tetracycline and Pneumococcal-Infections

Pneumococcal diseases are a leading cause of morbidity and mortality among children globally, and the burden of these diseases might be worsened by antimicrobial resistance. To understand the effect of pneumococcal conjugate vaccine (PCV) deployment on antimicrobial resistance in pneumococci, we assessed the susceptibility of paediatric pneumococcal isolates to various antimicrobial drugs before and after PCV implementation.. We did a systematic review of studies reporting antimicrobial susceptibility profiles of paediatric pneumococcal isolates between 2000 and 2020 using PubMed and the Antimicrobial Testing Leadership and Surveillance database (ATLAS; Pfizer). Population-based studies of invasive pneumococcal disease or nasopharyngeal colonisation were eligible for inclusion. As primary outcome measures, we extracted the proportions of isolates that were non-susceptible or resistant to penicillin, macrolides, sulfamethoxazole-trimethoprim, third-generation cephalosporins, and tetracycline from each study. Where available, we also extracted data on pneumococcal serotypes. We estimated changes in the proportion of isolates with reduced susceptibility or resistance to each antibiotic class using random-effects meta-regression models, adjusting for study-level and region-level heterogeneity, as well as secular trends, invasive or colonising isolate source, and countries' per-capita gross domestic product.. From 4910 studies screened for inclusion, we extracted data from 559 studies on 312 783 paediatric isolates. Susceptibility of isolates varied substantially across regions both before and after implementation of any PCV product. On average across all regions, we estimated significant absolute reductions in the proportions of pneumococci showing non-susceptibility to penicillin (11·5%, 95% CI 8·6-14·4), sulfamethoxazole-trimethoprim (9·7%, 4·3-15·2), and third-generation cephalosporins (7·5%, 3·1-11·9), over the 10 years after implementation of any PCV product, and absolute reductions in the proportions of pneumococci resistant to penicillin (7·3%, 5·3-9·4), sulfamethoxazole-trimethoprim (16·0%, 11·0-21·2), third-generation cephalosporins (4·5%, 0·3-8·7), macrolides (3·6%, 0·7-6·6) and tetracycline (2·0%, 0·3-3·7). We did not find evidence of changes in the proportion of isolates non-susceptible to macrolides or tetracycline after PCV implementation. Observed changes in penicillin non-susceptibility were driven, in part, by replacement of vaccine-targeted serotypes with non-vaccine serotypes that were less likely to be non-susceptible.. Implementation of PCVs has reduced the proportion of circulating pneumococci resistant to first-line antibiotic treatments for pneumonia. This effect merits consideration in assessments of vaccine impact and investments in coverage improvements.. Bill & Melinda Gates Foundation.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Child; Drug Resistance, Bacterial; Humans; Macrolides; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Regression Analysis; Streptococcus pneumoniae; Sulfamethoxazole; Tetracycline; Trimethoprim; Vaccines, Conjugate

This article reviews the molecular mechanisms of resistance to fluoroquinolones, erythromycin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole in Streptococcus pneumoniae. Resistance to fluoroquinolones primarily involves mutations in the DNA gyrase gene, gyrA, and in the topoisomerase IV genes, parC and parE, although in vitro studies have indicated that some strains may use an efflux mechanism for resistance to certain fluoroquinolones. Ciprofloxacin resistance results from initial and necessary mutations in ParC leading to low-level resistance and subsequent mutations in GyrA leading to high-level resistance. Sparfloxacin resistance results from initial mutations in GyrA, with ParC mutations occurring subsequently. A single amino acid substitution in ParE has also been associated with low-level resistance in S pneumoniae. Two mechanisms have been described for resistance to erythromycin. Coresistance to macrolides, lincosamides, and streptogramin B type antibiotics is a result of modification of the ribosome through methylation of an adenine residue in domain V of the 23S rRNA. This methylation is encoded by the methylase gene, ermAM. Resistance only to 14-and 15-membered macrolides is a result of efflux of the antibiotic from the cell, encoded by the gene, mefE, in S pneumoniae, and appears to be rapidly emerging as the predominant mechanism of resistance to erythromycin in many countries. The production of chloramphenicol acetyltransferase, an enzyme capable of catalyzing the conversion of chloramphenicol to its nonfunctional 1-acetoxy, 3-acetoxy, and 1,3-diacetoxy derivatives, leads to chloramphenicol resistance in S pneumoniae. Chloramphenicol acetyltransferase is encoded by a cat gene identical to the cat gene from the Staphylococcus aureus plasmid, pC194. Tetracycline resistance occurs through ribosomal protection encoded by the genes tet(M) and tet(O). It is possible that the Tet(M) and Tet(O) proteins cause tetracycline to be released from the ribosome, although the precise mechanism remains unclear. Resistance to trimethoprim is mediated through a single amino acid substitution in the chromosomal dihydrofolate reductase gene of S pneumoniae, which is thought to disrupt the bond with trimethoprim without affecting the action of the dihydrofolate reductase. Sulphonamide resistance appears to result from repetitions of one or two amino acids in the chromosomal dihydropteroate synthase. Although resistance exists to nearly all ant

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Cats; Drug Resistance, Multiple; Erythromycin; Fluoroquinolones; Folic Acid Antagonists; Humans; Microbial Sensitivity Tests; Molecular Biology; Penicillins; Pneumococcal Infections; Sensitivity and Specificity; Streptococcus pneumoniae; Tetracycline; Trimethoprim

Anaerobic bacteria were isolated from the subdural space in all four cases of subdural empyema encountered over a 2 and a half year period. Only one aerobe was isolated in these cases. The bacteriology of subdural empyema was further analyzed from a review of 327 cases reported in the English literature. Anaerobes accounted for 12 per cent of 234 cases; In addition, 27 per cent of cases were reportedly "sterile." These data support our finding that anaerobic bacteria may play a far more important role in subdural empyema than was previously appreciated.

Topics: Adolescent; Ampicillin; Anaerobiosis; Bacteroides; Bacteroides Infections; Brain Abscess; Child; Chloramphenicol; Clindamycin; Dexamethasone; Drainage; Female; Humans; Male; Meninges; Methicillin; Middle Aged; Penicillins; Peptostreptococcus; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Streptococcus pneumoniae; Subdural Space; Tetracycline

Topics: Adult; Anti-Bacterial Agents; Cephalosporins; Child; Chloramphenicol; Erythromycin; Escherichia coli Infections; Gentamicins; Humans; Infant; Klebsiella Infections; Microbial Sensitivity Tests; Neomycin; Otorhinolaryngologic Diseases; Penicillins; Pneumococcal Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Streptococcal Infections; Streptomycin; Sulfonamides; Tetracycline; Tracheoesophageal Fistula

Topics: Adolescent; Adult; Aminosalicylic Acids; Bronchitis; Child; Child, Preschool; Erythromycin; Female; Haemophilus Infections; Herpesviridae Infections; Humans; Infant; Isoniazid; Male; Mycoplasma Infections; Penicillins; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumocystis; Pneumonia, Staphylococcal; Pneumonia, Viral; Radiography; Respiratory Tract Infections; Skin Tests; Streptococcal Infections; Tetracycline; Tuberculosis, Pulmonary

Topics: Aminoglycosides; Ampicillin; Anti-Infective Agents; Antifungal Agents; Antitubercular Agents; Antiviral Agents; Bronchitis; Cephalosporins; Chloramphenicol; Drug Combinations; Humans; Lincomycin; Meningococcal Infections; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcal Infections; Sulfamethoxazole; Sulfonamides; Tetracycline; Trimethoprim; Urinary Tract Infections

Topics: Acute Disease; Anti-Bacterial Agents; Bacitracin; Bronchitis; Chloramphenicol; Chronic Disease; Ear Diseases; Humans; Labyrinth Diseases; Laryngitis; Neomycin; Novobiocin; Otitis Externa; Otitis Media; Penicillins; Pneumococcal Infections; Polymyxins; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Tonsillitis; Tracheal Diseases

Topics: Bacteriological Techniques; Diagnosis; Embolism; Endocarditis, Bacterial; Erythromycin; Fever; Heart Defects, Congenital; Heart Valves; Humans; Lung Diseases; Penicillin Resistance; Penicillins; Pneumococcal Infections; Postoperative Complications; Prognosis; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Azithromycin; Carrier State; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pharynx; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trachoma

Topics: Administration, Oral; Bacteria; Child; Child, Preschool; Clinical Trials as Topic; Evaluation Studies as Topic; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Nasopharynx; Penicillins; Placebos; Pneumococcal Infections; Respiratory Tract Infections; Staphylococcal Infections; Tetracycline; Thailand; Viruses

Streptococcus pneumoniae remains a leading cause of morbidity and mortality worldwide. In this study, we sought to analyze serotype distributions, antibiotic resistance, and genetic relationships of 106 clinical invasive pneumococcal isolates recovered in Tunisia between 2012 and 2018, prior to the routine use of pneumococcal conjugate vaccines (PCV).. We used multiplex PCR, the disk diffusion method and/or E-test, and multi-locus sequence typing (MLST).. The most frequent serotypes were 14 (17%), 19F (14.2%), and 3 (11.3%). Of the 106 S. pneumoniae isolates, 67.9% were penicillin non-susceptible (29.4% were resistant), 45.3% were amoxicillin non-susceptible (17% were resistant), and 16% were cefotaxime non-susceptible. For antibiotics other than β-lactams, resistance rates to erythromycin, tetracycline, cotrimoxazole, and chloramphenicol were 62.3, 33, 22.6, and 4.7%, respectively. Two isolates were non-susceptible to levofloxacin. Among 66 erythromycin-resistant pneumococci, 77.3% exhibited the cMLSB phenotype, and 87.9% carried ermB gene. All tetracycline-resistant strains harbored the tetM gene. The potential coverage by 7-, 10-, and 13-valent pneumococcal conjugate vaccines were 55.7, 57.5, and 81.1%, respectively. A multilocus sequence typing analysis revealed great diversity. Fifty different sequence types (STs) were identified. These STs were assigned to 10 clonal complexes and 32 singletons. The most common STs were 179, 2918, 386, and 3772 - related mainly to 19F, 14, 6B/C, and 19A serotypes, respectively.. This study demonstrated that the majority of the serotypes of invasive pneumococci in the Tunisian population were 14, 19F, and 3. Moreover, we noted a high degree of genetic diversity among invasive S. pneumoniae isolates. The highest proportions of antibiotic non-susceptible isolates were for penicillin, erythromycin, and tetracycline. Further molecular characteristics are required to monitor the genetic variations and to follow the emergence of resistant pneumococci for the post-vaccination era in Tunisia.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Erythromycin; Humans; Microbial Sensitivity Tests; Multilocus Sequence Typing; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Tetracycline; Tunisia

