Distribution of serotypes and antibiotic resistance among pneumococci in Northern Ireland

doi:10.1016/S0163-4453(88)97556-1

Journal of Infection

Volume 16, Issue 3, May 1988, Pages 235-242

https://doi.org/10.1016/S0163-4453(88)97556-1 Get rights and content

Summary

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/1). 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.

References (37)

CatesKL et al.
A penicillin-resistant pneumococcus
J Pediatr
(1978)
MacfarlaneJT et al.
Hospital study of adult community acquired pneumonia
Lancet
(1982)
MorganAD et al.
Streptococcus pneumoniae serotypes causing pneumonia in Edinburgh and Nottingham
Lancet
(1983)
ColmanG et al.
Systemic disease caused by pneumococci
J Infect
(1983)
EvansW et al.
Tetracycline resistant pneumococcus
Lancet
(1963)
TurnerGC
Tetracycline-resistant pneumococci in a general hospital
Lancet
(1963)
PercivalA et al.
Increased incidence of tetracycline-resistant pneumococci in Liverpool in 1968
Lancet
(1969)
HansmanD et al.
A resistant pneumococcus
Lancet
(1967)
WallRA et al.
Penicillin-resistant pneumococci in London
Lancet
(1981)
DaviesAJ et al.
Hospital-acquired infection with Streptococcus pneumoniae
J Hosp Infect
(1985)

MakelaPH et al.

Pneumococcal vaccine and otitis media

Lancet

(1980)

LundE

Distribution of pneumococcus types at different times in different areas

RobbinsJB et al.

Consideration for formulating the second-generation pneumococcal capsular polysaccharide vaccine with emphasis on the cross-reactive types within groups

J Infect Dis

(1983)

AustrianR et al.

Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia

Ann Intern Med

(1964)

HookEW et al.

Failure of intensive care unit support to influence mortality from pneumococcal bacteraemia

JAMA

(1983)

BilleJ et al.

Risk of death in adult pneumococcal bacteraemia

HansmanD et al.

Pneumococci relatively insensitive to penicillin in Australia and New Guinea

Med J Aust

(1974)

ApplebaumPC et al.

Multiple-antibiotic resistance of pneumococci

S Afr MMWR

(1977)

Cited by (28)

