Indian J Pediatr (October 2014) 81(10):1124–1125 DOI 10.1007/s12098-014-1485-5
SCIENTIFIC LETTER
Changing Patterns of Antimicrobial Susceptibility of Invasive Pneumococcal Diseases after Introduction of Pneumococcal Conjugate Vaccine Nuri Bayram & Hurşit Apa & Gamze Gülfidan & İlker Günay & Nurettin Ünal & İlker Devrim
Received: 6 June 2013 / Accepted: 2 May 2014 / Published online: 25 May 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: Streptococcus pneumoniae is one of the leading causes of severe invasive vaccine-preventable bacterial diseases in children. Emergence of antibiotic resistance complicates the treatment of invasive pneumococcal diseases (IPD) [1] . In Turkey, pneumococcal conjugate vaccine (PCV) was adopted in the national immunization schedule since November 2008. A study from Turkey revealed the potential coverage of PCV7, PCV10, and PCV13 as 69.5, 75.8, and 85.3 % respectively [2]. We aimed to investigate the antimicrobial susceptibility of isolates, and change in patterns of drug resistance before and after introduction of PCV. This retrospective study was conducted in Dr. Behçet Uz Children’s Hospital between December 2007 and May 2013. A case of IPD was defined as isolation of S.pneumoniae from sterile sites. Automated culture system (Biomerieux, France) was used for identification and antimicrobial susceptibility tests were performed according to CLSI’s criteria. N. Bayram (*) : H. Apa : İ. Devrim Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey e-mail: [email protected] G. Gülfidan Department of Microbiology and Clinical Microbiology, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey İ. Günay : N. Ünal Department of Pediatrics, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
S. pneumoniae was identified from blood, pleural fluid and cerebrospinal fluid specimens of 43 patients. Penicillin resistance was present in 24/43 (55.8 %) isolates; 5 (11.6 %) were intermediate, and 19 (44.2 %) were highly resistant. Overall resistance to cefotaxime was 11.6 %, erythromycin was 48.8 %, and rifampicin was 20.9 %. Durational changes in resistance patterns are reviewed in Fig. 1. No statistically significant incline in resistance to penicillin (p=0.441) and cefotaxime (p=0.207) were observed after introduction of PCV7; however erythromycin resistant ratio was found to be significantly lower in post-vaccination era (p=0.016). A multicenter study from Turkey reported the rate of penicillin nonsusceptible isolates as 33.7 % [2]. Another report suggested 38.7 % of pneumococcal isolates were nonsusceptible to penicillin; 31 % were intermediate-resistant, and 8 % were high-level resistant to penicillin before widespreading use of PCV [3]. In our study, the overall penicillin resistant strains were found to be 55.8 %, in which half of them were highly resistant. Recent studies showed that routine usage of PCV significantly declined IPD incidence due to vaccine serotypes in the non-vaccinated population indicating herd immunity [4, 5]. The rate of the resistant strains had not increased after the initiation of pneumococcal vaccines in our study. The results of this pilot study suggest the need for a national surveillance for determining dominant serotypes, serotype changes and resistance patterns for evaluating the effect of PCV7 introduction.
Indian J Pediatr (October 2014) 81(10):1124–1125
1125
Fig. 1 Overall susceptibility patterns of the Streptococcus pneumoniae isolates
Conflict of Interest None. Source of Funding None.
References 1. Centers for Disease Control and Prevention. Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006– 2015. MMWR Morb Mortal Wkly Rep. 2006;55:511–5. 2. Ceyhan M, Gurler N, Yaman A, Ozturk C, Oksuz L, Ozkan S, et al. Serotypes of Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Turkey: baseline evaluation of the
introduction of the pneumococcal conjugate vaccine nationwide. Clin Vaccine Immunol. 2011;18:1028–30. 3. Yalçin I, Gürler N, Alhan E, Yaman A, Turgut M, Celik U, et al. Serotype distribution and antibiotic susceptibility of invasive Streptococcus pneumoniae disease isolates from children in Turkey, 2001–2004. Eur J Pediatr. 2006;165:654–7. 4. Isaacman DJ, McIntosh ED, Reinert RR. Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines. Int J Infect Dis. 2010;14:197–209. 5. Jefferies JM, Macdonald E, Faust SN, Clarke SC. 13-valent pneumococcal conjugate vaccine (PCV13). Hum Vaccine. 2011;7:1012–8.