Serotype 3 pneumococci remains a significant cause of disease despite its inclusion in PCV13. Whilst clonal complex 180 (CC180) represents the major clone, recent studies have refined the population structure into three clades: Iα, Iβ and II, with the last being a recent divergent and more antibiotic-resistant. We present a genomic analysis of serotype 3 isolates from paediatric carriage and all-age invasive disease, collected between 2005 and 2017 in Southampton, UK. Forty-one isolates were available for analysis. Eighteen were isolated during the annual cross-sectional surveillance of paediatric pneumococcal carriage. The remaining 23 were isolated from blood/cerebrospinal fluid specimens at the University Hospital Southampton NHS Foundation Trust laboratory. All carriage isolates were CC180 GPSC12. Greater diversity was seen with invasive pneumococcal disease (IPD) with three GPSC83 (ST1377:

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Erythromycin; Genomics; Humans; Middle Aged; Oxacillin; Pneumococcal Infections; Serogroup; Streptococcus pneumoniae; Tetracycline; United Kingdom

The genetic mechanisms of resistance, clonal composition, and the occurrence of pili were analyzed in 39 pneumococcal strains isolated from healthy children in the southeastern region of Poland. Strains with resistance to combinations of erythromycin, clindamycin, and tetracycline were found in clonal groups (CGs) related to Tennessee 23F-4 and Taiwan 19F-14 clones. Capsular switching possibly occurred in the Spain 9V-3 clone and its variants to serotypes 35B and 6A, as well as DLVs of Tennessee 23F-4 to serotype 23A. The double-locus variants of Colombia 23F-26 presented serotype 23B. The major transposons carrying the erythromycin and tetracycline resistance genes were Tn

Topics: Anti-Bacterial Agents; Child, Preschool; Erythromycin; Humans; Infant; Microbial Sensitivity Tests; Molecular Epidemiology; Nasopharynx; Pneumococcal Infections; Pneumococcal Vaccines; Poland; Serogroup; Streptococcus pneumoniae; Tetracycline; Vaccination

Topics: Azithromycin; Bacterial Typing Techniques; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; High-Throughput Nucleotide Sequencing; Hospitals, Pediatric; Humans; Infant; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Myanmar; Phylogeny; Pneumococcal Infections; Respiratory Tract Infections; Streptococcus pneumoniae; Tetracycline; Whole Genome Sequencing

Antimicrobial-resistant strains of Streptococcus pneumoniae have become one of the greatest challenges to global public health today and inappropriate use of antibiotics and high level of antibiotic use is probably the main factor driving the emergence of resistance worldwide. The aim of this study is, therefore, to assess the antimicrobial resistance profiles and multidrug resistance patterns of S. pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia.. A hospital-based prospective study was conducted from January 2018 to December 2019 at Addis Ababa city and Amhara National Region State Referral Hospitals. Antimicrobial resistance tests were performed from isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal fluid, blood, sputum, eye discharge, ear discharge, and pleural and peritoneal fluids) from all collection sites were initially cultured on 5% sheep blood agar plates and incubated overnight at 37 °C in a 5% CO. Of the 57 isolates, 17.5% were fully resistant to penicillin. The corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5 and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was co-resistance to penicillin, erythromycin, clindamycin, and tetracycline.. Most S. pneumoniae isolates were susceptible to ceftriaxone and cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to several commonly used antibiotics including penicillin. Hence, it is important to periodically monitor the antimicrobial resistance patterns to select empirical treatments for better management of pneumococcal infection.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Chloramphenicol; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Ethiopia; Female; Hospitals; Humans; Male; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Prospective Studies; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is the sixth largest cause of death in the UK. It is usually caused by

Topics: Drug Resistance, Bacterial; Erythromycin; Genomic Islands; Humans; Macrolides; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Tetracycline; United Kingdom

Streptococcus pneumoniae causes serious infections worldwide. The aim of this study was to determine the molecular characteristic, antibiotic resistance pattern and capsular types of invasive S. pneumoniae in Tehran, Iran.. Of the 44 pneumococcal invasive isolates, 39 (89%) were isolated from children and 5 (11%) from adults. The results show that all pneumococcal isolates were susceptible to linezolid but had varying resistance to trimethoprim-sulfamethoxazole (86%), erythromycin (73%), tetracycline (66%), clindamycin (43%), penicillin (16%), chloramphenicol (14%) and levofloxacin (2%). The range of erythromycin, tetracycline and penicillin MICs were 2 - ≥ 256 μg/mL, 4 - ≥ 48 μg/mL, and 0.047 - ≥ 256 respectively. All of the penicillin resistant isolates were multidrug resistant (MDR) and in addition to penicillin were resistant to tetracycline, erythromycin and trimethoprim-sulfamethoxazole. The most common capsular types detected in 64% of the pneumococcal isolates was 6A/B, 19A, 15A, 23F. The multilocus sequence typing (MLST) of 10 pneumococcal isolates revealed 9 different sequence types (STs), including ST 15139 (capsular type 19A) and ST 15140 (capsular type 23F), which have not previously been reported.. The study revealed that the S. pneumoniae isolates belonged to diverse capsular types and clones with high rate of resistance to erythromycin, tetracycline, and penicillin.

Topics: Adult; Anti-Bacterial Agents; Bacterial Capsules; Bacterial Typing Techniques; Child; Drug Resistance, Multiple, Bacterial; Erythromycin; Gene Expression Regulation, Bacterial; Humans; Iran; Microbial Sensitivity Tests; Multilocus Sequence Typing; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

This study was performed to analyze the serotype distribution of Streptococcus pneumoniae causing invasive pneumococcal disease (IPD) in children aged 5 years and under in Malaysia and to assess the antimicrobial resistance.. From 2014 to 2017, a total of 245 invasive S. pneumoniae isolates from children ≤5 years of age were received from hospitals all around Malaysia. All isolates were identified and subjected to serotyping and antimicrobial susceptibility testing.. Of the 245 isolates, 117 (48.0%) were from children aged <1year, 46 (19.05%) were from children aged 1-2 years, and 82 (33.0%) were from children aged 2-5 years. The most common serotypes were 14 (26.9%), 6B (19.6%), 19A (11.8%), 6A (10.6%), and 19F (6.9%) and vaccine coverage was 88.2% for PCV13, 64.1% for PCV10, and 63.3% for PCV7. Resistance to penicillin was 0.2% for non-meningitis cases and 22.2% for meningitis cases; erythromycin resistance was reported in 42.9%, co-trimoxazole in 35.9%, and tetracycline in 42.9%.. Serotypes 14, 6B, 19A, 6A, and 19F were the most common serotypes isolated from children with IPD in Malaysia during this pre-vaccination era. The lack of reports on the serotype distribution has limited action for the implementation of PCV in the national immunization programme (NIP). The information from this study may benefit future policies for the introduction of PCV in the Malaysian NIP and ultimately may reduce the morbidity and mortality among children in Malaysia.

Topics: Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Heptavalent Pneumococcal Conjugate Vaccine; Hospitals; Humans; Infant; Malaysia; Male; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Vaccination Coverage

The aim of this study was to investigate nasopharyngeal carriage rate and antibiotic susceptibility patterns of Streptococcus pneumoniae among school children.. Three hundred eleven (43.8%) became culture positive for S. pneumoniae. The carriage rate among children, 3-5 years old was 62.5%, which was higher than the carriage rate of 38.6% among 6-13 years old children. Age ≤ 5 years and co-sleeping with siblings remained significantly associated with S. pneumoniae carriage. 155 (49.8%) of the isolates were resistant to co-trimoxazole, 152 (48.9%) of the isolates were resistant to tetracycline, and 88 (28.3%) of isolates were resistant to oxacillin. Multi drug resistant S. pneumoniae was observed in 90 (28.9%) of isolates. There is high prevalence of S. pneumoniae in primary school children in our study area. Relatively high carriage rate of resistance to oxacillin, tetracycline and co-trimoxazole were observed. These findings provide baseline data for future studies to further compare pneumococcal carriage rates and antibiotic resistance patterns.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Ethiopia; Female; Humans; Male; Microbial Sensitivity Tests; Nasopharynx; Pneumococcal Infections; Siblings; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination

Streptococcus pneumoniae serotype 5 is among the most common serotypes causing invasive pneumococcal disease (IPD) in The Gambia. We anticipate that introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13) into routine vaccination in The Gambia will reduce serotype 5 IPD. However, the emergence of new clones that have altered their genetic repertoire through capsular switching or genetic recombination after vaccination with PCV-13 poses a threat to this public health effort. In order to monitor for potential genetic changes post-PCV-13 vaccination, we established the baseline population structure, epidemiology, and antibiotic resistance patterns of serotype 5 before the introduction of PCV-13.. Fifty-five invasive S. pneumoniae serotype 5 isolates were recovered from January 2009 to August 2011 in a population-based study in the Upper River Region of The Gambia. Serotyping was done by latex agglutination and confirmed by serotype-specific Polymerase Chain Reaction (PCR). Genotyping was undertaken using Multilocus Sequence Typing (MLST). Antimicrobial sensitivity was done using disc diffusion. Contingency table analyses were conducted using Pearson's Chi(2) and Fisher's exact test. Clustering was performed using Bionumerics version 6.5.. MLST resolved S. pneumoniae serotype 5 isolates into 3 sequence types (ST), namely ST 289(6/55), ST 3339(19/55) and ST 3404(30/55). ST 289 was identified as the major clonal complex. ST 3339, the prevalent genotype in 2009 [84.6% (11/13)], was replaced by ST 3404 [70.4% (19/27)] in 2010 as the dominant ST. Interestingly, ST 3404 showed lower resistance to tetracycline and oxacillin (P < 0.001), an empirical surrogate to penicillin in The Gambia.. There has been an emergence of ST 3404 in The Gambia prior to the introduction of PCV-13. Our findings provide important background data for future assessment of the impact of PCV-13 into routine immunization in developing countries, such as The Gambia.

