Increase in erythromycin-resistant Streptococcus pneumoniae in Colombia, 1994-2008
Keywords:
Streptococcus pneumoniae, erythromycin, drug resistance, surveillance, genotype, phenotype.
Abstract
Introduction. Streptococcus pneumoniae is a commonly implicated agent in invasive disease. For infections of S. pneumoniae resistant to β-lactam, macrolides are an alternative treatment. However, resistance to macrolides has increased worldwide as well.Objective. The frequency of resistance to erythromycin was determined for S. pneumoniae over a 15-year surveillance period, and the resistant isolates were characterized phenotypically and genotypically.
Materials and methods. Demographic data of the patients, antimicrobial susceptibility and serotypes were analyzed for 3,241 S. pneumoniae isolates recovered between 1994 and 2008. The phenotypes were determined by the double-disc technique and genotypes by PCR (polymerase chain reaction) and PFGE (pulsed field gel electrophoresis). Isolates were recovered from invasive diseases and were provided by national public health laboratories.
Results. Of the 3,241 isolates, 136 were resistant to erythromycin. In the 12-year period between 1994-1996 and 2006-2008, resistance in each 2-year sampling had increased from 2.4% to 6.9% in children under 6 years and from 3.3% to 5.7% in adults.
The most common serotypes were 6B (36.8%), 14 (16.9%) and 6A (17.6%). Constitutive phenotype cMLSB was determined in 87 isolates; 82 of these expressed the ermB gene. Phenotype M was determined in 46 isolates; 45 had the mefA gene. An additional three isolates expressed the inducible phenotype (iMLSB), and one expressed the ermB gene. By PFGE, 50 of the isolates were found to be related to international clones--58% were Spain6B-ST90, 26% Spain9V-ST156, 8% Colombia23F-ST338 and 8% Spain23F-ST81.
Conclusion. The increase in erythromycin resistance was primarily related to the mechanism of ribosomal methylation. More than half the cases were congeneric with the clone Spain6B-ST90 that has been circulating in Colombia since 1994.
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References
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18. Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard-7th ed. Document M7-A7. Wayne, PA: Clinical and Laboratory Standards Institute; 2006.
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20. Fasola EL, Bajaksouzian S, Appelbaum PC, Jacobs MR. Variation in erythromycin and clindamycin susceptibilities of Streptococcus pneumoniae by four test methods. Antimicrob Agents Chemother. 1997;41:129-34.
21. Montanari MP, Mingoia M, Giovanetti, Varaldo PE. Differentiation of resistance phenotypes among erythromycin-resistant pneumococci. J Clin Microbiol. 2001; 39:1311-5.
22. Sutcliffe J, Grebe T, Tait-Kamradt A, Wondrack L. Detection of erythromycin-resistant determinants by PCR. Antimicrob Agents Chemother. 1996;40:2562-6.
23. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.
24. Dean AG, Dean JA, Columbier D, Burton AH, Brendel KA, Smith DC, et al. Epi Info versión 6.0: A word processing, data-base and statistics program for epidemiology on microcomputers. Atlanta, Georgia: Centers for Disease Control and Prevention; 1994.
25. Reinert RR, Ringelstein A, van der Linden M, Cil MY, Al-Lahham A, Schmitz FJ. Molecular epidemiology of macrolide-resistant Streptococcus pneumoniae isolates in Europe. J Clin Microbiol. 2005;43:1294-300.
26. Xu X, Cai L, Xiao M, Kong F, Oftadeh S, Zhou F, et al. Distribution of serotypes, genotypes, and resistance determinants among macrolide-resistant Streptococcus pneumoniae isolates. Antimicrob Agents Chemother. 2010;54:1152-9.
27. Calatayud L, Ardanuy C, Cercenado E, Fenoll A, Bouza E, Pallares R, et al. Serotypes, clones, and mechanisms of resistance of erythromycin-resistant Streptococcus pneumoniae isolates collected in Spain. Antimicrob Agents Chemother. 2007;51:3240-6.
28. van der Linden M, Al-Lahham A, Haupts S, Reinert RR. Clonal spread of mef-positive macrolide-resistant Streptococcus pneumoniae isolates causing invasive disease in adults in Germany. Antimicrob Agents Chemother. 2007;51:1830-4.
29. Palavecino EL, Riedel I, Duran C, Bajaksouzian S, Joloba M, Davies T, et al. Macrolide resistance phenotypes in Streptococcus pneumoniae in Santiago, Chile. Int J Antimicrob Agents. 2002;20:108-12.
30. Farrell DJ, File TM, Jenkins SG. Prevalence and antibacterial susceptibility of mef(A)-positive macrolide-resistant Streptococcus pneumoniae over 4 years (2000 to 2004) of the PROTEKT US Study. J Clin Microbiol. 2007;45:290-3.
