1
|
Halwani M. Prevalence of Penicillin Resistance Among Streptococcus pneumoniae Isolates in a General Hospital in Southwest Saudi Arabia: A Five-Year Retrospective Study. Cureus 2024; 16:e55326. [PMID: 38559551 PMCID: PMC10981866 DOI: 10.7759/cureus.55326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
Background The rise in infections caused by penicillin-resistant strains of Streptococcus pneumoniae has become a global concern. However, the magnitude of this problem in Southwest Saudi Arabia has never been investigated. Therefore, this study aims to determine the prevalence of this bacteria in the region using in vitro data. Materials and methods This study retrospectively studied pneumococcal isolates collected by the Microbiology Laboratory of a general hospital in Al Baha, Saudi Arabia, from January 2013 to December 2017. A minimum inhibitory concentration (MIC) ≥ 8 mg/L was used as a cutoff concentration to detect the resistant isolates. Results A total of 201 S. pneumoniae isolates were identified using the VITEK® 2 system (bioMérieux SA, Marcy-l'Étoile, France). Most of these isolates (61%) were obtained from respiratory specimens, including sputum, tracheal aspirates, and bronchoalveolar lavage. Eye swabs accounted for 15% of the isolates, blood samples contributed 12%, ear swabs accounted for 7%, and cerebrospinal fluid (CSF) 3.4%. The resistance of S. pneumoniae during the five years varied from 61% to 76%, with an overall resistance of 70% (141/201). The resistance rate per year was 71% (43/60) in 2013, 76% (35/46) in 2014, 61% (22/36) in 2015, 68% (20/29) in 2016, and 66% (21/30) in 2017. Conclusion The data confirm the presence of penicillin-resistant S. pneumoniae in Southwest Saudi Arabia. Furthermore, the high resistance suggests a potential concern, emphasizing the need for penicillin control, surveillance, and vaccination to address this growing problem.
Collapse
Affiliation(s)
- Muhammad Halwani
- Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha, SAU
| |
Collapse
|
2
|
Chiș AA, Rus LL, Morgovan C, Arseniu AM, Frum A, Vonica-Țincu AL, Gligor FG, Mureșan ML, Dobrea CM. Microbial Resistance to Antibiotics and Effective Antibiotherapy. Biomedicines 2022; 10:biomedicines10051121. [PMID: 35625857 PMCID: PMC9138529 DOI: 10.3390/biomedicines10051121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
Currently, the efficacy of antibiotics is severely affected by the emergence of the antimicrobial resistance phenomenon, leading to increased morbidity and mortality worldwide. Multidrug-resistant pathogens are found not only in hospital settings, but also in the community, and are considered one of the biggest public health concerns. The main mechanisms by which bacteria develop resistance to antibiotics include changes in the drug target, prevention of entering the cell, elimination through efflux pumps or inactivation of drugs. A better understanding and prediction of resistance patterns of a pathogen will lead to a better selection of active antibiotics for the treatment of multidrug-resistant infections.
Collapse
|
3
|
Antimicrobial Resistant Streptococcus pneumoniae: Prevalence, Mechanisms, and Clinical Implications. Am J Ther 2018; 24:e361-e369. [PMID: 28430673 DOI: 10.1097/mjt.0000000000000551] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a major cause of pneumonia, meningitis, sepsis, bacteremia, and otitis media. S. pneumoniae has developed increased resistance to multiple classes of antibiotics. STUDY DESIGN Systematic literature review of prevalence, mechanisms, and clinical implications in S. pneumoniae resistance. AREAS OF UNCERTAINTY Since S. pneumoniae resistance to penicillin was first reported with subsequent development of resistance to other classes of drugs, selection of appropriate antibiotic treatment is challenging. DATA SOURCES We searched PubMed (English language) for citations to antibiotic resistance in S. pneumoniae published before March 1, 2016. RESULTS We present a review of S. pneumoniae resistance to beta-lactams, macrolides, lincosamides, fluoroquinolones, tetracyclines, and trimethoprim-sulfamethoxazole (TMP-SMX). There has been a steady decline in susceptibility of S. pneumoniae to commonly used beta-lactams. Phenotypic expression of penicillin resistance occurs as a result of a genetic structural modification in penicillin-binding proteins. Between 20% and 40% of S. pneumoniae isolates are resistant to macrolides. Macrolide resistance mechanisms include ribosomal target site alteration, alteration in antibiotic transport, and modification of the antibiotic. Approximately 22% of S. pneumoniae isolates are resistant to clindamycin. Similar to macrolide resistance, clindamycin involves a target site alteration. The prevalence of fluoroquinolone resistance is low, although increasing. S. pneumoniae resistance to fluoroquinolones occurs by accumulated mutations within the bacterial genome, increased efflux, or acquisition of plasmid-encoded genes. S. pneumoniae resistance has also increased for the tetracyclines. The primary mechanism is mediated by 2 genes that confer ribosomal protection. The prevalence of TMP-SMX resistance is around 35%. As with fluoroquinolones, resistance to TMP-SMX is secondary to mutations in the bacterial genome. CONCLUSIONS Effective treatment of resistant S. pneumoniae is a growing concern. New classes of drugs, newer formulations of older drugs, combination antibiotic therapy, nonantibiotic modalities, better oversight of antibiotic usage, and enhanced preventive measures hold promise.
