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Cephalosporin-resistant pneumococci and sickle cell disease

Martha L Miller1, Caroline A Obert, Geli Gao

  • 1St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.

Emerging Infectious Diseases
|August 17, 2005
PubMed

Insights

Sickle cell disease patients have a high risk of invasive pneumococcal disease. Antimicrobial resistance to cephalosporins is prevalent in these patients, potentially impacting treatment effectiveness.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Genetics

Background:

  • Sickle cell disease (SCD) patients face a significantly elevated risk, 600-fold higher, for invasive pneumococcal disease (IPD) compared to healthy individuals.
  • High-level cephalosporin resistance in Streptococcus pneumoniae was identified in the 1990s, but its prevalence within the SCD population remained uncharacterized.

Purpose of the Study:

  • To investigate the prevalence and characteristics of antimicrobial drug-resistant pneumococcal strains in patients with sickle cell disease in Tennessee.
  • To identify novel or previously unrecognized resistant clones in this vulnerable patient group.

Main Methods:

  • Multilocus sequence typing (MLST) was employed to analyze pneumococcal isolates obtained from sickle cell disease patients.
  • Antimicrobial susceptibility testing was performed to determine resistance patterns, specifically against cefotaxime and penicillin.

Main Results:

  • Twenty-one percent of the analyzed pneumococcal strains exhibited resistance to both cefotaxime and penicillin.
  • Among the 14 cephalosporin-resistant strains, 9 belonged to previously identified highly resistant sequence types.
  • Cephalosporin resistance was newly identified in three distinct clones: Maryland6B, ST660, and a novel clone, designated ST1753.

Conclusions:

  • High-level cephalosporin resistance in Streptococcus pneumoniae is more widespread than previously understood.
  • The significant prevalence of cephalosporin-resistant strains in sickle cell disease patients may compromise the effectiveness of third-generation cephalosporins for treating invasive pneumococcal disease in this population.

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