Ann Lab Med.  2014 May;34(3):210-215. 10.3343/alm.2014.34.3.210.

Distribution of Serotypes and Antibiotic Susceptibility Patterns Among Invasive Pneumococcal Diseases in Saudi Arabia

• A Al-Sherikh Y
• K Gowda L
• Mohammed Ali MM
• John J
• Khaled Homoud Mohammed D
• Chikkabidare Shashidhar P

• KMID: 1791922
• DOI: http://doi.org/10.3343/alm.2014.34.3.210

Abstract

BACKGROUND
Streptococcus pneumoniae causes life-threatening infections such as meningitis, pneumonia, and febrile bacteremia, particularly in young children. The increasing number of drug-resistant isolates has highlighted the necessity for intervening and controlling disease. To achieve this, information is needed on serotype distribution and patterns of antibiotic resistance in children.
METHODS
All cases of invasive pneumococcal disease (IPD) in children aged less than 15 yr recorded at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, were reviewed for serotyping and antibiotic susceptibility. Isolates were collected from 78 consecutive patients with IPD between 2009 and 2012. All collected isolates were subjected to serotyping by co-agglutination, sequential multiplex PCR, and single PCR sequetyping as previously described.
RESULTS
The most frequently isolated IPD serotypes were 23F, 6B, 19F, 18C, 4, 14, and 19A, which are listed in decreasing order and cover 77% of total isolates. The serotype coverage for the pneumococcal conjugate vaccine (PCV)7, PCV10, and PCV13 was 77%, 81%, and 90%, respectively. Results from sequential multiplex PCR agreed with co-agglutination results. All serotypes could not be correctly identified using single PCR sequetyping. Minimum inhibitory concentration showed that 50 (64%) isolates were susceptible to penicillin, whereas 70 (90%) isolates were susceptible to cefotaxime.
CONCLUSIONS
The most common pneumococcal serotypes occur with frequencies similar to those found in countries where the PCV has been introduced. The most common serotypes in this study are included in the PCVs. Addition of 23A and 15 to the vaccine would improve the PCV performance in IPD prevention.

Keyword

Pneumococcus; Pneumococcal conjugate vaccine; Serotype; Vaccination

MeSH Terms

Adolescent
Anti-Bacterial Agents/*pharmacology
Bacterial Proteins/genetics
Cefotaxime/pharmacology
Child
Child, Preschool
DNA, Bacterial/analysis
Humans
Infant
Meningitis/*diagnosis/microbiology
Microbial Sensitivity Tests
Multiplex Polymerase Chain Reaction
Penicillins/pharmacology
Pneumococcal Vaccines/immunology
Pneumonia/*diagnosis/microbiology
Protein Tyrosine Phosphatases/genetics
Retrospective Studies
Saudi Arabia
Serotyping
Streptococcus pneumoniae/*drug effects/genetics
Anti-Bacterial Agents
Bacterial Proteins
Cefotaxime
DNA, Bacterial
Penicillins
Pneumococcal Vaccines
Protein Tyrosine Phosphatases

Figure

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  Fig. 1 Antibiotic susceptibility patterns (%) of pneumococcal isolates from patients under age 15.

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  Fig. 2 Antibiotic susceptibility profiles of different serotypes against penicillin.

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  Fig. 3 Vaccine coverage by PCV-7, 10, and 13.Abbreviation: PCV, pneumococcal conjugate vaccine.

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  Fig. 4 Serotype prevalence and cumulative frequency of pneumococcal isolates in patients under age 15.

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