Tolerance to Vancomycin in Pneumococci: Detection with a Molecular Marker and Assessment of Clinical Impact
| Autor: | Juan Li, Carina A. Rodriguez, Cynthia G. Whitney, Elaine Tuomanen, Kathryn M. Edwards, Lauren Mitchell, Robyn M. Atkinson, Chin-Shang Li, Jack Sublett, P. Joan Chesney, Tiebin Liu, Wally Bitar |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Genetic Markers
Male Population Drug Resistance Drug resistance Biology medicine.disease_cause Polymorphism Single Nucleotide Microbiology Vancomycin Nasopharynx Streptococcus pneumoniae medicine Humans Immunology and Allergy Meningitis Child education Alleles Antibacterial agent education.field_of_study N-Acetylmuramoyl-L-alanine Amidase medicine.disease Survival Analysis Virology Anti-Bacterial Agents Pneumococcal infections Infectious Diseases Genes Bacterial Genetic marker Carrier State Female Protein Kinases medicine.drug |
| Zdroj: | The Journal of Infectious Diseases. 190:1481-1487 |
| ISSN: | 1537-6613 0022-1899 |
| Popis: | BACKGROUND: Vancomycin is often added to therapy for meningitis caused by Streptococcus pneumoniae. Tolerant bacteria without classic resistance that escape killing by multiple antibiotics have been reported sporadically. We determined the prevalence of tolerance to vancomycin in pneumococci and its effect on the outcome of meningitis. METHODS: Archival samples of 215 nasopharyngeal (NP) and 113 meningitis isolates were tested for the killing efficacy of vancomycin. Specific DNA sequence changes in a transporter locus were identified for tolerant isolates. Similar tests were conducted prospectively on 517 NP isolates from healthy children. RESULTS: In archival isolates, tolerance to vancomycin was detected in 3.7% of NP and 10.6% of invasive isolates. Patients with meningitis caused by tolerant isolates had a worse estimated 30-day survival than did patients with meningitis caused by nontolerant isolates (49% vs. 86%; P = .048); 62.5% of tolerant archival NP isolates harbored a specific sequence change for pep27 and vex2 (P = .021). Prospective analysis of 517 carriage isolates indicated that 8.1% were tolerant to vancomycin and that 82.1% of tolerant isolates harbored the specified marker gene sequences (P = .001). CONCLUSIONS: Tolerance to vancomycin exists in the population of pneumococci. Tolerant isolates are associated with meningitis of increased mortality, and these isolates can be tracked by specific marker sequences in 2 genes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|