临床肺炎链球菌常见序列型青霉素耐药性的流行病学研究

从菌种的水平研究和阐述临床分离的肺炎链球菌青霉素耐药机制存在一定的局限。为探讨以序列型(Sequence type,ST)为基础研究肺炎链球菌青霉素耐药机制的可行性,本研究分析了1997~2014年间北京常见STs肺炎链球菌488株和2015年重庆酉阳县、四川中江县常见STs菌株88株的青霉素最低抑菌浓度(Minimun inhibitory concentration,MIC)的分布及年份分布。结果显示北京分离株中除了ST342外,属于某一种ST的所有分离株的青霉素MIC值具有一定分布范围,或者<0.25 mg/L,或者≥0.25 mg/L。青霉素MIC <0.25 mg/L的分离株多分布于2001年以前,此年份后≥0.25 mg/L的分离株出现,并逐渐成为主要种群。但这个年份分布规律对于某一种ST并不明显,某一种ST在最初发现的几个年份中就具有不同青霉素MIC水平的分离株。重庆酉阳县和四川中江县常见STs型青霉素MIC分布于0.25~2.0 mg/L(≥0.25 mg/L),包括ST271、ST320和ST81。本研究从流行病学角度揭示了肺炎链球菌临床分离株常见STs的青霉素MIC值分布规律,支持以STs为基础研究其青霉素耐药机制。     

无乳链球菌临床株对四环素类的敏感性研究

为探讨无乳链球菌对四环素类的敏感性及其与耐药基因、多位点序列分型(multilocus sequence typing,MLST)之间的关系,本研究收集2014-2017年深圳市南山区人民医院分离自患者的136株无乳链球菌临床分离株,采用琼脂平板稀释法分析四环素类最低抑菌浓度(minimum inhibitory concentration,MIC)。采用聚合酶链反应检测菌株四环素类耐药基因(tetM、tetK、tetO),MLST测定ST型别,并分析四环素类敏感性与其耐药基因及ST型别之间的关系。结果显示,无乳链球菌对四环素类的耐药率为46.32%,耐四环素类菌株主要携带tetM基因,主要为ST17型和ST19型,且ST17型菌株对四环素类的耐药率显著高于ST19型(P<0.05)。结果提示,无乳链球菌的主要四环素类耐药基因为tetM,ST17型、ST19型是主要流行型别,且ST17型菌株对四环素类的敏感性低于ST19型。     

19群肺炎链球菌国家标准菌株分子特征分析及在菌株质量控制中的应用

目的明确19群肺炎链球菌(Streptococcus pneumoniae)国家标准菌株的分子特征,为完善中国肺炎链球菌国家标准菌株的质量标准提供依据。方法在传统肺炎链球菌菌种检定方法的基础上,应用16S rRNA基因分析、聚合酶链式反应(polymerase chain reaction,PCR)血清分型、多位点序列分型(multilocus sequence type,MLST)和脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)分型等多种分子生物学质控方法,对来源于中国医学细菌保藏管理中心的20株19群肺炎链球菌国家标准菌株进行分析。结果 20株19群肺炎链球菌的16S rRNA基因序列与肺炎链球菌模式株NCTC 7465的16S rRNA基因序列的相似性在99.64%～100%之间,碱基差异0～5 bp。PCR血清分型结果表明:11株19F型菌株均检测到大小为304 bp的19F型特异性扩增条带,6株19A型菌株均检测到大小为478 bp的19A型特异性扩增条带,PCR血清分型结果与血清凝集试验结果一致。MLST分型结果表明,相同血清型的菌株可以具有不同的序列型(sequence type,ST)。共获得12个ST型,其中6个ST型(10496、10497、10501、10502、10503和10509)为首次报道。PFGE分型结果显示:各型别菌株各具有其特征性PFGE带型(9～17条带),相同血清型或ST型菌株可能具有不同的PFGE带型。共存在18种不同的PFGE带型,其中19F型和19A型菌株中各有一对菌株的ST型和PFGE图谱完全一致。菌株的传代稳定性考察结果显示:在25代以内31708菌株的PFGE带型未发生变化,遗传特征是稳定的。结论 16S rRNA基因分析、PCR血清分型、MLST分型和PFGE分型等分子生物学方法应用于中国肺炎链球菌国家标准菌株的质量控制,可获得更加全面的肺炎链球菌标准菌株身份信息数据(包括序列、PCR扩增片段、序列型、图谱等),为进一步完善中国肺炎链球菌国家标准菌株的质量标准提供依据和数据支撑。     

