant sequence types in the clinical and normal isolates, respectively. There was no significant difference in other sequence types between clinical and normal flora isolates. Three polyclonal complexes including Sweden15A -25, Spain23F-1 and Spain9V-3 constituted 58% of the isolates. Our results suggest that the genetic diversity and transposon distribution were high among S. pneumoniae, particularly in the isolates containing erm(B) and double antibiotic resistant genes (erm/mef). The results presented here could influence the change in the current vaccination practices in Iran which currently calls for vaccination with PCV7 or PCV10.
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Affiliation(s)
- Malihe Talebi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Azadegan
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Sadeghi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Tuberculosis Department, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Katouli
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Parviz Owlia
- Molecular Microbiology Research Center (MMRC), Shahed University, Tehran, Iran
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