Pneumococcal conjugate vaccines - A European perspective
2004, International Journal of Medical Microbiology
Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and acute otitis media in children and adults worldwide. In the age group of <2 years the incidence of invasive pneumococcal disease ranges from ∼14 cases per 100,000 in Germany and the Netherlands and more than 90 per 100,000 children in Spain. The vulnerability of children to S. pneumoniae can also be demonstrated by the high rate of sequelae (>20% in Germany) and the high mortality (7.5%) in pneumococcal meningitis. Furthermore, antibiotic resistance of S. pneumoniae is increasing in Europe, particularly in France, Spain, and Eastern European countries, whereas Germany and Northern Europe are only marginally affected. A 7-valent pneumococcal conjugate vaccine (7vPCV) that was shown to be highly efficacious in preventing invasive pneumococcal disease in infants in the USA was licensed in Europe in 2001. It is expected that broad usage of the vaccine would reduce the incidence of invasive pneumococcal disease and the levels of pneumococcal resistance significantly. Important questions have been raised regarding the effectiveness of this vaccine in high-risk populations, serotype replacement, the efficacy of this vaccine in otitis media, and the co-administration of the new vaccine with other standard childhood vaccines used in various European countries. France and Spain currently have the most-wide ranging guidelines recommending pneumococcal vaccination for children. Overall, the development of pneumococcal conjugate vaccines is a significant step in the control of pneumococcal disease in children in Europe. Further progress in pneumococcal vaccine development can be expected from conjugate vaccines including more than seven serotypes (9-valent, 11-valent).
Antibiotic resistance and serotypes of Streptococcus pneumoniae at Birmingham Public Health Laboratory, 1989-94
1996, Journal of Infection
Antibiotic resistance of 1515 consecutive laboratory isolates of Streptococcus pneumoniae between 1989 and 1994 was analyzed. Overall, 39 (2.6%) isolates were resistant to penicillin, 102 (6.7%) resistant to erythromycin and 52 (3.4%) resistant to tetracycline. There was a higher proportion of penicillin resistant isolates from sterile sites compared with “non-sterile sites” (5% vs. 2.2%; P<0.02). This same pattern occurred with erythromycin (12.5% vs. 5.6%; P<0.001). From 1989–90 to 1993–94 the penicillin resistance rate increased from 0.8% to 8% and the erythromycin from 5.7% to 8.4%, whereas the tetracycline resistance rate fell from 3.7% to 2.8%. The increase in resistance to penicillin largely occurred in the final 12 months of this study period.
One hundred and fifty isolates (9.9%) were serotyped, including isolates from sterile sites and those with penicillin resistance. The commonest serotypes of penicillin-sensitive pneumococci were 14, 19, 9 and 6. The majority of penicillin-resistant pneumococci (PRP) were of serotype 9 (64%) followed by 6, 23 and 19. Overall 95% of these isolates were of serotypes represented in the 23-valent pneumococcal polysaccharide vaccine (Pneumovax II). PRP were more likely to have resistance to erythromycin (2.3%) or tetracycline (2.3%) compared to penicillin-sensitive pneumococci (6% and 3% respectively).
Most of the PRP were isolated from patients aged over 50 years including 11 isolates from blood cultures of patients with pneumonia or septicaemia. There was a possible epidemiological association between four patients with PRP but surveillance cultures of hospital contacts revealed no extra cases. These results show a worrying increase in infections due to PRP which has implications for clinical and laboratory staff in the diagnosis and treatment of serious pneumococcal infections.
Pneumonies à pneumocoques résistants
1995, Annales de l'Institut Pasteur/Actualites
En France, depuis 1980, sont survenus des changements profonds de sensibilité des pneumocoques aux antibiotiques, macrolides et β-lactamines essentiellement, avec isolement d'un grand nombre de souches multirésistantes. Le tableau clinique de la pneumonie à pneumocoque ne varie pas en fonction de la sensibilité de celui-ci. Trois grammes d'amoxicilline demeurent le traitement de référence. La prévention repose, en particulier chez les sujets âgés, sur la vaccination anti-pneumococcique.
Epidemiology of pneumococcal resistance to antibiotics in france. National cooperative survey (1984-1993)
1994, Medecine et Maladies Infectieuses
Le Réseau National de Surveillance de la résistance des pneumocoques aux antibiotiques en France (1984–1993; 14 786 souches étudiées) a montré que celle-ci atteint des niveaux élevés : en 1993, le niveau de résistance était de 24 % pour la tétracycline, 34 % pour l'érythromycine, 27 % pour le chloramphénicol et 37 % pour le cotrimoxazole. Particulièrement alarmant est le changement de sensibilité à la pénicilline G : moins de 1 % de souches de sensibilité diminuée avant 1986, comparé aux 25 % observés en 1993. La fréquence des souches de haut niveau de résistance à la pénicilline (CMI > 1 mg/l), parmi les pneumocoques résistants à la pénicilline (PRP) a augmenté de 13 % en 1988 à 50 % en 1993. Parmi les PRP isolés en 1993, les 6 sérogroupes ou sérotypes les plus fréquents, dans l'ordre de fréquence sont : 23 (55 %), 9 (13,9 %), 6 (8,2 %), 14 (7,3 %), 15 (4,9 %), 19 (3,7 %). 70 % des PRP associent multi-résistance et résistance à la pénicilline. Des techniques fiables sont capables de détecter les PRP. Les PRP portent une sensibilité diminuée vis-à-vis de toutes les bêta-lactamines, mais les CMI varient pour chaque molécule. Tout isolement de PRP lié à une infection doit faire l'objet d'une détermination des CMI de la pénicilline et des bêta-lactamines les plus utilisées.
The National Cooperative Survey of pneumococcal antimicrobial resistance in France (1984–1993; 14 786 strains studied) shows that the resistance reaches high levels : in 1993, the resistance rates were, tetracycline (24 %), erythromycin (34 %), chloramphenicol (27 %) and sulfa/trimethoprim (37 %). Particularly alarming is the change in susceptibility to penicillin G : fewer than 1 % of strains isolated before 1986 exhibited diminished susceptibility, compared with 25 % in 1993. The frequency of strains with high- level resistance to penicillin (MIC > 1 mg/l) among penicillin resistant pneumococci (PRP) increased from 13 % in 1988 to 50 % in 1993. Among PRP isolated in 1992 : the most prevalent serogroups or serotypes, in order of frequency, were : 23 (55 %), 9 (13.9 %), 6 (8.2 %), 14 (7.3 %), 15 (4.9 %), 19 (3.7 %). 70 % of PRP combine multiresistance and penicillin resistance. Rigorous analytical techniques enable the detection of strains with reduced sensitivity to beta-lactams. The reduced sensitivity of PRP isolates leads to a fall in the sensitivity to all beta-lactams and the MIC will vary according to the type of beta-lactam. Infecting PRP strains should have penicillin and clinicaly useful beta-lactams MICs determination.
Penicillin resistance among Streptococcus pneumoniae in Europe
1994, Diagnostic Microbiology and Infectious Disease
Penicillin resistance in Streptococcus pneumoniae which has been occasionally described in European isolates since the early 1970s, presently constitutes a general problem, although its rate may vary largely between countries and areas. Spain and Hungary show the highest rates of resistance and were probably the starting point for further dissemination to adjacent and distant countries. In Europe, resistant strains belong predominantly to serotypes 6, 9, 14, 19, and 23, and are isolated more frequently from pediatric than from adult patients, and from respiratory and CSF samples rather than blood. Although penicillin resistance in pneumococci is usually a well-recognized problem, some difficulties, mainly related to methodologic aspects of in vitro susceptibility testing, still subsist for its proper surveillance, but may be overcome through the adoption of adequate diagnostic protocols and tools.
Co-existent cross-infection with Streptococcus pneumoniae and group B streptococci on an adult oncology unit
1993, Journal of Hospital Infection
An outbreak of respiratory infection in an adult oncology unit is described where there was evidence of co-existent cross-infection with Streptococcus pneumoniae serotype 14 and Lancefield group B streptococcus type Ia. The presumed route of transmission was droplet spread from patient to patient. No further cases arose after the ward had been closed to new admissions and all symptomatic patients were treated with erythromycin. We suggest that patients with pneumococcal pneumonia on units housing elderly debilitated patients should be isolated. Infection control teams should be aware of the ability of Lancefield group B streptococci to spread by cross-infection among adult patients.

View all citing articles on Scopus

View full text

Distribution of serotypes and antibiotic resistance among pneumococci in Northern Ireland

Summary

J Pediatr

Lancet

Lancet

J Infect

Lancet

Lancet

Lancet

Lancet

Lancet

J Hosp Infect

Lancet

Distribution of pneumococcus types at different times in different areas

Consideration for formulating the second-generation pneumococcal capsular polysaccharide vaccine with emphasis on the cross-reactive types within groups

J Infect Dis

Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia

Ann Intern Med

Failure of intensive care unit support to influence mortality from pneumococcal bacteraemia

JAMA

Risk of death in adult pneumococcal bacteraemia

Pneumococci relatively insensitive to penicillin in Australia and New Guinea

Med J Aust

Multiple-antibiotic resistance of pneumococci

S Afr MMWR