驴源兽疫链球菌的分离鉴定及多位点序列分型分析

【目的】本研究采集了新疆地区驴腺疫病料,从样品中分离鉴定可疑病原菌并对其进行基因水平的分型与进化分析。【方法】对采集的新疆地区某驴场驴腺疫病驴颌下淋巴结拭子进行细菌分离培养,对2个分离株(HT111、HT321)进行染色、培养、生化试验、药敏试验,对其16S rRNA及SeM基因进行测序和进化分析,并通过PCR扩增7个管家基因,利用多位点序列分型(MLST)方法鉴定其分子分型。【结果】2个分离株均属马链球菌兽疫亚种,其中HT111对测试的13种抗生素中的3种(青霉素、克拉霉素和四环素)耐药,HT321对8种抗生素(阿莫西林、头孢呋辛、头孢噻呋、青霉素、克拉霉素、克林霉素、土霉素和四环素)耐药。序列分型发现了一种新的ST型为ST420 (HT321),分离株HT111为ST179型。【结论】本研究在新疆地区首次分离了驴源马链球菌兽疫亚种,并鉴定出一个新的ST型(ST420),为驴腺疫的流行病学提供了参考数据。     

致细菌性肝脓肿的肺炎克雷伯杆菌多位点序列分型及药敏分析

目的了解致细菌性肝脓肿的肺炎克雷伯杆菌多位点序列分型及药敏情况。方法收集2011年1月至2012年6月在浙江大学医学院附属第一医院感染科住院的细菌性肝脓肿患者,脓液培养为肺炎克雷伯杆菌的23株菌株,对23株菌株进行多位点序列分型;应用K—B纸片扩散法检测23株肺炎克雷伯杆菌菌株对10种抗菌药物的敏感性;应用超广谱β-内酰胺酶（ESBLs）确认试验了解23株菌株的产ESBLs情况。结果23株菌株经过多位点序列分型：ST23为最主要序列型,共有10株,ST25、ST30、ST65、ST86、ST163、ST367、ST375、ST380、ST660、ST700及ST806各1株,2株为新的ST型,未发现文献报道的产耐碳氢酶烯酶的常见sT型;23株菌株的药敏结果对哌拉西林他唑巴坦及头孢哌酮舒巴坦等8种抗菌药物的耐药率为0％,对头孢呋辛耐药率4．4％,而对氨苄西林的耐药率为100％;ESBLs确认试验其中22株为ESBL^-;1株为ESBL^＋。结论收治的致细菌性肝脓肿的肺炎克雷伯杆菌均为敏感菌株,可以经验性的选用青霉素（三代头孢）复合制剂,避免碳氢酶烯类抗生素的乱用及滥用。     

儿童感染肺炎链球菌的 青霉素结合蛋白基因突变分析

目的分析儿童感染肺炎链球菌的青霉素结合蛋白基因突变与青霉素耐药水平之间的关系。方法自2012年1月至2014年12月期间分离的1 317株肺炎链球菌中随机抽取出青霉素MIC=2.0μg/mL、4.0μg/mL、≥8.0μg/mL各20株共60株作为实验菌株,采用PCR方法对实验菌株进行青霉素结合蛋白PBP1a、PBP1b、PBP2a、PBP2b、PBP2x、PBP3的基因扩增,扩增产物进一步纯化和测序,测序结果与青霉素敏感肺炎链球菌R6就国际上公认的PBPs保守序列进行比对分析。结果 60株肺炎链球菌的PBP2b、PBP1a、PBP2x、PBP2a基因的保守区或保守区附件均发现氨基酸突变,未发现PBP3与PBP1b突变。中介与耐药菌株基因突变位点存在重合,主要出现在单一的PBP1a序列的370STMK模体元件内Thr371Ser置换突变或伴有PBP2b序列的Thr451Ala/Ser和Ala624Gly置换突变,同时PBP2a序列的465SLN模体元件前置位发生Ser461Ala的置换突变。结论肺炎链球菌对青霉素中、高水平耐药菌株绝大部分合并有不同PBP序列中4~6个氨基酸的置换突变,但合并多个氨基酸置换突变并非就必然引起耐药水平的相应升高。中、高水平耐药与PBP1a、PBP2b、PBP2a的变异关系密切,其中PBP1a的STMK保守区域Thr371Ser置换是引起耐药的主要因素之一。     

