J Korean Med Sci.  2017 Sep;32(9):1431-1439. 10.3346/jkms.2017.32.9.1431.

Changes in the Serotype Distribution among Antibiotic Resistant Carriage Streptococcus pneumoniae Isolates in Children after the Introduction of the Extended-Valency Pneumococcal Conjugate Vaccine

• Lee JK
• Yun KW
• Choi EH
• Kim SJ
• Lee SY
• Lee HJ

• KMID: 2385948
• DOI: http://doi.org/10.3346/jkms.2017.32.9.1431

Abstract

This study investigated the serotype distribution and antimicrobial resistance of 3,820 nasopharyngeal Streptococcus pneumoniae isolates from infants and children who presented with respiratory symptoms at Seoul National University Children's Hospital from July 2010 to June 2015 after the introduction of the extended-valency pneumococcal conjugate vaccines (PCVs). Serotypes and antimicrobial susceptibility were determined using the Quellung reaction and E-test, respectively. S. pneumoniae was isolated from 397 (10.4%) specimens. The most common serotypes were 19A (14.0%), 23A (12.8%), 15B/C (10.7%), 11A (10.1%), 6C (7.8%), and 6A (6.3%) among the typeable pneumococci (n = 335). The PCV serotype proportions significantly decreased (59.1% in 2010/11 to 17.0% in 2014/15, P < 0.001), whereas the non-PCV serotype proportions significantly increased (40.9% in 2010/11 to 83.0% in 2014/15, P < 0.001). The non-susceptibility rates for penicillin (oral), penicillin (parenteral, non-meningitis), cefotaxime, and erythromycin were 97.8%, 22.8%, 27.7%, and 95.5%, respectively. The proportions of PCV serotypes responsible for non-susceptibility to penicillin (parenteral, non-meningitis) and multidrug resistance significantly decreased (80.8% to 21.1%, P < 0.001 and 64.3% to 12.3%, P < 0.001, respectively), whereas the non-PCV serotype proportions significantly increased (19.2% to 78.9%, P < 0.001 and 35.7% to 87.7%, P < 0.001, respectively). Serotypes 23A and 15B/C demonstrated significant proportional increase among the antibiotics resistant strains. Thus, the PCV serotype proportions decreased and the non-PCV serotype proportions increased among nasopharyngeal carriage pneumococci after the introduction of extended-valency PCVs in Korea. Antimicrobial non-susceptibility rates for penicillin and erythromycin remain high despite the decrease in the proportion of PCV serotypes responsible for antimicrobial resistance over time.

Keyword

Streptococcus pneumoniae; Serotype; Antimicrobial Resistance; Pneumococcal Conjugate Vaccines

MeSH Terms

Anti-Bacterial Agents
Cefotaxime
Child*
Drug Resistance, Multiple
Erythromycin
Humans
Infant
Korea
Penicillins
Pneumonia
Seoul
Serogroup*
Streptococcus pneumoniae*
Streptococcus*
Vaccines, Conjugate
Anti-Bacterial Agents
Cefotaxime
Erythromycin
Penicillins
Vaccines, Conjugate

Figure

• 

  Fig. 1 Serotype distributions of PCVs among pneumococcal carriage isolates from children in post-PCV10/13 period, 2010–2015. PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F); PCV13 specific serotypes (3, 6A, and 19A). There was no PCV10/13 additional serotype (1, 5, and 7F).PCV = pneumococcal conjugate vaccine.

• 

  Fig. 2 Changes in serotype distributions of PCVs among pneumococcal carriage isolates from children in the post-PCV10/13 period from 2010–2015.PCV = pneumococcal conjugate vaccine.*Statistically significant (P < 0.050) using Pearson's χ2 test linear-by-linear association model.

• 

  Fig. 3 Changes of penicillin non-susceptible (A) and multidrug resistant (B) serotypes in post-PCV10/13 period, 2010–2015. *Statistically significant (P < 0.050) using Pearson's χ2 test linear-by-linear association model.

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