Topics: Anti-Bacterial Agents; Cluster Analysis; Drug Resistance, Microbial; Gambia; Genotype; Humans; Latex Fixation Tests; Multilocus Sequence Typing; Oxacillin; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prevalence; Serogroup; Streptococcus pneumoniae; Tetracycline; Vaccination

Although serogroup 20 is not part of any conjugate pneumococcal vaccine, its serotype 20A, but not 20B, belongs to the polysaccharide 23-valent formula. Little is known about its clinical, laboratorial and epidemiological characteristics.. The purpose of this study was to evaluate the bacterial genotypes (by PFGE and MLST), clinical characteristics of patients (from review of medical records) and antimicrobial susceptibility of serogroup 20 isolates which were recovered from patients with invasive pneumococcal disease (IPD) from 2007 to 2012. Subtyping to determine 20A and 20B types was also performed by sequencing the genes of the cps locus.. Sixteen isolates were genotyped and were highly related. All pneumococci were resistant to tetracycline and 31 % were non-susceptible to trimethoprim/sulfamethoxazole. Penicillin MIC ranged from 0.004 to 1 μg/mL and non-susceptibility (MIC ≥ 0.12 μg/mL) was observed in 5/16 isolates (31 %). All isolates belonged to subtype 20B. Most patients were male with a median age of 62 years and presented at least one underlying disease (mostly respiratory conditions). All isolates belonged to ST8889 and to a unique PFGE clone.. A high clonal occurrence of serotype 20B pneumococci recovered from patients with IPD in Brazil was observed. As a non-PCV10 serotype, selective pressure may be responsible for this unusual occurrence of serogroup 20. However, temporal variation effect should not be underestimated; therefore it is an issue that warrants continued monitoring.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Brazil; Cerebrospinal Fluid; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Pneumococcal Infections; Serogroup; Streptococcus pneumoniae; Tetracycline

Our whole genome sequence (WGS) pipeline was assessed for accurate prediction of antimicrobial phenotypes. For 2316 invasive pneumococcal isolates recovered during 2015 we compared WGS pipeline data to broth dilution testing (BDT) for 18 antimicrobials. For 11 antimicrobials categorical discrepancies were assigned when WGS-predicted MICs and BDT MICs predicted different categorizations for susceptibility, intermediate resistance or resistance, ranging from 0.9% (tetracycline) to 2.9% (amoxicillin). For β-lactam antibiotics, the occurrence of at least four-fold differences in MIC ranged from 0.2% (meropenem) to 1.0% (penicillin), although phenotypic retesting resolved 25%-78% of these discrepancies. Non-susceptibility to penicillin, predicted by penicillin-binding protein types, was 2.7% (non-meningitis criteria) and 23.8% (meningitis criteria). Other common resistance determinants included mef (475 isolates), ermB (191 isolates), ermB + mef (48 isolates), tetM (261 isolates) and cat (51 isolates). Additional accessory resistance genes (tetS, tet32, aphA-3, sat4) were rarely detected (one to three isolates). Rare core genome mutations conferring erythromycin-resistance included a two-codon rplD insertion (rplD69-KG-70) and the 23S rRNA A2061G substitution (six isolates). Intermediate cotrimoxazole-resistance was associated with one or two codon insertions within folP (238 isolates) or the folA I100L substitution (38 isolates), whereas full cotrimoxazole-resistance was attributed to alterations in both genes (172 isolates). The two levofloxacin-resistant isolates contained parC and/or gyrA mutations. Of 11 remaining isolates with moderately elevated MICs to both ciprofloxacin and levofloxacin, seven contained parC or gyrA mutations. The two rifampin-resistant isolates contained rpoB mutations. WGS-based antimicrobial phenotype prediction was an informative alternative to BDT for invasive pneumococci.

Topics: Anti-Bacterial Agents; Chloramphenicol; Ciprofloxacin; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Mutation; Penicillin-Binding Proteins; Penicillins; Pneumococcal Infections; RNA, Ribosomal, 23S; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States

The present analysis focuses on phenotypic and genotypic characterizations of efflux-mediated erythromycin resistance in Streptococcus pneumoniae due to an increase in macrolide resistance in S. pneumoniae worldwide.. We investigated the prevalence of efflux-mediated erythromycin resistance and its relevant genetic elements from 186 specimens of S. pneumonia isolated from clinical and normal flora from Tehran, Iran. The presence of erythromycin resistance genes was tested by PCR with two sets of primers, specific for erm(B) and mef(A/E), and their genetic elements with tetM, xis, and int genes. Isolates were typed with the BOX PCR method and tested for resistance to six antibiotics.. Antibiotic susceptibility tests revealed that 100% and 47% isolates were resistant to tetracycline and erythromycin, respectively. The erythromycin and clindamycin double-disc diffusion test for macrolide-lincosamide-streptograminB (MLSB) resistance phenotype showed 74 (84%) isolates with the constitutive MLSB phenotype and the remaining with the M phenotype. BOX PCR demonstrated the presence of 7 types in pneumococci with the M phenotype. Fourteen (16%) isolates with the M phenotype harbored mef(A/E), tetM, xis, and int genes.. The present results suggest dissemination of polyclonal groups of S. pneumoniae with the M phenotype carrying resistance genes attributed to transposon 2009.

Topics: Anti-Bacterial Agents; Bacterial Proteins; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Erythromycin; Genotype; Humans; Microbial Sensitivity Tests; Phenotype; Pneumococcal Infections; Polymerase Chain Reaction; Streptococcus pneumoniae; Tetracycline

Streptococcus pneumoniae is the cause of high mortality among children worldwide. Antimicrobial treatment and vaccination are used to control pneumococcal infections. In Ghana, data on antimicrobial resistance and the prevalence of multidrug-resistant pneumococcal clones are scarce; hence, the aim of this study was to determine the antibiogram of S. pneumoniae recovered from Ghanaian children younger than six years of age and to what extent resistances were due to the spread of certain sero- and multilocus sequence typing (MLST) types. The susceptibility of 115 pneumococcal isolates, recovered in a previous study, to six antimicrobials was determined by disk diffusion test. Overall, 90.4% of isolates were intermediate penicillin resistant, 99.1% were trimethoprim resistant, 73.0% were tetracycline resistant, and 33.9% were sulfamethoxazole resistant. Low resistance was recorded for erythromycin (2.6%) and cefotaxime (5.2%). Overall, 72.2% of isolates were resistant to penicillin (I or R) and at least two other antimicrobials. MLST of 20 isolates showing resistance to at least four antimicrobials revealed a high diversity documented by 16 different clones, none of which had previously been associated with multidrug resistance. The resistances found may have emerged due to nonprudent antimicrobial use practices and there is a need to monitor and promote prudent antimicrobial usage in Ghana.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Cefotaxime; Child; Child, Preschool; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Ghana; Humans; Infant; Male; Multilocus Sequence Typing; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Sulfamethoxazole; Tetracycline; Trimethoprim

To evaluate the susceptibility patterns among Streptococcus pneumoniae recovered during the years 2010-2012 and to correlate these with serotypes.. Pneumococci from invasive sites were serotyped by sequential multiplex PCR and/or Quellung reaction. Etest strips were used to determine the minimal inhibitory concentrations, and the Clinical and Laboratory Standards Institute (CLSI) guidelines were used for interpretation. Genetic determinants of macrolide resistance were assessed by PCR, and the occurrence of the D phenotype was analyzed following the recommendations of the CLSI.. One hundred fifty-nine S. pneumoniae were studied; most were recovered from blood and were associated with serotypes 14, 3, 4, 23F, 20, 7F, 12F, 19A, and 19F. Pneumococcal conjugate vaccine PCV7, PCV10, and PCV13 and 23-valent polysaccharide vaccine serotypes represented 38.2%, 48.7%, 64.5%, and 85.5%, respectively. β-Lactam non-susceptibility (non-meningitis) was basically related to serotype 19A. For meningitis, it was observed in 21.4% (serotypes 14, 3, 9V, 23F, and 24F). Resistance to erythromycin occurred in 8.2% and mefA was the most common macrolide genetic determinant. One isolate was resistant to levofloxacin. Non-susceptibility to trimethoprim-sulfamethoxazole was 37.7% and to tetracycline was 22.0%.. Our population of pneumococci represents a transition era, soon after the introduction of PCV10. Non-susceptible patterns were found to be associated with classical PCV serotypes (especially serotype 14), which is still highly prevalent, and non-PCV10 ones (19A), which may disseminate, occupying the biological niche left by the vaccine serotypes.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brazil; Child; Child, Preschool; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Humans; Infant; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

In France, the use of the 7-valent pneumococcal conjugate vaccine (PCV7) lead to an overall significant decrease in PCV7 invasive pneumococcal disease (IPD) incidence. However, the decrease in vaccine serotype prevalence was partially counterbalanced by the serotype replacement phenomenon. In this study, we analyzed the role of the newly described serotype 6C as one of the replacement serotypes. This work was conducted on a large time scale from the early PCV7 era (2002-2003) to the PCV13 era (2010-2011), both on IPD strains recovered from the whole population and nasopharyngeal colonizing strains isolated in infant less than two years, who are known to be the main reservoir for pneumococci. Serotype 6C took advantage over 6A and 6B serotypes, which both decreased over time. A continuous and significant increase in 6C IPD was observed in adults along the study period; in contrast, in children less than two years, only an increase in 6C nasopharyngeal carriage was found, the prevalence of serotype 6C in IPD remaining very low over time. Among 101 6C invasive and colonizing strains studied by MLST, 24 STs were found to be related to three major clonal complexes, CC395, CC176, and CC315. STs related to CC176 tend to disappear after 2009 and were essentially replaced by ST386 (CC315), which dramatically increased over time. This clonal expansion may be explained by the erythromycin and tetracycline resistances associated with this clone. Finally, the decrease observed in nasopharyngeal 6C carriage since 2010, likely related to the PCV13 introduction in the French immunization schedule, is expected to lead to a decrease in 6C IPD in adults thereafter.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Clone Cells; Drug Resistance, Bacterial; Erythromycin; Female; France; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Multilocus Sequence Typing; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Tetracycline; Vaccines, Conjugate

Antibiotic resistant and invasive pneumococci may spread temporally and locally in day care centers (DCCs). We examined 267 children attending four DCCs located in the same city and 70 children staying at home in three seasons (autumn, winter, and spring) to determine prevalence, serotype distribution, antibiotic resistance patterns, and transmission of pneumococcal strains colonizing upper respiratory tract of healthy children without antipneumococcal vaccination. By pheno- and genotyping, we determined clonality of pneumococci, including drug-resistant strains. The average carriage of pneumococci in three seasons was 38.2%. 73.4% and 80.4% of the isolates belonged to serotypes present in 10- and 13-valent conjugate vaccine, respectively. Among the pneumococcal strains, 33.3% were susceptible to all antimicrobial tested and 39.2% had decreased susceptibility to penicillin. Multidrug resistance was common (35.7%); 97.5% of drug-resistant isolates represented serotypes included to 10- and 13-valent conjugate vaccine. According to BOX-PCR, clonality definitely was observed only in case of serotype 14. Multivariate analysis determined DCC attendance as strongly related to pneumococcal colonization in all three seasons, but important seasonal differences were demonstrated. In children attending DCCs, we observed dynamic turnover of pneumococcal strains, especially penicillin nonsusceptible and multidrug resistant, which were mostly distributed among serotypes included to available pneumococcal conjugate vaccines.