大熊猫源肺炎克雷伯菌耐药性和分子分型研究

【目的】对大熊猫源肺炎克雷伯菌进行耐药性及分子分型分析,掌握肺炎克雷伯菌在大熊猫圈养种群中的耐药和流行情况,指导临床用药。【方法】对2018–2019年收集到的178株大熊猫源肺炎克雷伯菌使用纸片扩散法(K-B法)分析耐药表型,使用Wafergen Smartchip超高通量荧光定量PCR法分析其耐药基因和可移动遗传元件,使用多位点序列分型(MLST)法分析其序列类型(ST)。【结果】178株大熊猫源肺炎克雷伯菌对多西环素耐药率最高(15.2%),而且2019年分离到的肺炎克雷伯菌对头孢噻肟、亚胺培南和阿奇霉素的耐药性显著高于2018年(P<0.05);检出耐药基因106种(106/227),可移动遗传元件11种(11/19),涉及的耐药机制主要为外排泵(42.0%)、抗生素失活(41.8%)和改变作用靶位(16.2%);MLST分型显示大熊猫源肺炎克雷伯菌主要分为42个不同的ST型,且ST型与耐药性具有一定的相关性。【结论】从2018年到2019年大熊猫源肺炎克雷伯菌对β-内酰胺类和大环内酯类抗生素耐药率有所增加,耐药机制以外排泵和抗生素失活为主。ST17、ST23和ST400...     

儿科病房无乳链球菌感染的临床特点和 病原菌基因多态性

目的研究儿科病房无乳链球菌感染的临床表现,并对分离的无乳链球菌进行基因多态性分析。方法收集台州市中心医院新生儿室和儿科病房2017年1月至2017年12月无乳链球菌侵袭性感染病例,分析临床表现特点。采用多位点序列分型技术,对分离的无乳链球菌7个管家基因进行PCR扩增及测序,并与BLAST数据库中的序列进行比对分析,明确菌株序列性(ST)。结果本次研究共纳入7例患儿,分离到7株无乳链球菌。7株无乳链球菌基因型中2株病原菌基因型为ST12,2株ST249,1株ST23,1株ST1076及未知型1株。小儿无乳链球菌感染临床表现为败血症的有4例,其中2例病原菌基因型为ST12,2例为ST249。临床表现为脑膜炎的1例,基因型为ST249。结论该院小儿无乳链球菌感染的基因型以ST12和ST249为主;临床表现以败血症和化脓性脑膜炎为主,预后不佳。     

11群肺炎链球菌荚膜多糖合成相关基因的分子生物学研究

目的利用分子生物学方法,研究7株11群肺炎链球菌荚膜多糖合成相关基因(cps loci)。方法根据11群肺炎链球菌荚膜多糖合成相关基因设计合成5对特异性引物,以7株肺炎链球菌基因组DNA作为模板进行PCR扩增,并对扩增产物进行序列测定及基因序列比对,确定其血清型。多位点序列分型(multilocus sequence typing,MLST)技术分析7株11群肺炎链球菌序列型(ST)。采用相邻合并分析(neighbour-joining analysis),根据MLST的7个管家基因和cps基因分别绘制系统发育树。结果根据wcw C、gct和wcj E等3个基因产物确定5株原11A型肺炎链球菌为11A型,无11E型;根据wcwR和gct等2个基因产物确定2株原11B型肺炎链球菌为11B型。获得7株不包括4个合成调控基因(wzg、wzh、wzd和wze)的11群肺炎链球菌cps loci,长度为11～12 kb,11A型具有12个开放式阅读框(ORF),11B型具有11个ORF。5株11A型肺炎链球菌部分cps基因序列差异较大; 2株11B型肺炎链球菌部分cps基因序列相似性高于99%。根据MLST分析发现3种新的ST型。根据MLST的7个管家基因绘制的系统发育树和cps基因绘制的系统发育树差异很大。结论从分子水平上确定了11A和11B血清型。获得了5株11A型和2株11B型肺炎链球菌ST型和部分荚膜多糖合成相关基因(cps loci),完善了11群肺炎链球菌的菌种档案。     

