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Evolution of Clonal and Susceptibility Profiles of Serotype 19A Streptococcus pneumoniae among Invasive Isolates from Children in Spain, 1990 to 2008

2011; American Society for Microbiology; Volume: 55; Issue: 5 Linguagem: Inglês

10.1128/aac.01494-10

1098-6596

David Tarragó, Lorenzo Aguilar, Raquel Hidalgo García, María-José Giménez, Juan-José Granizo, Asunción Fenoll,

Gallbladder and Bile Duct Disorders

ABSTRACT The genetic structure and antibiotic nonsusceptibility of all serotype 19A Streptococcus pneumoniae pediatric pneumococcal isolates received at the Spanish Pneumococcal Reference Laboratory (1990 to 2008) were analyzed. Of them, 410 (79.8%) isolates belonged to 14 sequence types (STs) with >10 isolates each, and 104 to 73 STs (with 21 new STs, ST5141 to ST5161, with one isolate each). Time trends in 2000 to 2008 ( n = 471) were explored by lineal regression. Serotype 19A increased from 5.7% in 2000 to 16.8% in 2008 ( R 2 = 0.872; P = 0.001). Decreasing trends ( P < 0.03) were found for ST202 ( R 2 = 0.774) and ST81 ( R 2 = 0.559), and increasing trends ( P < 0.03) for ST878 ( R 2 = 0.544) and ST320 ( R 2 = 0.530), both belonging to the clonal complex (CC) Denmark 14 -32 and first detected in 2003 and 2007, respectively, and ST2013 ( R 2 = 0.704) and ST4461 ( R 2 = 0.707), both appearing in 2004. Penicillin nonsusceptibility was clustered in ST81, ST276, ST320, ST878, ST2013, and ST4461 (>90% nonsusceptibility), and amoxicillin and cefotaxime nonsusceptibility in ST320: 87% amoxicillin (MIC 50 /MIC 90 = 8/8 μg/ml) and 43.5% cefotaxime (MIC 50 /MIC 90 = 1/2 μg/ml) nonsusceptibility. No trends were found for erythromycin nonsusceptibility (ranging from 38.5% to 66.7%) and cefotaxime nonsusceptibility (ranging from 0.0% to 7.8%), but increasing trends ( P < 0.02) were found for oral penicillin (from 16.7% in 2000 to 56.3% in 2008; R 2 = 0.628) and amoxicillin (from 0.0% before 2007 to 13.8% in 2008; R 2 = 0.628) nonsusceptibility. This study warns about the emergence of serotype 19A STs associated with high-level antibiotic nonsusceptibility, with a role for ST320 and ST878 occupying the niche left by some pneumococcal 7-valent conjugate vaccine (PCV7)-related resistant STs. The rapid expansion of serotype 19A and STs related to antibiotic resistance indicates that vaccines covering serotype 19A present advantages in countering invasive disease.