Collapse
|
4
|
Antimicrobial Susceptibilities of Abiotrophia defectiva, Granulicatella adiacens, and Granulicatella elegans. Antimicrob Agents Chemother 2015; 60:1411-20. [PMID: 26666926 DOI: 10.1128/aac.02645-15] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/07/2015] [Indexed: 01/18/2023] Open
Abstract
Nutritionally variant streptococci (NVS) are fastidious Gram-positive cocci comprised of the species Abiotrophia defectiva, Granulicatella adiacens, and Granulicatella elegans. NVS are an important cause of bacteremia and infective endocarditis (IE) associated with significant morbidity and mortality. Antimicrobial susceptibility testing (AST) was performed for 14 antimicrobials using the broth microdilution MIC method described in the Clinical and Laboratory Standards Institute (CLSI) M45 guideline. A total of 132 clinical NVS blood isolates collected from 2008 to 2014 were tested. Species level identification of NVS isolates was achieved by 16S rRNA gene sequencing and/or matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Ninety isolates were identified as G. adiacens, 37 as A. defectiva, and 5 as G. elegans. All isolates were susceptible to vancomycin (MIC90 = 1 μg/ml), and none displayed high-level resistance to aminoglycosides. G. adiacens was considerably more susceptible to penicillin than A. defectiva (38.9% versus 10.8% of isolates susceptible) but was less susceptible to cephalosporins than was A. defectiva (43.3% versus 100% of isolates susceptible to ceftriaxone). Several isolates were resistant to levofloxacin (6%), erythromycin (51%), and clindamycin (10%). The MIC90 for daptomycin was ≥ 4 μg/ml for G. adiacens and A. defectiva. G. elegans isolates were 100% susceptible to all antimicrobials tested, with the exception of erythromycin, to which only 20% were susceptible. This study provides antimicrobial susceptibility data for a recent collection of NVS and demonstrates important NVS species-related differences with respect to susceptibility to penicillin, cephalosporins, carbapenems, and daptomycin. Species-level identification of NVS organisms when susceptibility testing is not readily available may aid in treatment decisions.
Collapse
|
5
|
Bertsch D, Rau J, Eugster MR, Haug MC, Lawson PA, Lacroix C, Meile L. Listeria fleischmannii sp. nov., isolated from cheese. Int J Syst Evol Microbiol 2013; 63:526-532. [DOI: 10.1099/ijs.0.036947-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A study was performed on three isolates (LU2006-1T, LU2006-2 and LU2006-3), which were sampled independently from cheese in western Switzerland in 2006, as well as a fourth isolate (A11-3426), which was detected in 2011, using a polyphasic approach. The isolates could all be assigned to the genus
Listeria
but not to any known species. Phenotypic and chemotaxonomic data were compatible with the genus
Listeria
and phylogenetic analysis based on 16S rRNA gene sequences confirmed that the closest relationships were with members of this genus. However, DNA–DNA hybridization demonstrated that the isolates did not belong to any currently described species. Cell-wall-binding domains of
Listeria monocytogenes
bacteriophage endolysins were able to attach to the isolates, confirming their tight relatedness to the genus
Listeria
. Although PCR targeting the central portion of the flagellin gene flaA was positive, motility was not observed. The four isolates could not be discriminated by Fourier transform infrared spectroscopy or pulsed-field gel electrophoresis. This suggests that they represent a single species, which seems to be adapted to the environment in a cheese-ripening cellar as it was re-isolated from the same type of Swiss cheese after more than 5 years. Conjugation experiments demonstrated that the isolates harbour a transferable resistance to clindamycin. The isolates did not exhibit haemolysis or show any indication of human pathogenicity or virulence. The four isolates are affiliated with the genus
Listeria
but can be differentiated from all described members of the genus
Listeria
and therefore they merit being classified as representatives of a novel species, for which we propose the name Listeria fleischmannii sp. nov.; the type strain is LU2006-1T ( = DSM 24998T = LMG 26584T).