31. Mendonça-Souza CR, Carvalho M da G, Barros RR, Dias CA, Sampaio JL, Castro AC, et al. Occurrence and characteristics of erythromycin-resistant Streptococcus pneumoniae strains isolated in three major Brazilian states. Microb Drug Resist. 2004;10:313-20.
32. Melo-Cristino J, Ramírez M, Serrano N, Hänscheid T. Resistance in Streptococcus pneumoniae isolated from patients with community-acquired lower respiratory tract infections in Portugal: Results of a 3-Year (1999-2001). Microb Drug Resist. 2003;9:73-80.
33. Weisblum B. Erythromycin resistance by ribosome modification. Antimicrob Agents Chemother 1995;39:577-85.
34. Roberts MC. Update on macrolide-lincosamide-streptogramin, ketolide, and oxazolidinone resistance genes. FEMS Microbiol Lett. 2008;282:147-59.
35. Temime L, Boelle PY, Opatowski L, Guillemot D. Impact of capsular switch on invasive pneumococcal disease incidence in a vaccinated population. PLoS One. 2008;3:e3244.
2. Van Bambeke F, Reinert RR, Appelbaum PC, Tulkens PM, Peetermans WE. Multidrug-resistant Streptococcus pneumoniae infections: Current and future therapeutic options. Drugs. 2007;67:2355-82.
3. Lonks JR, Garau J, Gómez L, Xercavins M, Ochoa de Echagüen A, Gareen IF, et al. Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. Clin Infect Dis. 2002;35:556-64.
4. Jenkins SG, Farrell DJ. Increase in pneumococcus macrolide resistance, United States. Emerg Infect Dis. 2009;15:1260-4.
5. Corso A, Faccone C, Galiá P, Gagetti M, Rodríguez J, Pace M. et al. Prevalence of mef and ermB genes in invasive pediatric erythromycin-resistant Streptococcus pneumoniae isolates from Argentina. Rev Argent Microbiol. 2009;41:29-33.
6. Leclercq R, Courvalin P. Resistance to macrolides and related antibiotics in Streptococcus pneumoniae. Antimicrob Agents Chemother. 2002;46:2727-34.
7. Marimón JM, Iglesias L, Vicente D, Pérez-Trallero E. Molecular characterization of erythromycin-resistant clinical isolates of the four major antimicrobial-resistant Spanish clones of Streptococcus pneumoniae (Spain23F-1, Spain6B-2, Spain9V-3, and Spain14-5). Microb Drug Resist. 2003;9:133-7.
8. Chiou CC, McEllistrem MC. Novel penicillin, cephalosporin, and macrolide resistant clones of Streptococcus pneumoniae serotypes 23F and 19F in Taiwan which differ from international epidemic clones. J Clin Microbiol. 2001;39:1144-7.
9. Vela MC, Fonseca N, Di Fabio JL, Castañeda E. Presence of international multiresistant clones of Streptococcus pneumoniae in Colombia. Microb Drug Resist. 2001; 7:153-64.
10. Reyes J, Hidalgo M, Díaz L, Rincón S, Moreno J, Vanegas N, et al. Characterization of macrolide resistance in Gram-positive cocci from Colombian hospitals: A countrywide surveillance. Int J Infect Dis. 2007;11:329-36.
11. De la Pedrosa EG, Morosini MI, van der Linden M, Ruiz-Garbajosa P, Galán JC, Baquero F, et al. Polyclonal population structure of Streptococcus pneumoniae isolates in Spain carrying mef and mef plus erm(B). Antimicrob Agents Chemother. 2008;52:1964-9.
12. Whitney C, Pilishvili T, Farley M, Schaff ner W, Craig A, Lynfield R, et al. Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet. 2006;368:1495-502.
13. Instituto Nacional de Salud. Serotipos y patrones de susceptibilidad antimicrobiana de patógenos de importancia en salud pública. Fecha de consulta: 31 de julio de 2009. Disponible en: http://www.ins.gov.co/?idcategoria=6134#.
14. Organización Panamericana de la Salud. Informe Regional de SIREVA II: Datos por país y por grupo de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis en procesos invasores 2000-2005. Washington, D.C.: OPS; 2007. (THS/EV - 2007/002:1-387). Fecha de consulta: 31 de julio de 2009. Disponible en: http://www.paho.org/Spanish/AD/THS/EV/LABS-Sireva.pdf.
15. Organización Panamericana de la Salud. Informe regional de SIREVA II, 2006: datos por país y por grupos de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis, en procesos invasores. Washington, D.C.: OPS; 2008. (THR/EV - 2008/001:1-288). Fecha de consulta: 31 de julio de 2009. Disponible en: http://www.paho.org/Spanish/AD/THS/EV/labs_Sireva_II_2006.pdf.
16. Organización Panamericana de la Salud. Informe regional de SIREVA II, 2007: datos por país y por grupos de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis, en procesos invasores. Washington, D.C.: OPS; 2008. (THR/EV - 2008/003:1-310). Fecha de consulta: 31 de julio de 2009. Disponible en: http://new.paho.org/hq/index.php?option=com_content&task=view&id=1077&Itemid=591&limit=1&limitstart=2.