Topics: Anti-Bacterial Agents; Carrier State; Child Day Care Centers; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Multivariate Analysis; Odds Ratio; Penicillins; Phenotype; Pneumococcal Infections; Poland; Prevalence; Respiratory System; Respiratory Tract Infections; Seasons; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus pneumoniae is the main pathogen that causes respiratory infections in children younger than five years. The increasing incidence of macrolide- and tetracycline-resistant pneumococci among children has been a serious problem in China for many years. The molecular characteristics of erythromycin-resistant pneumococcal isolates that were collected from pediatric patients younger than five years in Beijing in 2010 were analyzed in this study.. A total of 140 pneumococcal isolates were collected. The resistance rates of all isolates to erythromycin and tetracycline were 96.4% and 79.3%, respectively. Of the 135 erythromycin-resistant pneumococci, 91.1% were non-susceptible to tetracycline. In addition, 30.4% of the erythromycin-resistant isolates expressed both the ermB and mef genes, whereas 69.6% expressed the ermB gene but not the mef gene. Up to 98.5% of the resistant isolates exhibited the cMLSB phenotype, and Tn6002 was the most common transposon present in approximately 56.3% of the resistant isolates, followed by Tn2010, with a proportion of 28.9%. The dominant sequence types (STs) in all erythromycin-resistant S. pneumoniae were ST271 (11.9%), ST81 (8.9%), ST876 (8.9%), and ST320 (6.7%), whereas the prevailing serotypes were 19F (19.3%), 23F (9.6%), 14 (9.6%), 15 (8.9%), and 6A (7.4%). The 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) coverage of the erythromycin-resistant pneumococci among the children younger than five years were 45.2% and 62.2%, respectively. ST320 and serotype 19A pneumococci were common in children aged 0 to 2 years. CC271 was the most frequent clonal complex (CC), which accounts for 24.4% of all erythromycin-resistant isolates.. The non-invasive S. pneumoniae in children younger than five years in Beijing presented high and significant resistance rates to erythromycin and tetracycline. The expressions of ermB and tetM genes were the main factors that influence pneumococcal resistance to erythromycin and tetracycline, respectively. Majority of the erythromycin-resistant non-invasive isolates exhibited the cMLSB phenotype and carried the ermB, tetM, xis, and int genes, suggesting the spread of the transposons of the Tn916 family. PCV13 provided higher serotype coverage in the childhood pneumococcal diseases caused by the erythromycin-resistant isolates better than PCV7. Further long-term surveys are required to monitor the molecular characteristics of the erythromycin-resistant S. pneumoniae in children.

Topics: Anti-Bacterial Agents; Child, Preschool; China; DNA Transposable Elements; Drug Resistance, Bacterial; Erythromycin; Female; Genes, Bacterial; Humans; Incidence; Infant; Infant, Newborn; Male; Molecular Epidemiology; Multilocus Sequence Typing; Pneumococcal Infections; Respiratory Tract Infections; Serotyping; Streptococcus pneumoniae; Tetracycline

To analyse the epidemiology of isolates of serotype 6C among invasive pneumococci isolated from children and adults in Spain between 1997 and 2009, and to characterize serotype 6C clones and macrolide and quinolone resistance mechanisms.. Antimicrobial susceptibility was determined following CLSI guidelines. Phenotypic characterization of macrolide-resistant isolates was performed by the double disc diffusion method. Genes associated with resistance to erythromycin and tetracycline were sought by PCR, while quinolone resistance was analysed by restriction fragment length polymorphism of the quinolone resistance-determining region. Isolates were typed by multilocus sequence typing.. Seven hundred and eighty-nine of 866 serotype 6A pneumococci collected from 1997 to 2009 were available. Of these, 213 (27.0%) were serotype 6C; 16/163 (9.8%) in the 1997-2001 (pre-PCV7) period, 37/322 (11.5%) in the 2002-05 (early-PCV7) period and 160/381 (42.0%) in the 2006-09 (late-PCV7) period. The overall proportions of serotype 6C increased from 0.1% (pre-PCV7) to 1% (late-PCV7) for paediatric isolates and from 0.3% to 1.7% among adult isolates. A major serotype 6C lineage (ST224/ST1150/ST4821), accounting for 66.7% of the isolates, was identified across the whole period. In the late-PCV7 period the antimicrobial non-susceptibility of serotype 6C increased in association with the emergence of the ST386/ST4310/ST4825 lineage, which carried a Tn6002 transposon [erm(B) and tet(M) genes].. Serotype 6C pneumococci were identified in Spain during the period 1997-2009. The increase in serotype 6C in the late-PCV7 period was associated with the spread of the ST224/ST1150/ST4821 lineage and the emergence of the ST386/ST4310/ST4825 lineage.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; DNA, Bacterial; Drug Resistance, Bacterial; Female; Genotype; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Infant; Infant, Newborn; Macrolides; Male; Middle Aged; Multilocus Sequence Typing; Pneumococcal Infections; Pneumococcal Vaccines; Polymorphism, Restriction Fragment Length; Quinolones; Serotyping; Spain; Streptococcus pneumoniae; Tetracycline; Young Adult

Macrolide resistance in Streptococcus pneumoniae has emerged as an important clinical problem worldwide over the past decade. The aim of this study was to analyze the phenotypes (serotype and antibiotic susceptibility), genotypes (multilocus sequence type [MLST] and antibiotic resistance gene/transposon profiles) among the 31% (102/328) of invasive isolates from children in New South Wales, Australia, in 2005 that were resistant to erythromycin. Three serotypes--19F (47 isolates [46%]), 14 (27 isolates [26%]), and 6B (12 isolates [12%])--accounted for 86 (84%) of these 102 isolates. Seventy four (73%) isolates had the macrolide-lincosamide-streptogramin B (MLS(B)) resistance phenotype and carried Tn916 transposons (most commonly Tn6002); of these, 73 (99%) contained the erythromycin ribosomal methylase gene [erm(B)], 34 (47%) also carried the macrolide efflux gene [mef(E)], and 41 (55%) belonged to serotype 19F. Of 28 (27%) isolates with the M phenotype, 22 (79%) carried mef(A), including 16 (57%) belonging to serotype 14, and only six (19%) carried Tn916 transposons. Most (84%) isolates which contained mef also contained one of the msr(A) homologues, mel or msr(D); 38 of 40 (95%) isolates with mef(E) (on mega) carried mel, and of 28 (39%) isolates with mef(A), 10 (39%) carried mel and another 11(39%) carried msr(D), on Tn1207.1. Two predominant macrolide-resistant S. pneumoniae clonal clusters (CCs) were identified in this population. CC-271 contained 44% of isolates, most of which belonged to serotype 19F, had the MLS(B) phenotype, were multidrug resistant, and carried transposons of the Tn916 family; CC-15 contained 23% of isolates, most of which were serotype 14, had the M phenotype, and carried mef(A) on Tn1207.1. Erythromycin resistance among S. pneumoniae isolates in New South Wales is mainly due to the dissemination of multidrug-resistant S. pneumoniae strains or horizontal spread of the Tn916 family of transposons.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Child, Preschool; DNA Transposable Elements; Drug Resistance, Bacterial; Erythromycin; Genotype; Humans; Macrolides; Microbial Sensitivity Tests; New South Wales; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae

All Streptococcus pneumoniae strains isolated from paediatric clinical samples at Heraklion University General Hospital in the 10-year period 2000-2009 were tested for serotype and susceptibility to antimicrobials. Among a total of 258 strains, 159 were isolated in the 5-year period 2000-2004, before the introduction of the heptavalent pneumococcal conjugate vaccine (PCV7), and 99 in the post-PCV7 5-year period 2005-2009. The prevalence of PCV7-included serotypes decreased in the post-PCV7 period (p = 0.0002), but an increase was observed for serotypes 7F (p = 0.002) and 19A (p = 0.004). Pan-susceptibility rates and susceptibility to cotrimoxazole increased in the post-PCV7 period (p = 0.01 and p = 0.008, respectively), but serotype 19A emerged as a contributor to multi-resistance (p = 0.007). PCV7 was followed by decreased S. pneumoniae resistance and prevalence of vaccine-related serotypes but increased prevalence of serotypes 7F and 19A. Continuing surveillance is required after the recent introduction of PCV10 and PCV13.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactams; Child; Child, Preschool; Chloramphenicol; Clindamycin; Greece; Heptavalent Pneumococcal Conjugate Vaccine; History, 21st Century; Humans; Immunization Programs; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Pneumococcal Vaccines; Quinolones; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccines, Conjugate; Vancomycin

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Chile; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The antimicrobial resistance of Streptococcus pneumoniae, or pneumococcus, is a growing global problem. In our study, 3,571 invasive pneumococcal isolates, recovered from blood and cerebrospinal fluid samples from patients in Finland between the years 2002 and 2006, showed an increase in erythromycin nonsusceptibility from 16% to 28% (P < 0.0001) over the 5-year study period, as well as a doubling of penicillin nonsusceptibility from 8% to 16% (P < 0.0001). Erythromycin nonsusceptibility increased especially in isolates derived from 0- to 2-year-old children and was 46% for this age group in 2006. Although multiresistance, defined as nonsusceptibility to penicillin, erythromycin, and tetracycline, was fairly rare (5.1% in 2006), 38% of the erythromycin-nonsusceptible isolates were also penicillin nonsusceptible, while 74% of the penicillin-nonsusceptible isolates were nonsusceptible to erythromycin. In contrast to the situation in continental Europe, but mirroring that in North America, the most frequent macrolide resistance determinant carried by 56% of the tested macrolide-resistant pneumococci was the mef gene. Serotypes 14, 9V, 19A, 6B, and 19F were most frequently nonsusceptible to erythromycin or penicillin. The penicillin-resistant invasive isolates (n = 88) were genotyped by multilocus sequence typing, which revealed the presence of 25 sequence types, 9 of which were novel. The majority of the isolates were related to one of several globally disseminated penicillin- or multiresistant clones, most importantly the rlrA adhesion pilus carrying clones Spain(9V) ST156 and Taiwan(19F) ST236. The penicillin-resistant pneumococcal population in Finland is therefore a combination of internationally recognized genotypes as well as novel ones.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteremia; Blood; Cerebrospinal Fluid; Child; Child, Preschool; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Erythromycin; Finland; Genotype; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Young Adult

A rare clinical isolate of Streptococcus pneumoniae, highly resistant to telithromycin, contained erm(B) with a truncated leader peptide and a mutant ribosomal protein L4. By transformation of susceptible strains, this study shows that high-level telithromycin resistance is conferred by erm(B), wild type or mutant, in combination with a (69)GTG(71)-to-TPS mutation in ribosomal protein L4.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Culture Media; Drug Resistance, Bacterial; Genotype; Humans; Ketolides; Methyltransferases; Microbial Sensitivity Tests; Mutation; Phenotype; Pneumococcal Infections; Ribosomal Proteins; Streptococcus pneumoniae

The genes erm(B), mef(A), and both erm(B) and mef(A) were identified in 42.6, 10.1, and 47.3%, respectively, of the erythromycin-resistant Streptococcus pneumoniae isolates. Of the strains, 3.8% were nonsusceptible to levofloxacin and had 1 to 6 amino acid changes in the quinolone resistance-determining region, including a new mutation, Asn94Ser, in the product of parC. Levofloxacin with reserpine was highly specific for efflux screening.