Collapse
Affiliation(s)
- David Bertsch
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Jörg Rau
- Chemisches und Veterinäruntersuchungsamt Stuttgart (CVUAS), 70736 Fellbach, Germany
| | - Marcel R. Eugster
- Laboratory of Food Microbiology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Martina C. Haug
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Paul A. Lawson
- Department of Botany and Microbiology, University of Oklahoma, Norman, OK 73019, USA
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| |
Collapse
|
6
|
Solomon K, Murray S, Scott L, McDermott S, Drudy D, Martin A, O'Donoghue C, Skally M, Burns K, Fenelon L, Fitzpatrick F, Kyne L, Fanning S. An investigation of the subtype diversity of clinical isolates of Irish Clostridium difficile ribotypes 027 and 078 by repetitive-extragenic palindromic PCR. J Med Microbiol 2011; 60:1080-1087. [PMID: 21459905 DOI: 10.1099/jmm.0.029983-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A repetitive-extragenic palindromic PCR (rep-PCR) subtyping method (DiversiLab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within Clostridium difficile ribotypes 027 and 078. Clinical isolates of ribotypes 027 (toxinotype III) (n = 30) and 078 (toxinotype V) (n = 23) were provided by health-care facilities across the Republic of Ireland over 2 months in 2006 and 1 month in 2009. Ribotype 027 isolates were significantly more related to each other (9 different subtype profiles) when compared to ribotype 078 isolates (14 different profiles) (P = 0.001; cut-off >90 % similarity). Almost half of ribotype 078 isolates (45.5 %) showed no relationship to each other. The clonality of ribotype 027 isolates suggests effective adaptation to the human niche, whereas the considerable genetic diversity within ribotype 078 isolates suggests that they may have originated from a variety of sources. Subtyping correlated well with antimicrobial susceptibility, in particular clindamycin susceptibility for ribotype 027, but diverse antimicrobial-susceptibility profiles were seen in ribotype 078 isolates, even within a single health-care facility. Between 2006 and 2009, a change in the predominant subtype of ribotype 027 was seen, with the recent clone representing half of all ribotype 027 isolates studied. This strain exhibited 89 % similarity to a rep-PCR profile of the North American NAP-1 strain.
Collapse
Affiliation(s)
- K Solomon
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - S Murray
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - L Scott
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S McDermott
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Drudy
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Martin
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - C O'Donoghue
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - M Skally
- Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K Burns
- Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - L Fenelon
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
- Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland
| | - L Kyne
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - S Fanning
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| |
Collapse
|
7
|
Merino Díaz L, Torres Sánchez MJ, Aznar Martín J. Prevalence and mechanisms of erythromycin and clindamycin resistance in clinical isolates of beta-haemolytic streptococci of Lancefield groups A, B, C and G in Seville, Spain. Clin Microbiol Infect 2007; 14:85-7. [PMID: 18034859 DOI: 10.1111/j.1469-0691.2007.01881.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Susceptibility to erythromycin and clindamycin was determined in 860 consecutive clinical isolates of beta-haemolytic streptococci belonging to groups A (GAS, n = 134), B (GBS, n = 689), C (GCS, n = 19) and G (GGS, n = 18). Erythromycin resistance was 26.1% in GAS, 15.7% in GBS, 5.3% in GCS and 33.3% in GGS. The highest rate of clindamycin resistance (33.3%) was in GGS, followed by GBS (15.8%), GCS (15.8%) and GAS (5.2%). The M phenotype was predominant in GAS (80%), the constitutive MLS(B) phenotype was predominant in GBS (75%), and all GGS isolates showed the inducible MLS(B) phenotype. The uncommon erythromycin-susceptible and clindamycin-resistant phenotype was found in four GBS and two GCS isolates.
Collapse
Affiliation(s)
- L Merino Díaz
- Servicio de Microbiología, Hospitales Universitarios, Virgen del Rocío, Sevilla, Spain
| | | | | |
Collapse
|