SCIENTIFIC LETTER
Changing Patterns of Antimicrobial Susceptibility of Invasive Pneumococcal Diseases after Introduction of Pneumococcal Conjugate Vaccine Nuri Bayram & Hurşit Apa & Gamze Gülfidan & İlker Günay & Nurettin Ünal & İlker Devrim
Received: 6 June 2013 / Accepted: 2 May 2014 / Published online: 25 May 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: Streptococcus pneumoniae is one of the leading causes of severe invasive vaccine-preventable bacterial diseases in children. Emergence of antibiotic resistance complicates the treatment of invasive pneumococcal diseases (IPD) [1] . In Turkey, pneumococcal conjugate vaccine (PCV) was adopted in the national immunization schedule since November 2008. A study from Turkey revealed the potential coverage of PCV7, PCV10, and PCV13 as 69.5, 75.8, and 85.3 % respectively [2]. We aimed to investigate the antimicrobial susceptibility of isolates, and change in patterns of drug resistance before and after introduction of PCV. This retrospective study was conducted in Dr. Behçet Uz Children’s Hospital between December 2007 and May 2013. A case of IPD was defined as isolation of S.pneumoniae from sterile sites. Automated culture system (Biomerieux, France) was used for identification and antimicrobial susceptibility tests were performed according to CLSI’s criteria. N. Bayram (*) : H. Apa : İ. Devrim Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey e-mail: [email protected] G. Gülfidan Department of Microbiology and Clinical Microbiology, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey İ. Günay : N. Ünal Department of Pediatrics, Dr. Behçet Uz Children’s Hospital, İzmir, Turkey
S. pneumoniae was identified from blood, pleural fluid and cerebrospinal fluid specimens of 43 patients. Penicillin resistance was present in 24/43 (55.8 %) isolates; 5 (11.6 %) were intermediate, and 19 (44.2 %) were highly resistant. Overall resistance to cefotaxime was 11.6 %, erythromycin was 48.8 %, and rifampicin was 20.9 %. Durational changes in resistance patterns are reviewed in Fig. 1. No statistically significant incline in resistance to penicillin (p=0.441) and cefotaxime (p=0.207) were observed after introduction of PCV7; however erythromycin resistant ratio was found to be significantly lower in post-vaccination era (p=0.016). A multicenter study from Turkey reported the rate of penicillin nonsusceptible isolates as 33.7 % [2]. Another report suggested 38.7 % of pneumococcal isolates were nonsusceptible to penicillin; 31 % were intermediate-resistant, and 8 % were high-level resistant to penicillin before widespreading use of PCV [3]. In our study, the overall penicillin resistant strains were found to be 55.8 %, in which half of them were highly resistant. Recent studies showed that routine usage of PCV significantly declined IPD incidence due to vaccine serotypes in the non-vaccinated population indicating herd immunity [4, 5]. The rate of the resistant strains had not increased after the initiation of pneumococcal vaccines in our study. The results of this pilot study suggest the need for a national surveillance for determining dominant serotypes, serotype changes and resistance patterns for evaluating the effect of PCV7 introduction.
Indian J Pediatr (October 2014) 81(10):1124–1125
1125
Fig. 1 Overall susceptibility patterns of the Streptococcus pneumoniae isolates
Conflict of Interest None. Source of Funding None.
References 1. Centers for Disease Control and Prevention. Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006– 2015. MMWR Morb Mortal Wkly Rep. 2006;55:511–5. 2. Ceyhan M, Gurler N, Yaman A, Ozturk C, Oksuz L, Ozkan S, et al. Serotypes of Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Turkey: baseline evaluation of the
introduction of the pneumococcal conjugate vaccine nationwide. Clin Vaccine Immunol. 2011;18:1028–30. 3. Yalçin I, Gürler N, Alhan E, Yaman A, Turgut M, Celik U, et al. Serotype distribution and antibiotic susceptibility of invasive Streptococcus pneumoniae disease isolates from children in Turkey, 2001–2004. Eur J Pediatr. 2006;165:654–7. 4. Isaacman DJ, McIntosh ED, Reinert RR. Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines. Int J Infect Dis. 2010;14:197–209. 5. Jefferies JM, Macdonald E, Faust SN, Clarke SC. 13-valent pneumococcal conjugate vaccine (PCV13). Hum Vaccine. 2011;7:1012–8.