Topics: Anti-Bacterial Agents; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Bacterial; Erythromycin; Fluoroquinolones; Genes, Bacterial; Hospitals; Humans; Korea; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Molecular Epidemiology; Mutation; Ofloxacin; Pneumococcal Infections; Polymerase Chain Reaction; Prevalence; Reserpine; Respiratory Tract Infections; Retrospective Studies; Streptococcus pneumoniae

The aim of this study was to analyze the distributions of antibiotic susceptibility patterns, serotypes, phenotypes, genotypes, and macrolide resistance genes among 125 nonduplicated erythromycin-resistant Streptococcus pneumoniae clinical isolates collected in a Spanish point prevalence study. The prevalence of resistance to macrolides in this study was 34.7%. Multiresistance (to three or more antimicrobials) was observed in 81.6% of these strains. Among 15 antimicrobials studied, cefotaxime, moxifloxacin, telithromycin, and quinupristin-dalfopristin were the most active drugs. The most frequent serotypes of erythromycin-resistant isolates were 19F (25%), 19A (17%), 6B (12%), 14 (10%), and 23F (10%). Of the 125 strains, 109 (87.2%) showed the MLS(B) phenotype [103 had the erm(B) gene and 6 had both erm(B) and mef(E) genes]. Sixteen (12.8%) strains showed the M phenotype [14 with mef(E) and 2 with mef(A)]. All isolates were tested by PCR for the presence of the int, xis, tnpR, and tnpA genes associated with conjugative transposons (Tn916 family and Tn917). Positive detection of erm(B), tet(M), int, and xis genes related to the Tn916 family was found in 77.1% of MLS(B) phenotype strains. In 16 strains, only the tndX, erm(B), and tet(M) genes were detected, suggesting the presence of Tn1116, a transposon recently described for Streptococcus pyogenes. Five clones, namely, Sweden(15A)-25, clone(19F) ST87, Spain(23F)-1, Spain(6B)-2, and clone(19A) ST276, accounted for half of the MLS(B) strains. In conclusion, the majority of erythromycin-resistant pneumococci isolated in Spain had the MLS(B) phenotype, belonged to multiresistant international clones, and carried the erm(B), tet(M), xis, and int genes, suggesting the spread of transposons of the Tn916 family.

Topics: Anti-Bacterial Agents; Clone Cells; Drug Resistance, Multiple, Bacterial; Electrophoresis, Polyacrylamide Gel; Erythromycin; Genes, Bacterial; Microbial Sensitivity Tests; Phenotype; Pneumococcal Infections; Serotyping; Spain; Streptococcus pneumoniae; Tetracycline Resistance

The aim of our study was to evaluate a frequency of isolation and susceptibility to antibiotics of Streptococcus pneumoniae penicillin resistant among 154 strains S. pneumoniae isolated between 2003 and 2006 in University Hospital of Dr. A. Jurasza in Bydgoszcz. Antimicrobial susceptibility was assessed by disc-diffusion method according to the guidelines of Clinical and laboratory Standards Institute and The national Reference Centre for Antimicrobial Susceptibility. Minimal inhibitory concentrations for penicillin and cefotaxime were assessed by E-test method. Study shows increasing isolation of SPPR strains from 8,2% in 2003 to 32,0% in 2006. Strains were mostly isolated from patients ofNeurosurgery and Neurotraumatology Clinic and Rehabilitation Clinic. SPPR strains were mainly isolated from respiratory tract. Over 68% of SPPR showed intermediate resistance to penicillin and 73,3% of strains were susceptible to cefotaxime. Between 2003 and 2006 increased percentage of resistance strains to erythromycin, tetracycline and sulphometoxasol.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Carrier State; Child; Child, Preschool; Erythromycin; Hospitalization; Humans; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Retrospective Studies; Species Specificity; Sputum; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The capacity of Streptococcus pneumoniae to produce capsular polysaccharide (CPS) is essential for virulence. The CPS biosynthesis proteins CpsB, CpsC, and CpsD function to regulate CPS production via tyrosine phosphorylation of CpsD. This mechanism of regulating CPS production is important for enabling S. pneumoniae to cause invasive disease. Here, we identify mutations affecting the attachment of CPS to the cell wall. These mutations were located in cpsC, such that CpsC functioned independently from CpsD tyrosine phosphorylation. These mutants produced WT levels of CPS, but were unable to cause bacteremia in mice after intranasal challenge. This finding suggests that cell-wall attachment of CPS is essential for invasive pneumococcal disease; production of WT levels of CPS alone is not sufficient. We also show that cpsB mutants, which lack the phosphotyrosine-protein phosphatase, produced less CPS than the WT strain, but attached substantially more CPS to their cell wall. Thus, the phosphorylated form of CpsD promotes attachment of CPS to the cell wall.

Topics: Animals; Aspartic Acid; Bacterial Proteins; Cell Line, Tumor; Cell Wall; Drug Resistance, Bacterial; Erythromycin; Humans; Membrane Fusion; Mice; Mutation; Pneumococcal Infections; Polysaccharides, Bacterial; Protein Tyrosine Phosphatases; Protein-Tyrosine Kinases; Streptococcus pneumoniae; Tetracycline; Virulence

Group A streptococcus (GAS) has been described as an emerging cause of severe invasive infections. A retrospective hospital-based study was conducted, including GAS isolates causing invasive or non-invasive infections from January 1999 to June 2003 in Barcelona. Demographic and clinical information on the invasive cases was obtained from medical files. GAS isolates collected from 27 patients with invasive infections and 99 patients with non-invasive infections were characterized by emm type and subtype, superantigen (SAg) gene profile (speA-C, speF-J, speL, speM, ssa and smeZ), allelic variants of speA and smeZ genes, antibiotic susceptibility and genetic resistance determinants. The most prevalent emm type was emm1 (17.5%), followed by emm3 (8.7%), emm4 (8.7%), emm12 (7.1%) and emm28 (7.1%). The smeZ allele and SAg gene profiles were closely associated with the emm type. The speA2, speA3 and speA4 alleles were found in emm1, emm3 and emm6 isolates, respectively. Overall, 27.8, 25.4 and 11.9% of isolates were resistant to erythromycin, tetracycline or both agents, respectively. Reduced susceptibility to ciprofloxacin and levofloxacin (MIC 2-4 microg ml(-1)) was found in 3.2% of isolates. mef(A)-positive emm types 4, 12 and 75, and erm(B)-positive emm types 11 and 25 were responsible for up to 80% of the erythromycin-resistant isolates. No significant differences in emm-type distribution, SAg gene profile or resistance rates were found between invasive and non-invasive isolates. The SAg and antibiotic resistance genes appeared to be associated with the emm type and were independent of the disease type.

Topics: Alleles; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Drug Resistance; Erythromycin; Genes, Bacterial; Genetic Variation; Hospitals; Humans; Levofloxacin; Medical Records; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Sequence Data; Ofloxacin; Pneumococcal Infections; Retrospective Studies; Spain; Species Specificity; Streptococcus pyogenes; Superantigens; Tetracycline; Urban Population

To investigate the antibiotics-resistance type and molecular epidemiology of Streptococcus pneumoniae isolated from children in Hangzhou.. The sensitivities of 323 strains of Streptococcus pneumoniae to 9 antibiotics were determined in vitro by Kirby-Bauer diffuse methods, and MICs of penicillin and cefotaxime were determined by E-test methods.. Among all 323 strains isolated from children during the period from August 2001 to July 2002, 136 strains (42.1%) were sensitive to penicillin, while 57 strains (17.7%) were penicillin-resistant. Penicillin MICs ranged from 0.012 microg/ml to 4.0 microg/ml. All the strains were sensitive to cefotaxime and its MICs ranged from 0.012 microg/ml to 4.0 microg/ml. The most resistant antibiotic was erythromycin and it's resistant-rate was as high as 90.7%, followed by tetracycline (87.6%), trimethoprim-sulfamethoxazole (48.6%) and chloromycetin (14.9%). Totally 197 strains (61.0%) were multi-drug-resistant pneumococci and most of them were resistant to trimethoprim-sulfamethoxazole, erythromycin and tetracycline at the same time. Two strains (0.6%) were resistant to rifampin and none was resistant to vancomycin and ofloxacin. BOX PCR typing was carried out and no overwhelming fingerprinting pattern was found among penicillin resistant Streptococcus pneumoniae strains which were isolated from patients, while the banding patterns were always similar or identical among the strains isolated from the same specimen or from the same patient at different time, respectively.. The antibiotics-resistant rate of pneumococci was high in Hangzhou, but the third-generation cephalosporins were still the best antibiotics against Streptococcus pneumoniae. One child could be infected or colonized by more than one pneumococci clone at the same or different time.

