Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru
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...
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2022.866186/full |
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| author | Brayan E. Gonzales Erik H. Mercado Maria Pinedo-Bardales Noemi Hinostroza Francisco Campos Eduardo Chaparro Eduardo Chaparro Olguita Del Águila María E. Castillo María E. Castillo Andrés Saenz Isabel Reyes Theresa J. Ochoa Theresa J. Ochoa |
| author_facet | Brayan E. Gonzales Erik H. Mercado Maria Pinedo-Bardales Noemi Hinostroza Francisco Campos Eduardo Chaparro Eduardo Chaparro Olguita Del Águila María E. Castillo María E. Castillo Andrés Saenz Isabel Reyes Theresa J. Ochoa Theresa J. Ochoa |
| author_sort | Brayan E. Gonzales |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T08:50:09Z |
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| language | English |
| last_indexed | 2024-04-13T08:50:09Z |
| publishDate | 2022-05-01 |
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| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-a83b7239aa1a4c6fa7e1460538a9aeef2022-12-22T02:53:30ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882022-05-011210.3389/fcimb.2022.866186866186Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, PeruBrayan E. Gonzales0Erik H. Mercado1Maria Pinedo-Bardales2Noemi Hinostroza3Francisco Campos4Eduardo Chaparro5Eduardo Chaparro6Olguita Del Águila7María E. Castillo8María E. Castillo9Andrés Saenz10Isabel Reyes11Theresa J. Ochoa12Theresa J. Ochoa13Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruDepartamento de Pediatría, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, PeruDepartamento de Pediatría, Hospital Nacional Cayetano Heredia, Lima, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, PeruServicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, PeruOficina de Epidemiología, Instituto Nacional de Salud del Niño, Lima, PeruDepartamento de Pediatría, Hospital Nacional Daniel Alcides Carrión, Lima, PeruServicio de Hospitalización, Hospital de Emergencias Pediátricas, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, PeruStreptococcus 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.https://www.frontiersin.org/articles/10.3389/fcimb.2022.866186/fullStreptococcus pneumoniaemacrolide-resistanceinvasive pneumococcal diseasepneumococcal conjugate vaccinehealthy carrier |
| spellingShingle | Brayan E. Gonzales Erik H. Mercado Maria Pinedo-Bardales Noemi Hinostroza Francisco Campos Eduardo Chaparro Eduardo Chaparro Olguita Del Águila María E. Castillo María E. Castillo Andrés Saenz Isabel Reyes Theresa J. Ochoa Theresa J. Ochoa Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru Frontiers in Cellular and Infection Microbiology Streptococcus pneumoniae macrolide-resistance invasive pneumococcal disease pneumococcal conjugate vaccine healthy carrier |
| title | Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru |
| title_full | Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru |
| title_fullStr | Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru |
| title_full_unstemmed | Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru |
| title_short | Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru |
| title_sort | increase of macrolide resistance in streptococcus pneumoniae strains after the introduction of the 13 valent pneumococcal conjugate vaccine in lima peru |
| topic | Streptococcus pneumoniae macrolide-resistance invasive pneumococcal disease pneumococcal conjugate vaccine healthy carrier |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2022.866186/full |
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