海南岛光滑假丝酵母菌多位点序列分型研究

目的:对海南省光滑假丝酵母菌临床分离株进行基因分型研究,了解菌株的遗传特征及遗传进化关系.方法:采用多位点序列分型(Multilocus sequence typing,MLST)技术,对临床分离的25株光滑假丝酵母菌6个管家基因序列进行测定;并将各个基因的序列与MLST数据库中储存的序列比对,确定其等位基因谱型及菌株序列型(STs).结果:25株临床分离的光滑假丝酵母菌通过MLST产生ST7、ST19、ST15、ST26、ST45共5个不同的序列型,其中ST7为主要序列型.结论:海南省光滑假丝酵母菌感染型别丰富,具有多样性;MLST分型具有较高的分辨力,可用于流行病学和菌群多态性的研究.     

Phenotypic and Genotypic Characteristic of Invasive Pneumococcal Isolates from Both Children and Adult Patients from a Multicenter Surveillance in China 2005–2011

Streptococcus pneumoniae is an important pathogen in both children and the elderly, but previous studies in China have provided limited information about invasive pneumococcal disease (IPD). A total of 240 IPD S. pneumoniae strains (from 105 children and 135 adults) were collected from 12 cities in China in 2005–2011. Their phenotypes and genetic characteristics were analyzed. Streptococcus pneumoniae remained highly resistant to macrolides, tetracycline, and cotrimoxazole each year. Serotypes were assigned to the 240 isolates, and 19A (22.1%), 19F (21.7%), 14 (7.5%), 3 (7.1%), and 23F (5.4%) were the most prevalent, accounting for 63.8% of all strains. Serogroup 19 strains were significantly more common among children than among adults (58.7% vs 32.4%, respectively; P < 0.001). Serotypes 19F and 19A demonstrated higher resistance to β-lactams and cephalosporins than the other serotypes. The coverage of PCV13 was superior to that calculated for PCV7 and PCV10 (77.9% vs 40.8% and 47.1%, respectively), and coverage was higher in children than in adults (85.6% vs 72.1%, respectively; P = 0.012). A multilocus sequence typing analysis revealed great diversity, with nine clonal complexes and 83 singletons among all the strains. Specifically, CC271 was more common in children, whereas singletons were more prevalent in adults. Among the serogroup 19 strains, 84.7% were ST271, ST320, or ST236, belonging to CC271. The homogeneous genetic background of 19F and 19A, together with the high resistance of these strains, suggests that clonal spread is responsible for the high prevalence of serogroup 19 in IPD. This is the first large study to investigate IPD strains in both children and adults in China.     

Molecular characterization of invasive isolations of penicillin-resistant Streptococcus pneumoniae recovered from adult patients

Streptococcus pneumoniae penicillin resistance is associated with the international dispersion of specifically identified strains. In Colombia, the presence and circulation of resistant strains Spain23F-1, Spain6B-2, Spain9V and Colombian23F-25 has been demonstrated in children less than 5 years old. Strain identities were established for 80 penicillin resistant S. pneumoniae isolates recovered from Colombian adult patients. Three approaches to genotypic characterization of the strains wrere used: a) chromosomal DNA was digested with Sma 1, and the products subjected to pulse-field gel electrophoresis (PFGE); b) restriction enzyme fragment comparison of the penicillin binding protein genes (pbp 1a, 2b and 2x), and c) pneumococcal surface protein A (PspA) family. The results showed that 2.5% of the isolates were genetically related to Spain23F-1 clone, 10% to Spain6B-2 clone, 37.5% to Spain9V-3, in addition, 14% of the capsular type 23F isolates were related to the Colombia23F-25 clone and demonstrated an intermediate level resistance to penicillin. Wide spread circulation of international strains as well as a Colombian strain highlighted the importance of these clones in maintaining the prevalence of resistance to penicillin in Colombia.     

