Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru.

Autor:	Gonzales BE; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru., Mercado EH; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru., Pinedo-Bardales M; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru., Hinostroza N; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru., Campos F; Departamento de Pediatría, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru., Chaparro E; Departamento de Pediatría, Hospital Nacional Cayetano Heredia, Lima, Peru.; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru., Del Águila O; Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru., Castillo ME; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.; Oficina de Epidemiología, Instituto Nacional de Salud del Niño, Lima, Peru., Saenz A; Departamento de Pediatría, Hospital Nacional Daniel Alcides Carrión, Lima, Peru., Reyes I; Servicio de Hospitalización, Hospital de Emergencias Pediátricas, Lima, Peru., Ochoa TJ; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
Jazyk:	angličtina
Zdroj:	Frontiers in cellular and infection microbiology [Front Cell Infect Microbiol] 2022 May 09; Vol. 12, pp. 866186. Date of Electronic Publication: 2022 May 09 (Print Publication: 2022).
DOI:	10.3389/fcimb.2022.866186
Abstrakt:	Streptococcus pneumoniae upper respiratory infections and pneumonia are often treated with macrolides, but recently macrolide resistance is becoming an increasingly important problem. The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the National Immunization Program of Peru in 2015. This study aimed to evaluate the temporal evolution of macrolide resistance in S. pneumoniae isolates collected in five cross-sectional studies conducted before and after this vaccine introduction, from 2006 to 2019 in Lima, Peru. A total of 521 and 242 S. pneumoniae isolates recovered from nasopharyngeal swabs from healthy carrier children < 2 years old (2 carriage studies) and samples from normally sterile body areas from pediatric patients with invasive pneumococcal disease (IPD) (3 IPD studies), respectively, were included in this study. Phenotypic macrolide resistance was detected using the Kirby-Bauer method and/or MIC test. We found a significant increase in macrolide resistance over time, from 33.5% to 50.0% in carriage studies, and from 24.8% to 37.5% and 70.8% in IPD studies. Macrolide resistance genes [ erm (B) and mef (A/E)] were screened using PCR. In carriage studies, we detected a significant decrease in the frequency of mef (A/E) genes among macrolide-resistant S. pneumoniae strains (from 66.7% to 50.0%) after introduction of PCV13. The most common mechanism of macrolide-resistant among IPD strains was the presence of erm (B) (96.0%, 95.2% and 85.1% in the 3 IPD studies respectively). Macrolide resistance was more common in serotype 19A strains (80% and 90% among carriage and IPD strains, respectively) vs. non-serotype 19A (35.5% and 34.4% among carriage and IPD strains, respectively). In conclusion, S. pneumoniae macrolide resistance rates are very high among Peruvian children. Future studies are needed in order to evaluate macrolide resistance trends among pneumococcal strains, especially now after the COVID-19 pandemic, since azithromycin was vastly used as empiric treatment of COVID-19 in Peru. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Gonzales, Mercado, Pinedo-Bardales, Hinostroza, Campos, Chaparro, Del Águila, Castillo, Saenz, Reyes and Ochoa.)
Databáze:	MEDLINE
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