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; China; Chloramphenicol; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Pneumococcal Infections; Respiratory Tract Infections; Rifampin; Streptococcus pneumoniae; Tetracycline; Trimethoprim

During the 6-year observation period from 1998 to 2003 in Moscow there was recorded in 2000-2001 a decrease in the emergence of Streptococcos pneumoniae resistance to many antibacterials, while during the following years the respective index increased. The above dynamics in the resistance emergence was likely due to a decrease in the use of antibiotics in 1998-1999. In 2003 the rate of resistance to penicillin was 18.6%, 0.4 and 2.1% of the isolates were resistant to amoxicillin and cefotaxime respectively, the rate of resistance to erythromycin reached 19%, 65.4% of the resistant strains showed M phenotype. High rates of resistance were as well observed with respect to tetracycline (40.1%), co-trimoxazole (29.1%) and chloramphenicol (18.6%). Resistance to levofloxacin and moxifloxacin was detected only in rare strains.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Drug Resistance; Erythromycin; Humans; Moscow; Nonlinear Dynamics; Penicillins; Phenotype; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Resistance, Multiple; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Quinolones; Sensitivity and Specificity; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the level of antibiotic resistance in pneumoniae (S. pneumoniae) isolated from nasal swabs of healthy children.. Cross-sectional community survey.. Survey was undertaken in general practice settings in Canberra during March and April 1998.. Four hundred and sixty-one children under 3 years of age enrolled in general practice trial of clinical practice guidelines for antibiotic use.. Resistance to penicillin, erythromycin, co-trimoxazole, tetracycline, chloramphenicol and cefotaxime among the isolates of S. pneumoniae.. A total of 461 nasal swabs were collected and S. pneumoniae was isolated from 171 (37.1%). Penicillin resistance was found in 12.3% of these isolates, with high level resistance in 0.6%. Resistance rates were higher for cotrimoxazole (44.4%) and erythromycin (18.1%) than for penicillin. Multidrug resistance was found in 19% of these isolates. There was a significant association between the attendance at a day care centre and carriage of pneumococcus (53% vs 32%, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7, P < 0.001). Children who attended day care centers and had received antibiotics during the 4 months prior to swab collection were three times more likely to carry an antibiotic-resistant isolate than children who had neither attended a day care centre nor received antibiotics (68% vs 40%, OR 3.1, 95% CI 1.2-8.4, P = 0.02).. The level of antibiotic resistance in pneumococci from healthy children was of concern. Carriage of pneumococcus was significantly higher in children who attended a day care centre. Resistance was significantly correlated with antibiotic use in combination with day-care attendance. These findings warrant more judicious use of antibiotics in children.

Topics: Cefotaxime; Child, Preschool; Chloramphenicol; Cross-Sectional Studies; Drug Resistance, Microbial; Drug Resistance, Multiple; Erythromycin; Humans; Infant; Infant, Newborn; Odds Ratio; Penicillins; Pneumococcal Infections; Prevalence; Risk Factors; South Australia; Statistics, Nonparametric; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

During 1995 and 1996, 393 and 566 strains of Streptococcus pneumoniae, isolated from acute otitis media, were respectively sent to the National Reference Center for Pneumococci by its corresponding centers.. The resistance rates for 1995 and 1996 were respectively: for penicillin: 65.4 and 70.3% (18.6 and 24.9% of intermediately resistant strains, 46.8 and 45.4% of fully resistant strains), for erythromycin: 57.5 and 68.5%, for tetracycline: 43.2 and 42.6%, for trimethoprim-sulfamethoxazole: 47.5 and 50.9%. Minimal inhibitory concentrations (MICs) of various betalactams were determined against a representative sample of strains (n = 99).. Amoxicillin, cefpodoxime and cefuroxime MICs remained low against numerous penicillin resistant strains, indicating that these three oral antibiotics (in combination with clavulanate for amoxicillin) have a useful potential for the treatment of acute otitis media when risk factors for pneumococcal penicillin-resistant infections are detected.

Topics: Acute Disease; Amoxicillin; beta-Lactam Resistance; beta-Lactams; Cefpodoxime; Ceftizoxime; Cefuroxime; Erythromycin; France; Humans; Microbial Sensitivity Tests; Otitis Media; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The prevalence of penicillin-resistant Streptococcus pneumoniae in clinical isolates from the Pathology Department of the Singapore General Hospital, in 1995, was 25%. Most of the resistant isolates belonged to serogroup 19 and were resistant to multiple antibiotics. Field-inversion gel electrophoresis (FIGE), after chromosomal digestion with the restriction enzymes Apal and Smal, was performed on all isolates of multiresistant serogroup 19 S. pneumoniae so as to determine whether they were of clonal origin. Twenty-six isolates, including six controls, were studied. Analysis of the FIGE patterns revealed three distinct clusters of closely related strains. The predominant clone comprised ten isolates of multiresistant serogroup 19 S. pneumoniae and also included two controls of a different serogroup. The presence of multiresistant serogroup 19 S. pneumoniae in Singapore, appears to be due to the spread of a small number of clones.

Topics: Adult; Aged; Bacterial Typing Techniques; Child; Child, Preschool; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple; Electrophoresis, Capillary; Erythromycin; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Serotyping; Singapore; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Seventy tetracycline-resistant Streptococcus pneumoniae were tested for the presence of tetracycline resistance genes, tetM and tetO, using a polymerase chain reaction (PCR) assay and DNA-DNA hybridization. Seven isolates representing five serotypes (12, 22, 6A, 19F and 23) carried the tetO gene. Five of the isolates were genetically unrelated as judged using pulsed field gel electrophoresis (PFGE) analysis. Two 19F isolates came from the same patient, carried both tetM and tetO genes and had the same PFGE pattern. The other 63 isolates carried only the tetM gene. DNA sequences from three of the tetO-carrying isolates were determined; they showed 91-95% nucleotide sequence identity over 300 nucleotides, and 93-95% amino acid sequence identity over 100 amino acids. The isolates carrying both tetO and tetM genes could transfer the tetM gene into both Enterococcus faecalis and S. pneumoniae recipients, but not the tetO gene. There was no detectable transfer of the tetO gene, by conjugation, from the other five isolates.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Carrier Proteins; Child; Child, Preschool; Conjugation, Genetic; Electrophoresis, Gel, Pulsed-Field; Humans; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Polymerase Chain Reaction; Sequence Analysis, DNA; Serotyping; Streptococcus pneumoniae; Tetracycline; Tetracycline Resistance

We tested 83 penicillin-intermediate (Peni) and 50 penicillin-resistant (Penr) isolates of Streptococcus pneumoniae against eight oral antimicrobials. Clarithromycin's MICs (minimal inhibitory concentration) were generally the same or one to two dilutions less than those of azithromycin. Seventy-two percent of Peni isolates were susceptible to clarithromycin and azithromycin, in contrast to 42% and 40%, respectively, of Penr isolates. Cefuroxime activity exceeded that of cefprozil, which exceeded that of cefaclor, in Peni isolates. For all three cephalosporins, MICs of 90% of isolates tested were > or = 3 dilutions higher for Penr isolates than for Peni isolates. Percentages of Peni isolates susceptible to clindamycin and tetracycline were 92% and 83%, respectively, and 78% and 82% for Penr. Only 49% of Peni isolates and 4% of Penr isolates were susceptible to trimethoprim-sulfamethoxazole. Azithromycin, clarithromycin, cefuroxime, cefprozil, clindamycin, and tetracycline may be useful in treating infections caused by Peni S pneumoniae, but Penr isolates are frequently resistant to both old and newer agents.

Topics: Administration, Oral; Adult; Ambulatory Care; Anti-Bacterial Agents; Azithromycin; Cefaclor; Cefprozil; Cefuroxime; Cephalosporins; Child; Clarithromycin; Clindamycin; Culture Media; Humans; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The first case reports of infection with penicillin-resistant pneumococci (PRP, MIC > 0.1 mg/L) and multidrug-resistant pneumococci were made in Australia in 1967 and South Africa in 1977, respectively. Since this time these organisms have spread to become a worldwide problem. In Europe PRP prevalence rates of up to 40% have been reported from Spain and 58% from Hungary, although there has been considerable national, regional and local variation in these figures. Until recently the UK was considered to have low prevalence of PRP. As recently as 1990, 100% of 7255 strains of pneumococci from 61 centres across the UK were found to be penicillin sensitive. However, there have now been several reports of significant and rising levels of resistance nationwide. Erythromycin resistance has also risen from 2.8% to 8.6% between 1990 and 1995 in England and Wales. At the Northern Ireland Public Health Laboratory (NIPHL) 3171 strains of pneumococci were examined using the oxacillin screening test between 1988 and 1995, during which time the annual rate of penicillin resistance was found to increase from <1% to 10.6%. The proportion of PRP with high-level resistance (MIC > 1 mg/L) increased from 0% to 36% and levels of PRP cross-resistance to cephalosporins and ciprofloxacin were 89% and 78%, respectively, which are amongst the highest in the UK. Similar rates of penicillin resistance have now been reported from several geographically disparate regions in the UK including Liverpool, Manchester and London. The number of laboratories in England and Wales reporting the isolation of PRPs to the Central Public Health Laboratory increased from 23 (3%) in 1987 to 72 (21%) in 1991 and a recent study from this reference laboratory showed that the prevalence of pneumococcal resistance to penicillin had increased 2.5-fold between 1990 and 1995. Clearly both PRP and multidrug-resistant pneumococci are increasing in prevalence in the UK, and this increase is likely to continue. A recent model of the evolution of national PRP prevalence rates describes a slow emergence phase, followed by an exponential growth phase of around 10 years reaching a stationary phase when the proportion of PRP reaches 50%. It is possible that the UK is currently at the beginning of the exponential growth phase of PRP. This has implications for the future treatment of pneumococcal infections in this country and emphasizes the need for new anti-pneumococcal agents. The new quinolone grepafloxacin, which h

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Chloramphenicol; Ciprofloxacin; Drug Resistance, Multiple; Fluoroquinolones; Humans; Macrolides; Microbial Sensitivity Tests; Northern Ireland; Ofloxacin; Oxacillin; Penicillin Resistance; Penicillins; Piperazines; Pneumococcal Infections; Quinolones; Retrospective Studies; Streptococcus pneumoniae; Tetracycline

One hundred seventy six consecutive, non-duplicate pneumococcal isolates from clinical specimens collected from November 1994 through February 1995 in nine general hospitals throughout Belgium were tested for their in vitro susceptibilities to penicillin, ampicillin, amoxycillin with and without clavulanate, cefaclor, cefuroxime, cefonicid, cefprozil, cefpodoxime, cefotaxime, imipenem, tetracycline, and erythromycin by means of the NCCLS microdilution test. The overall rate of decreased susceptibility to penicillin was 12.5%, including 6.3% of intermediately and 6.3% of fully resistant isolates. Penicillin, ampicillin amoxycillin, amoxycillin/clavulanate, cefuroxime, cefotaxime and imipenem had the highest activity on a weight basis (MIC50 < or = 0.008 microgram/ml), followed by cefpodoxime and erythromycin (MIC50 of 0.015 microgram/ml), cefprozil and tetracycline (MIC50 of 0.12 microgram/ml), and eventually, cefaclor and cefonicid (MIC50 of 0.5 microgram/ml). Aggregate rates of susceptible plus intermediately resistant isolates at NCCLS-recommended breakpoints, i.e. overall percentages of isolates likely to respond to increased antibiotic doses in vivo (except for meningitis), were 100.0% for imipenem and cefotaxime, 98.9% for amoxycillin with and without clavulanate, 93.8% for penicillin, and 90.9% for cefuroxime. Overall rates of susceptibility to erythromycin and tetracycline amounted to 78.4% and 72.7%, respectively. MIC values of all beta-lactams increased with those of penicillin. Ampicillin was equally active as penicillin against isolates with reduced susceptibility to the latter (MIC90 of 2 micrograms/ml); imipenem, cefotaxime, and amoxycillin with and without clavulanate however, were more active (MIC90 3, 1, and 1 doubling dilution, respectively, below that of penicillin), while cefpodoxime, cefuroxime, cefprozil, cefonicid, and cefaclor on the other hand, were less active (MIC90, 1, 1, 2, 5, and 5 doubling dilutions, respectively, above that of penicillin). In conclusion, the present data confirm that pneumococcal resistance to penicillin has increased in Belgium, suggest that resistance to erythromycin may have stabilised, and reveal an unexpectedly high rate of resistance to tetracycline. Imipenem was the most active antibiotic tested overall, and amoxycillin with or without clavulanate the most active oral antibiotic, with activity almost similar to that of cefotaxime.