Serotype distribution of Streptococcus pneumoniae in north-western Greece and implications for a vaccination programme

Serotypes and antibiotic sensitivities were determined for 338 strains of Streptococcus pneumoniae from children of north-western Greece with invasive pneumococcal disease (IPD), acute otitis media (AOM) and nasopharyngeal carriage. The most common serotypes among the isolates from IPD were 14 and 19F, while 3, 19F, 9V and 14 were the major cause of AOM. In these groups, the heptavalent conjugate vaccine for pneumococci (7vPCV) seems to cover 90.5% of the serotypes isolated from children less than 2 years old. Serotypes 23F and 6B were the most prevalent in carrier strains. Overall, 23.7% of the isolates were penicillin nonsusceptible (PNS), 97% were fully susceptible to cefotaxime, 29% were resistant to erythromycin, 11.2% to co-trimoxazole and 1.2% to clindamycin.     

Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Isolates Causing Invasive Diseases from Shenzhen Children’s Hospital

Objective

To provide guidance for clinical disease prevention and treatment, this study examined the epidemiology, antibiotic susceptibility, and serotype distribution of Streptococcus pneumoniae (S. pneumoniae) associated with invasive pneumococcal diseases (IPDs) among children less than 14 years of age in Shenzhen, China.

Materials and Methods

All the clinical strains were isolated from children less than 14 years old from January 2009 to August 2012. The serotypes and antibiotic resistance of strains of S. pneumoniae were determined using the capsular swelling method and the E-test.

Results

A total of 89 strains were isolated and 87 isolates were included. The five prevailing serotypes were 19F (28.7%), 14 (16.1%), 23F (11.5%), 19A (9.2%) and 6B (6.9%). The most common sequence types (ST) were ST271 (21.8%), ST876 (18.4%), ST320 (8.0%) and ST81 (6.9%) which were mainly related to 19F, 14, 19A and 23F, respectively. The potential coverage by 7-, 10-, and 13-valent pneumococcal conjugate vaccine were 77.0%, 77.0%, and 89.7%, respectively. Among the 87 isolates investigated, 11.5% were resistant to penicillin, and for meningitis isolates, the resistance rate was 100%. Multi-drug resistance (MDR) was exhibited by 49 (56.3%) isolates. Eighty-four isolates were resistance to erythromycin, among which, 56 (66.7%) carried the ermB gene alone and 28 (33.3%) expressed both the ermB and mefA/E genes.

Conclusions

The potential coverage of PCV13 is higher than PCV7 and PCV10 because high rates of serotypes 19A and 6A in Shenzhen. The clinical treatment of IPD needs a higher drug concentration of antibiotics. Continued surveillance of the antimicrobial susceptibility and serotypes distribution of IPD isolates may be necessary.     

Molecular characteristics of penicillin-binding protein 2b, 2x, and 1a sequences in penicillin-nonsusceptible Streptococcus pneumoniae isolates in Shenyang, China

The aim of this study was to investigate the nature of the amino acid motifs found in penicillin-binding proteins (PBP) 2b, 2x, and 1a of penicillin-nonsusceptible Streptococcus pneumoniae isolates from Shenyang, China, and to obtain information regarding the prevalence of alterations within the motifs or in positions flanking the motifs. For 18 clinical isolates comprising 4 penicillin-susceptible S. pneumoniae, 5 penicillin-intermediate S. pneumoniae, and 9 penicillin-resistant S. pneumoniae. the DNA sequences of PBP2b, PBP2x, and PBP1a transpeptidase domains were determined and then genotyped by multilocus sequence typing. Sequence analysis revealed that most penicillin-nonsusceptible S. pneumoniae isolates (penicillin MIC > or = 1.5 microg/mL and cefotaxime MIC > or = 2 microg/mL) shared identical PBP2b, PBP2x, and PBP1a amino acid profiles. Most penicillin-resistant S. pneumoniae isolates were ST320 (4-16-19-15-6-20-1), the double-locus variant of the Taiwan19F-14 clone. This study will serve as a basis for future monitoring of genetic changes associated with the emergence and spread of beta-lactam resistance in Shenyang, China.     

