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Increase in Penicillin and multidrug resistance in Streptococcus pneumoniae (1993-2016): Report from a tertiary care
Afia Zafar1, Farida Khurram Lalani2, Ahmer Arif Longi3
1Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
Objective:
To determine the trend of resistance to antimicrobials in Streptococcus pneumoniae infections, and the impact of new Clinical and Laboratory Standards Institute guidelines on 1211 among meningeal isolates.
Methods:
The descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory in Karachi, and comprised Streptococcus pneumoniae isolation and antimicrobial susceptibility data over a period of 24 years, from 1993 to 2016, which was compared in terms of pre-2008 and post-2008 data, which was analysed using SPSS 19.
Results:
Of the 7415 non-duplicate isolates identified, 4700(63.4%) were from male patients and 2,715(36.6%) were from female patients. The overall mean age of the patients was 38±27 years. Penicillin resistance in non-meningeal isolates during the two periods was not significantly different (p>0.05), but a significant rise in penicillin resistance in meningeal isolates was observed in the second period (p<0.05). High resistance rates were observed for co-trimoxazole, tetracycline and erythromycin, and an increased trend of multi-drug resistant strains was also noted from 1999 {n=35/317(11%)} to 2016 {n=110/314 (36%)}.
Conclusions:
The emergence of multi-drug resistant strains was evident. The spike in penicillin-resistant Streptococcus pneumoniae in meningeal isolates may have been due to the revised guidelines by the Clinical and Laboratory Standards Institute.
Insights
Antimicrobial resistance in Streptococcus pneumoniae is increasing, particularly penicillin resistance in meningeal infections. Multi-drug resistant strains are emerging, potentially linked to updated Clinical and Laboratory Standards Institute guidelines.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Laboratory Science
Background:
- Streptococcus pneumoniae is a significant cause of bacterial infections, including meningitis.
- Antimicrobial resistance in S. pneumoniae poses a growing public health threat.
- Changes in antimicrobial susceptibility patterns necessitate ongoing surveillance.
Purpose of the Study:
- To analyze trends in antimicrobial resistance of Streptococcus pneumoniae isolates.
- To evaluate the impact of revised Clinical and Laboratory Standards Institute (CLSI) guidelines on resistance interpretation.
- To assess the emergence of multi-drug resistant strains over a 24-year period.
Main Methods:
- A retrospective observational study analyzing 7415 S. pneumoniae isolates from 1993-2016.
- Antimicrobial susceptibility data were compared pre- and post-2008 CLSI guideline revisions.
- Statistical analysis was performed using SPSS 19.
Main Results:
- A significant increase in penicillin resistance was observed in meningeal S. pneumoniae isolates after 2008 (p<0.05).
- High resistance rates were noted for co-trimoxazole, tetracycline, and erythromycin.
- A notable trend of increasing multi-drug resistant strains was observed from 1999 (11%) to 2016 (36%).
Conclusions:
- Multi-drug resistant Streptococcus pneumoniae strains are emerging.
- The rise in penicillin resistance among meningeal isolates may be associated with updated CLSI guidelines.
- Continuous monitoring of antimicrobial resistance patterns is crucial for effective treatment strategies.
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