17. Organización Panamericana de la Salud e Instituto Nacional de Salud Colombia. Programa de vigilancia de los serotipos y resistencia antimicrobiana de Streptococcus pneumoniae y Haemophilus influenzae. Manual de procedimientos del proyecto SIREVA II. 2004. p. 41-99. Fecha de consulta: 9 de diciembre de 2008. Disponible en: http://www.paho.org/Spanish/AD/THS/EV/LABS-manual-vigilancia-serotipos.pdf.
18. Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard-7th ed. Document M7-A7. Wayne, PA: Clinical and Laboratory Standards Institute; 2006.
19. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 16th informational supplement CLSI document M100-S18 2008. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
20. Fasola EL, Bajaksouzian S, Appelbaum PC, Jacobs MR. Variation in erythromycin and clindamycin susceptibilities of Streptococcus pneumoniae by four test methods. Antimicrob Agents Chemother. 1997;41:129-34.
21. Montanari MP, Mingoia M, Giovanetti, Varaldo PE. Differentiation of resistance phenotypes among erythromycin-resistant pneumococci. J Clin Microbiol. 2001; 39:1311-5.
22. Sutcliffe J, Grebe T, Tait-Kamradt A, Wondrack L. Detection of erythromycin-resistant determinants by PCR. Antimicrob Agents Chemother. 1996;40:2562-6.
23. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.
24. Dean AG, Dean JA, Columbier D, Burton AH, Brendel KA, Smith DC, et al. Epi Info versión 6.0: A word processing, data-base and statistics program for epidemiology on microcomputers. Atlanta, Georgia: Centers for Disease Control and Prevention; 1994.
25. Reinert RR, Ringelstein A, van der Linden M, Cil MY, Al-Lahham A, Schmitz FJ. Molecular epidemiology of macrolide-resistant Streptococcus pneumoniae isolates in Europe. J Clin Microbiol. 2005;43:1294-300.
26. Xu X, Cai L, Xiao M, Kong F, Oftadeh S, Zhou F, et al. Distribution of serotypes, genotypes, and resistance determinants among macrolide-resistant Streptococcus pneumoniae isolates. Antimicrob Agents Chemother. 2010;54:1152-9.
27. Calatayud L, Ardanuy C, Cercenado E, Fenoll A, Bouza E, Pallares R, et al. Serotypes, clones, and mechanisms of resistance of erythromycin-resistant Streptococcus pneumoniae isolates collected in Spain. Antimicrob Agents Chemother. 2007;51:3240-6.
28. van der Linden M, Al-Lahham A, Haupts S, Reinert RR. Clonal spread of mef-positive macrolide-resistant Streptococcus pneumoniae isolates causing invasive disease in adults in Germany. Antimicrob Agents Chemother. 2007;51:1830-4.
29. Palavecino EL, Riedel I, Duran C, Bajaksouzian S, Joloba M, Davies T, et al. Macrolide resistance phenotypes in Streptococcus pneumoniae in Santiago, Chile. Int J Antimicrob Agents. 2002;20:108-12.
30. Farrell DJ, File TM, Jenkins SG. Prevalence and antibacterial susceptibility of mef(A)-positive macrolide-resistant Streptococcus pneumoniae over 4 years (2000 to 2004) of the PROTEKT US Study. J Clin Microbiol. 2007;45:290-3.
31. Mendonça-Souza CR, Carvalho M da G, Barros RR, Dias CA, Sampaio JL, Castro AC, et al. Occurrence and characteristics of erythromycin-resistant Streptococcus pneumoniae strains isolated in three major Brazilian states. Microb Drug Resist. 2004;10:313-20.
32. Melo-Cristino J, Ramírez M, Serrano N, Hänscheid T. Resistance in Streptococcus pneumoniae isolated from patients with community-acquired lower respiratory tract infections in Portugal: Results of a 3-Year (1999-2001). Microb Drug Resist. 2003;9:73-80.
33. Weisblum B. Erythromycin resistance by ribosome modification. Antimicrob Agents Chemother 1995;39:577-85.
34. Roberts MC. Update on macrolide-lincosamide-streptogramin, ketolide, and oxazolidinone resistance genes. FEMS Microbiol Lett. 2008;282:147-59.
35. Temime L, Boelle PY, Opatowski L, Guillemot D. Impact of capsular switch on invasive pneumococcal disease incidence in a vaccinated population. PLoS One. 2008;3:e3244.
How to Cite
1.
Hidalgo M, Santos C, Duarte C, Castañeda E, Agudelo CI. Increase in erythromycin-resistant Streptococcus pneumoniae in Colombia, 1994-2008. biomedica [Internet]. 2011 Apr. 16 [cited 2024 May 19];31(1):124-31. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/343
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