The characteristics of nasopharyngeal Streptococcus pneumoniae in children attending a daycare unit

S. pneumoniae is a component of normal nasopharyngeal flora in children. Nasopharyngeal colonization in children attending daycare units has an important effect on the spread of S. pneumoniae. In this study, we aimed to investigate colonization status, antimicrobial susceptibility, and clonal relatedness of the S. pneumoniae strains in children attending a daycare unit. One hundred and six nasopharyngeal swabs were collected from 25 children attending a daycare unit in an 8-month period. S. pneumoniae was identified by a conventional method. Antibacterial sensitivities of the strains were tested by disc diffusion method. Pulsed field gel electrophoresis (PFGE) was used to analyze the clonal relationship of the strains. A total of 25 (23.5%) S. pneumoniae strains were identified from 106 nasopharyngeal swaps. S. pneumoniae growth was detected in at least one culture of the 19 children (colonization rate; 76%). Seven of the 25 strains (28%) showed resistance to penicillin, 5 (20%) were resistant to trimethoprim-sulfomethoxsazole. The other tested antibiotics were almost effective. The clonal relationship among strains was found as 54.5%. The highest rate of strain entry was in the winter months with strains of opaque colonies, which are known to be more pathogenic. However, the spreading rate among the children was the highest in the summer months and the strains detected in these months had transparent colonies with more transmitting characteristics. Therefore, to prevent S. pneumoniae infection in closed crowded areas, the summer months should not be overlooked.     

Nosopharyngeal microflora in ambulatory treated children and adults with upper respiratory tract infections

Upper respiratory tract consists resident and transient bacterial microflora, which in appropriate condition can cause infection. Bacteriological study was performed among 201 patients with upper respiratory tract infections treated in ambulatory. From nasal and pharyngeal swabs Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococci group A, B, C, G were isolated. Antibiotic susceptibility testing of isolated strains was performed using CLSI criteria. All isolated strains of streptococci were susceptible to penicillin; some of them demonstrated resistance to macrolides and lincosamides. Few isolated strains of H. influenzae demonstrated resistance to penicillin and cotrimoxazole. Azitromycin resistant strains were not detected. All isolated strains of M. catarrhalis were beta-lactamase positive and demonstrated resistance to penicillin. Strains of methicillin sensitive S. aureus (MSSA) were isolated most frequently from pharyngeal swabs (35.4%) and S. pneumoniae (33.3)--from nasal swabs.     

Effectiveness of the antibiotics chloramphenicol and rifampin in the treatment of Streptococcus pneumoniae-induced meningitis and systemic infections

Streptococcus pneumoniae, a common pathogen in pediatric infections, has become resistant to penicillin and make these infections difficult to treat. Rifampin and chloramphenicol have been recommended as alternative therapies, since they are less costly and more accessible to communities with limited resources. However, their use may be restricted by the differing levels of resistance found in target populations. The objective was to determine minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) for chloramphenicol and rifampin in strains of S. pneumoniae. These strains were newly isolated from children under age 5 that had demonstrated systemic infections and meningitis. A subgroup of 107 isolates of S. pneumoniae was selected from 324 strains isolated during a period of 2 years (1994-1996). Among these isolates, 60 were penicillin-resistant and 47 were susceptible; 53 isolates were from children with meningitis. MIC and MBC for chloramphenicol and rifampicin were obtained by standard methods recommended by the National Committee for Clinical Laboratory Standards (NCCLS). S. pneumoniae ATCC strain 49619 served as the control. An isolate was considered susceptible to chloramphenicol when MIC = 4 microg/ml and resistant when MIC = 8 microg/ml. A strain was considered susceptible to rifampin when MIC = 1 microg/ml and resistant when MIC = 4 microg/ml. MBC was determined by recording the lower concentration of the antibiotic that inhibited 99.9% of the initial inoculum. Chloramphenicol resistance was found in 21% of the 107 isolates. In the group susceptible to penicillin, 11% were resistant to chloramphenicol and in the group resistant to penicillin 28% was resistant to chloramphenicol as well. MBC was found > 4 microg/ml in 28% of the isolates susceptible to penicillin and in 60% of the resistant isolates. No isolates were found resistant to rifampin. However, 2 penicillin resistant isolates showed CBM > 1 microg/ml to rifampin, and one with CIM = 1 microg/ml had a MBC to rifampicin of 16 microg/ml. Meningitis isolates showed higher CIM and CBM than the group of total isolates. These data suggest that chloramphenicol is not recommended for invasive infections caused by S. pneumoniae in Colombia. Rifampin is a more effective therapy in combination with other antibiotics for treatment of this kind of infections. Further studies are necessary to clarify the significance of low levels of MBC to rifampin found in some strains, since this may affect the efficacy of therapies that include this antibiotic.     

