Insight Into Resistance Phenotypes of Emergent Non 13-valent Pneumococcal Conjugate Vaccine Type Pneumococci Isolated From Invasive Disease After 13-valent Pneumococcal Conjugate Vaccine Implementation in France.
Insight Into Resistance Phenotypes of Emergent Non 13-valent Pneumococcal Conjugate Vaccine Type Pneumococci Isolated From Invasive Disease After 13-valent Pneumococcal Conjugate Vaccine Implementation in France.
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DOI：
10.1093/ofid/ofw020
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发表时间：
2016-01
影响因子：
4.2
通讯作者：
Varon E
中科院分区：
文献类型：
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作者：
Janoir C;Lepoutre A;Gutmann L;Varon E
在法国实施13价结合肺炎球菌疫苗导致侵袭性肺炎球菌分离株的总体抗生素耐药性下降。然而，在新出现的非pcv13血清型中，12F、24F、15A和35B与抗生素耐药性相关，应进一步监测。背景。2010年，肺炎球菌13价结合疫苗（PCV13）在法国取代了PCV7，其中包含6种额外的血清型，包括耐多药的19A。本研究旨在分析法国引入PCV13后侵袭性肺炎球菌病（IPD）分离株的抗生素耐药性趋势。方法。对2008-2009年（PCV7时代晚期）和2011-2012年（PCV13时代）从IPD分离的5243株肺炎球菌进行血清型和抗生素耐药性分析。对幼儿分离的主要血清型（12F和24F）进行多位点序列分型分析。结果。总体而言，法国的抗生素耐药率下降（2008-2009年至2011-2012年青霉素耐药率为- 21.5%），主要原因是19A血清型的下降。在同时出现的非pcv13血清型中，血清型12F、24F、15A和35B始终与对一种或多种抗生素的耐药性相关。在2岁以下儿童中，血清型15A、35B和24F分别占青霉素不敏感和红霉素耐药分离株的37.8%和31.9%。氯霉素耐药和复方新诺明耐药主要与12F和24F血清型相关。遗传分析表明，虽然血清型12F肺炎球菌的出现是由于各种已有谱系的扩增，但血清型24F的增加与ST162青霉素敏感的复方新恶唑耐药谱系的克隆扩增有关。结论。我们发现，在法国，pcv13相关IPD的下降与抗生素耐药性的下降有关，但它可能有利于几种耐药非疫苗血清型的传播。然而，抗生素耐药性似乎并不是导致这种现象的唯一因素。
Implementation of 13-valent conjugate pneumococcal vaccine in France has led to an overall antibiotic resistance decrease among invasive pneumococcal isolates. However, among emerging non-PCV13 serotypes, 12F, 24F, 15A and 35B are associated to antibiotic resistance and should be further monitored. Background. In 2010, the pneumococcal 13-valent conjugate vaccine (PCV13), containing 6 additional serotypes including the multidrug-resistant 19A, replaced the PCV7 in France. This study aimed at analyzing trends in antibiotic resistance in invasive pneumococcal disease (IPD) isolates in France after PCV13 introduction. Methods. A total of 5243 pneumococci isolated from IPD in 2008–2009 (late PCV7 era) and 2011–2012 (PCV13 era) were studied according to their serotype and antibiotic resistance profile. Multilocus sequence typing analysis was performed on strains of the predominant serotypes (12F and 24F) isolated from young children. Results. Overall, the prevalence of antibiotic resistance decreased in France (−21.5% for penicillin from 2008–2009 to 2011–2012), mainly driven by the decline of the 19A serotype. Among non-PCV13 serotypes that concomitantly emerged, serotypes 12F, 24F, 15A, and 35B were consistently associated with resistance to 1 or more antibiotics. In children under 2 years, serotypes 15A, 35B, and 24F accounted together for 37.8% and 31.9% of penicillin-nonsusceptible and erythromycin-resistant isolates, respectively. Chloramphenicol and cotrimoxazole resistance were mainly associated with serotypes 12F and 24F, respectively. Genetic analysis showed that although emergence of serotype 12F pneumococci resulted from the expansion of various pre-existing lineages, increase in serotype 24F was related to the clonal expansion of the ST162 penicillin-susceptible cotrimoxazole-resistant lineage. Conclusions. We showed that decline of PCV13-related IPD was associated with a decline in antibiotic resistance in France, but that it likely favored the spread of several resistant nonvaccine serotypes. However, antibiotic resistance does not seem to be the only element that may drive this phenomenon.