Topics: Anti-Bacterial Agents; beta-Lactams; Erythromycin; Humans; Microbial Sensitivity Tests; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Erythromycin; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Ofloxacin; Pneumococcal Infections; Quinolones; Spiro Compounds; Streptococcus pneumoniae; Tetracycline

The most virulent pneumococcal serotype (type 3) has not to date been associated with multiple antimicrobial resistance. We report an unusual gastrointestinal presentation of fatal septicemia caused by a multiply resistant type 3 pneumococcus in a setting of increasing prevalence of multiple resistance, including resistance to erythromycin, clindamycin, and tetracycline.

Topics: Adolescent; Clindamycin; Drug Resistance, Microbial; Erythromycin; Gastroenteritis; Humans; Male; Penicillins; Pneumococcal Infections; Sepsis; Streptococcus pneumoniae; Tetracycline; Tetracycline Resistance

Altogether, 488 consecutive strains of Streptococcus pneumoniae isolated from clinical specimens were serotyped and their antibiotic susceptibility determined. Of all strains isolated, 89.7% (90.6% for strains isolated from patients with serious infection) were of types present in the new polyvalent (23-valent) pneumococcal vaccine. Four strains showed reduced susceptibility to penicillin (minimum inhibitory concentration 0.1-1.0 mg/l). Two of those strains (both serotype 23) were also of intermediate susceptibility to other antibiotics (ampicillin, cephradine, chloramphenicol and tetracycline) but were sensitive to erythromycin. A significant proportion (12%) was resistant to tetracycline.

Topics: Agglutination Tests; Ampicillin; Cephradine; Chloramphenicol; Counterimmunoelectrophoresis; Drug Resistance, Microbial; Erythromycin; Humans; Latex Fixation Tests; Northern Ireland; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline

Routine surveillance of pneumococcal isolates for resistance to antibiotics has revealed the emergence of an unusual pattern of multiple antimicrobial resistance in South Africa. Thirty-nine pneumococcal isolates, including 21 from clinical specimens, showed resistance to tetracycline, erythromycin, clindamycin, trimethoprim, and a combination product of trimethoprim and sulfamethoxazole sodium (co-trimoxazole), yet susceptibility to penicillin G. Multiple resistance has to date been almost invariably associated with resistance to beta-lactam antibiotics. A survey of nasopharyngeal carriage revealed carriage of an additional 21 isolates of multiply resistant pneumococci, representing 7.9% of children investigated in Johannesburg, but these organisms were not found in children in Soweto or four rural villages. We present the minimum inhibitory concentrations of 15 antimicrobial agents against 15 of these 21 strains. These findings are discussed in relation to exposure of these populations to antibiotics and to the treatment of local and systemic pneumococcal disease. Of all 60 isolates of multiply resistant pneumococci isolated to date, those fully characterized serologically belong to serotypes 6B, 14, or 19F.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child Day Care Centers; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Humans; Lactams; Middle Aged; Nasopharynx; Pneumococcal Infections; South Africa; Streptococcus pneumoniae; Sulfonamides; Tetracycline; Trimethoprim

Cefaclor and tetracycline were compared in a single-blind study designed to treat patients with acute bacterial bronchitis and acute exacerbations of chronic bronchitis. Twenty-five pathogens (including 19 of Haemophilus influenzae and four of Streptococcus pneumoniae) were obtained from sputum samples of 48 patients. No pathogen could be cultured from the sputum of 23 patients. All of these pathogens were susceptible to cefaclor, while 12 (63%) of the 19 H influenzae isolates and three of the four S pneumoniae isolates were resistant to tetracycline. When the susceptibility of the 25 isolates to other commonly used antibacterials was tested, 18 isolates of H influenzae were resistant to erythromycin and one was resistant to ampicillin. (One H influenzae isolate was not tested for erythromycin susceptibility.) The four isolates of S pneumoniae were susceptible to erythromycin and ampicillin. Satisfactory results were achieved in 21 of the 23 patients receiving cefaclor. After four to six days of cefaclor therapy, the other two patients were diagnosed as having bronchopneumonia, and parenteral antibiotic therapy was instituted. Of the 25 patients assigned to the tetracycline regimen, three with resistant H influenzae had unsatisfactory clinical responses and required parenteral antibiotic therapy for recovery. Although patients were randomly assigned to therapy, only three of the 16 patients infected with tetracycline-resistant organisms were assigned to the tetracycline group, and all three failed to respond to treatment. Had the patients been more evenly distributed according to susceptibilities, it is possible that more treatment failures would have occurred in the group receiving tetracycline.

Topics: Adult; Aged; Bronchitis; Cefaclor; Cephalexin; Diarrhea; Drug Eruptions; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Random Allocation; Tetracycline

A 15-month-old child developed an infectious pulmonary complication of open heart surgery. Cultures of the respiratory secretions showed growth of a 9L serotype of Streptococcus pneumoniae which was resistant to penicillin, tetracycline, and chloramphenicol. There was no evidence that the organism was spread among the family of the patient or hospital personnel.

Topics: Chloramphenicol; Female; Humans; Infant; Penicillin Resistance; Penicillins; Pneumococcal Infections; Postoperative Complications; Respiratory Tract Infections; Serotyping; Streptococcus pneumoniae; Tetracycline

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Humans; Infant; Meningitis, Pneumococcal; Middle Aged; Penicillin G; Penicillin Resistance; Pneumococcal Infections; Pneumonia, Staphylococcal; Respiratory Tract Infections; Streptococcus pneumoniae; Sulfonamides; Tetracycline

Annualy in the USA, the estimated occurence of pneumococcal disease exceeds 500 000 cases of pneumonia (50 000 deaths), 1 200 000 cases of otitis media and 5 000 cases of meningitis. The pneumococcus remains the single most important pathogen which can cause pneumonia. When bacteremia accompanied pneumococcal pneumonia (one-fifth of these), the case fatality rate is approximately of 25% and exceeds 50% in individuals over 50 years of age. Most of the deaths (60%) occur within the first five days of illnesses, despite prompt antibiotic treatment of these patients. Emergence of pneumococcal strains with diminished sensitivity for penicillin, or resistant to tetracycline and other antibiotics is also a factor which lend increasing support to the concept that high risk patients should be protected from pneumococcal infection by immunoprophylaxis. A change of capsular types associated with bacteriemic disease has occured, in the USA, during the past three decades. The types 1 and 3 are less common than in the pre-antibiotic era, and the types 4, 8, 12, and 14 have become more prevalent. Infections with type 2, an epidemic type, have occured infrequently in the past 20 years. In the USA, at the present time, nearly four-fifths of bacteremic cases are associated with only 14 of the 84 pneumococcal capsular type ; in descending frequency : 8, 4, 1, 14, 3, 51, 12, 6, 56, 9, 19, 23, 5 and 20 (American system of nomenclature). The predominant capsular types of otitis media are : 1, 3, 6, 7, 14, 18 and 23. The polyvalent pneumococcal polysaccharide vaccine newly developed in the USA, is safe, antigenic and effective. Its widespread use can be expected to reduce the number of deaths attribuable to pneumococcal bacteremia.

Topics: Adolescent; Adult; Aged; Humans; Immunotherapy; Middle Aged; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumonia, Pneumococcal; Sepsis; Tetracycline; United States

Susceptibility to penicillin was determined for 6000 strains of pneumococci isolated during 1974--76 from patients in Alberta and the adjacent region of the Northwest Territories. Strains were considered to be relatively resistant if the minimum inhibitory concentration (MIC) of penicillin was 0.16 microgram (0.26 U)/mL or more, which is eight or more times greater than the MIC for fully susceptible strains. Resistance was detected in 143 strains (2.4%) isolated from 122 patients and belonging to four capsular types. The MIC of the most resistant strains was 0.32 microgram (0.53 U/mL. Penicillin-resistant strains were highly resistant to oxacillin, the MIC being at least 30 times greater than that for penicillin-susceptible strains. Pneumococci resistant to penicillin may readily be detected by the narrowness or absence of a zone of inhibition around a 1-microgram oxacillin disc in susceptibility tests on blood agar. The degree of resistance reported here is relative and does not necessarily preclude successful treatment with full therapeutic doses of penicillin G, but penicillin preparations that give low blood concentrations may not be suitable for treating infections caused by these strains.