Identification of a streptococcal penicillin-binding protein that reacts very slowly with penicillin.

Penicillin-binding protein (PBP) 5 of Streptococcus faecium ATCC 9790 has an unusually low affinity for penicillin (50% binding occurred at a penicillin level of 8 micrograms/ml after 60 min of incubation, and the protein only became labeled after 20 min of incubation with high concentrations of radioactive penicillin). PBPs with similar properties are carried by strains of Streptococcus durans, Streptococcus faecalis, and Streptococcus lactis but not by strains of groups A, B, C, and G streptococci or Streptococcus pneumoniae. The strains carrying the slow-reacting PBP demonstrated a sensitivity to penicillin that was several hundred times lower than that of strains not carrying it. Spontaneous mutants with minimal inhibitory concentrations of penicillin of 20, 40, and 80 micrograms/ml were isolated from S. faecium ATCC 9790. They all showed a dramatic increase in the amount of slow-reacting PBP produced. Mutants with increased penicillin resistance were also isolated from wild-type strains of S. durans, S. faecalis, and S. faecium. All of them carried a greater amount of the slow-reacting PBP than that carried by the parent. Finally, it was found that resistant S. faecium ATCC 9790 mutants grew normally in the presence of penicillin concentrations that were far above that saturating all PBPs except PBP 5. Cell growth was, on the contrary, inhibited by a penicillin concentration that saturated the slow-reacting PBP by 90%. This penicillin dose was equal to the minimal inhibitory concentration.     

Serotypes and Patterns of Antibiotic Resistance in Strains Causing Invasive Pneumococcal Disease in Children Less than 5 Years of Age

Objective

The serotypes and patterns of antibiotic resistance of Streptococcus pneumoniae (S. pneumoniae) strains that cause invasive pneumococcal disease (IPD) in infants were analyzed to provide guidance for clinical disease prevention and treatment.

Methods

The clinical features of confirmed IPD were evaluated in 61 patients, less than 5 years of age, who were admitted to our hospital between January 2009 and December 2011. The serotypes and antibiotic resistance of strains of S.pneumoniae were determined using the capsular swelling method and the E-test.

Results

A total of 61 invasive strains were isolated. The serotype distribution of those isolates were 19A (41.0%), 14 (19.7%), 19F (11.5%), 23F (9.8%), 8 (4.9%), 9V (4.9%), 1 (3.3%), and 4, 6B, and 20 (each 1.6%). The percentage of S. pneumoniae strains resistant to erythromycin, clindamycin, and cotrimoxazole were 100%, 86.9%, and 100%, respectively. The percentage of S. pneumoniae strains resistant to penicillin, amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, cefotaxime, cefepime, and meropenem were 42.6%, 18.0%, 82.0%, 18.0%, 13.1%, 13.1%, and 36.1%, respectively. The percentage of multidrug-resistant strains was 95.6%. Strains of all serotypes isolated in this study were highly resistant to erythromycin, cotrimoxazole, and clindamycin. Strains with serotype 19A had the highest rates of resistance.

Conclusions

Serotype 19A strains were most frequently isolated from children with IPD treated in our hospital. The strains causing IPD are highly resistant to antibiotics.