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Persistence and complex evolution of fluoroquinolone-resistant Streptococcus pneumoniae clone

Debby Ben-David, Mitchell J Schwaber, Amos Adler

    Emerging Infectious Diseases
    |April 23, 2014
    PubMed

    Insights

    A rare, multidrug-resistant Streptococcus pneumoniae clone persisted for five years in an Israeli post-acute care facility. This highlights long-term care facilities as reservoirs for resistant bacteria, even with infection control measures.

    Area of Science:

    • Infectious Diseases
    • Microbiology
    • Epidemiology

    Background:

    • Multidrug-resistant Streptococcus pneumoniae (MDRSP) outbreaks in healthcare settings are infrequent.
    • Long-term care facilities (LTCFs) can act as reservoirs for antibiotic-resistant bacteria.

    Purpose of the Study:

    • To investigate the persistent transmission of a fluoroquinolone-resistant S. pneumoniae clone in an Israeli post-acute care facility.
    • To understand the genetic mechanisms and duration of spread for this resistant clone.

    Main Methods:

    • Longitudinal surveillance of S. pneumoniae isolates from a post-acute care facility between 2006 and 2011.
    • Molecular typing and antimicrobial susceptibility testing of identified S. pneumoniae clones.
    • Analysis of genetic mutations associated with fluoroquinolone resistance and capsular switching.

    Main Results:

    • A single clone of fluoroquinolone-resistant S. pneumoniae demonstrated persistent transmission over a five-year period (2006-2011).
    • Despite mandatory vaccination policies and fluoroquinolone restrictions, the clone continued to spread.
    • Genetic analysis revealed capsular switching and multiple antimicrobial nonsusceptibility mutations within this specific clone.

    Conclusions:

    • Long-term care facilities can serve as significant reservoirs for the sustained transmission of multidrug-resistant streptococci.
    • The persistence of this MDRSP clone underscores the challenges in controlling resistant bacterial infections in healthcare settings.
    • Continuous monitoring and targeted interventions are crucial for managing MDRSP in vulnerable populations within LTCFs.
    Keywords:
    Streptococcus pneumoniaeantimicrobial drug resistancebacteriaclonal evolutionfluoroquinoloneslong-term acute care hospital

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