Topics: Erythromycin; Humans; Lincomycin; Oxacillin; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Age Factors; Aged; Anti-Bacterial Agents; Bacteria; Chloramphenicol; Drug Resistance, Microbial; Humans; Kanamycin; Nitrofurantoin; Pneumococcal Infections; Polymyxins; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Sulfamethizole; Tetracycline; United States

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacitracin; Child; Child, Preschool; Chloramphenicol; Drug Therapy, Combination; Erythromycin; Eye Diseases; Female; Gentamicins; Humans; Infant; Male; Methicillin; Methods; Middle Aged; Neomycin; Nitrofurantoin; Novobiocin; Penicillin G; Penicillin Resistance; Pneumococcal Infections; Polymyxins; Streptococcus pneumoniae; Streptomycin; Tetracycline; Virulence

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteriological Techniques; Erythromycin; Female; Humans; Male; Middle Aged; Penicillins; Pneumococcal Infections; Pneumonia; Sepsis; Streptococcus pneumoniae; Tetracycline; United States

Topics: Humans; Microbial Sensitivity Tests; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Anti-Bacterial Agents; Australia; Carrier State; Cephalosporins; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumonia; Serotyping; Streptococcus pneumoniae; Tetracycline

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacteria; Cephalosporins; Chloramphenicol; Clindamycin; Cloxacillin; Drug Hypersensitivity; Erythromycin; Humans; Lincomycin; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Tetracycline; Vancomycin

Topics: Adult; Alcoholism; Ampicillin; Cephalothin; Chloramphenicol; Escherichia coli Infections; Fatty Liver; Female; Hepatitis; Humans; Klebsiella Infections; Liver Cirrhosis; Male; Methicillin; Middle Aged; Penicillins; Peritonitis; Pneumococcal Infections; Streptomycin; Syndrome; Tetracycline

Topics: Carrier State; Cross Infection; Demeclocycline; Doxycycline; Drug Resistance, Microbial; Humans; Lincomycin; Microbial Sensitivity Tests; Minocycline; Pneumococcal Infections; Pneumonia; Streptococcus pneumoniae; Tetracycline

Topics: Acute Disease; Age Factors; Ampicillin; Anti-Bacterial Agents; Child, Preschool; Chloramphenicol; Colistin; Erythromycin; Haemophilus; Haemophilus Infections; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Otitis Media; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes; Streptomycin; Tetracycline

Topics: Adolescent; Child; Child, Preschool; Female; Furunculosis; Humans; Infant; Male; Microbial Sensitivity Tests; Minocycline; Otitis Media; Otorhinolaryngologic Diseases; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Tetracycline; Tonsillitis

Topics: Ampicillin; Bronchitis; Chloramphenicol; Chronic Disease; Haemophilus influenzae; Humans; Pneumococcal Infections; Serotyping; Sputum; Streptococcus; Streptococcus pneumoniae; Sulfonamides; Tetracycline

Topics: Animals; Bacteria; Blood Proteins; Drug Resistance, Microbial; Escherichia coli; Hydrogen-Ion Concentration; Klebsiella; Klebsiella Infections; Mice; Microbial Sensitivity Tests; Ovalbumin; Pneumococcal Infections; Proline; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Tetracycline; Tetracyclines

Topics: Aged; Cephalosporins; Chloramphenicol; Digitalis Glycosides; Erythromycin; Female; Humans; Infections; Oxygen Inhalation Therapy; Penicillins; Pneumococcal Infections; Pneumonia; Respiratory Insufficiency; Streptococcal Infections; Tetracycline

Topics: Adult; Cephalothin; Chronic Disease; Humans; Male; Parotid Gland; Parotitis; Pneumococcal Infections; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Adult; Drug Resistance, Microbial; Erythromycin; Humans; Lincomycin; Male; Microbial Sensitivity Tests; Osteomyelitis; Pneumococcal Infections; Tetracycline

Topics: Acute Disease; Anti-Infective Agents; Chronic Disease; Hearing Disorders; Humans; Otitis Media; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Bronchitis; Child; Cross Infection; Drug Resistance, Microbial; England; Humans; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline

Topics: Adult; Aged; Chronic Disease; Drug Resistance, Microbial; Female; Follow-Up Studies; Humans; Infant; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Pneumococcal Infections; Prospective Studies; Serotyping; Streptococcus pneumoniae; Tetracycline

Topics: Anti-Bacterial Agents; Bacillus subtilis; Cephalosporins; Cornea; Escherichia coli Infections; Eye Diseases; Humans; Infections; Neisseria; Penicillins; Pneumococcal Infections; Proteus Infections; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Cephalosporins; Child; Cloxacillin; Colistin; Drug Synergism; Dysentery, Bacillary; Endocarditis, Bacterial; Humans; Infections; Lincomycin; Meningitis; Nafcillin; Neomycin; Oxacillin; Penicillin Resistance; Penicillins; Pneumococcal Infections; Polymyxins; Shigella; Streptococcal Infections; Sulfamethoxazole; Tetracycline; Urinary Tract Infections

Topics: Animals; Brain Chemistry; Chlortetracycline; Kidney; Liver; Lung; Oxytetracycline; Pneumococcal Infections; Rats; Spleen; Tetracycline

Topics: Adult; Aged; Australia; Cross Infection; Drug Resistance, Microbial; Humans; Male; Middle Aged; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Humans; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcal Infections; Streptococcus; Streptococcus pneumoniae; Tetracycline

Topics: Adult; Bronchiectasis; Female; Humans; Lung Diseases; Lymecycline; Male; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Staphylococcal Infections; Tetracycline; Tuberculosis, Pulmonary

Topics: Adult; Child; Humans; Isoniazid; Meningitis; Meningococcal Infections; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Sulfisoxazole; Suppuration; Tetracycline; Tuberculosis, Meningeal

Topics: Child, Preschool; Cross Infection; Drug Resistance, Microbial; Humans; Infant; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Child, Preschool; Drug Resistance, Microbial; Erythromycin; Female; Humans; Infant; Male; Pneumococcal Infections; Tetracycline

Topics: Aged; Drug Resistance, Microbial; Female; Humans; Pneumococcal Infections; Pneumonia; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Mice; Monoamine Oxidase Inhibitors; Pneumococcal Infections; Protein Synthesis Inhibitors; Research; Tetracycline; Tryptamines

Topics: Drug Resistance; Drug Resistance, Microbial; Humans; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumococcal; Tetracycline

Topics: Anti-Bacterial Agents; Bronchitis; Chloramphenicol; Erythromycin; Haemophilus influenzae; Novobiocin; Penicillins; Pneumococcal Infections; Pneumonia; Scotland; Staphylococcal Infections; Statistics as Topic; Streptomycin; Tetracycline; Virus Diseases

Topics: Anti-Bacterial Agents; Bacitracin; Child; Chloramphenicol; Chlortetracycline; Drainage; Empyema; Erythromycin; Escherichia coli Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Kanamycin; Novobiocin; Oleandomycin; Pediatrics; Penicillins; Pneumococcal Infections; Pneumothorax; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Surgical Procedures, Operative; Tetracycline; Vancomycin

Topics: Achromobacter; Anti-Bacterial Agents; Bacteriology; Chloramphenicol; Drug Resistance; Drug Resistance, Microbial; Erythromycin; Escherichia coli Infections; Haemophilus influenzae; Klebsiella; Maxillary Sinus; Maxillary Sinusitis; Penicillin V; Penicillins; Placebos; Pneumococcal Infections; Proteus Infections; Sinusitis; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Anti-Bacterial Agents; Chloramphenicol; Drug Resistance; Drug Resistance, Microbial; Erythromycin; Humans; Penicillins; Pharmacology; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Tetracycline; Troleandomycin

Topics: Bacteremia; Bacteriological Techniques; Chloramphenicol; Drug Therapy; Erythromycin; Immunization, Passive; Klebsiella; Leukocyte Count; New York; Penicillins; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumococcal; Sepsis; Statistics as Topic; Streptococcal Infections; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Boston; Chloramphenicol; Cross Infection; Drug Therapy; Erythromycin; Escherichia coli Infections; Hospitals, Urban; Humans; Kanamycin; Klebsiella; Massachusetts; Penicillins; Pneumococcal Infections; Proteus Infections; Staphylococcal Infections; Statistics as Topic; Streptococcal Infections; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Bacitracin; Chloramphenicol; Drug Resistance, Microbial; Epidemiology; Erythromycin; Genetics; Kanamycin; Neomycin; Novobiocin; Oleandomycin; Penicillin Resistance; Pharmacology; Pneumococcal Infections; Research; Streptococcus pneumoniae; Streptomycin; Tetracycline

Topics: Absorption; Anti-Bacterial Agents; Chlortetracycline; Mice; Mononuclear Phagocyte System; Oxytetracycline; Pharmacology; Pneumococcal Infections; Research; Staphylococcal Infections; Tetracycline

Topics: Anti-Bacterial Agents; Humans; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Adolescent; Amphotericin B; Child; Diphtheria; Enterovirus Infections; Escherichia coli Infections; Humans; Infant; Otolaryngology; Phosphates; Pneumococcal Infections; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance; Drug Resistance, Microbial; Geriatrics; Hospitals, General; Humans; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Anti-Bacterial Agents; Chloramphenicol; Erythromycin; gamma-Globulins; Kanamycin; Mice; Oleandomycin; Oxytetracycline; Penicillin G; Penicillins; Pneumococcal Infections; Research; Streptomycin; Sulfisomidine; Sulfisoxazole; Tetracycline

Topics: Anti-Bacterial Agents; Child; Chlorpromazine; Erythromycin; gamma-Globulins; Infant; Infant, Newborn; Oxytetracycline; Penicillins; Pneumococcal Infections; Pneumonia; Pneumonia, Viral; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Bacillus; Child; Chloramphenicol; Cross Infection; Hospitals; Humans; India; Infant; Micrococcus; Nose; Orthopedics; Penicillins; Pharynx; Pneumococcal Infections; Pseudomonas Infections; Staphylococcal Infections; Streptomycin; Tetracycline; Wounds and Injuries

Topics: Anti-Bacterial Agents; Chloramphenicol; Chlortetracycline; Conjunctivitis; Corynebacterium diphtheriae; Drug Resistance; Drug Resistance, Microbial; Erythromycin; Oxytetracycline; Penicillins; Pharmacology; Pneumococcal Infections; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Blood Chemical Analysis; Catalase; Chlortetracycline; Liver; Oxytetracycline; Pharmacology; Pneumococcal Infections; Protein Synthesis Inhibitors; Rats; Research; Tetracycline

Topics: Anti-Bacterial Agents; Biomedical Research; Bronchi; Bronchial Neoplasms; Bronchitis; Chloramphenicol; Drug Resistance; Drug Resistance, Microbial; Haemophilus influenzae; Humans; Lung Diseases; Lung Neoplasms; Neisseria; Pneumococcal Infections; Respiratory Tract Infections; Sputum; Streptomycin; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Brain; Humans; Meningitis; Meningitis, Pneumococcal; Pneumococcal Infections; Tetracycline

Topics: Anti-Bacterial Agents; Bronchiectasis; Bronchitis; Bronchitis, Chronic; Haemophilus influenzae; Humans; Pneumococcal Infections; Respiratory Tract Infections; Tetracycline

Topics: Anti-Bacterial Agents; Intestines; Pneumococcal Infections; Staphylococcal Infections; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Cortisone; Dermatologic Agents; Penicillins; Pneumococcal Infections; Protein Synthesis Inhibitors; Rabbits; Tetracycline