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The Emergent Invasive Serotype 4 ST10172 Strain Acquires vanG-Type Vancomycin-Resistance Element: A Case of a
Sopio Chochua1, Bernard Beall2, Wuling Lin1
1Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases.
Abstract:
We report a single case of invasive pneumococcal disease (IPD) by serotype 4, multilocus sequence type 10172 (ST10172) isolate with vanG-type resistance genes and reduced vancomycin susceptibility. The isolate was recovered during 2022 from a 66-year-old resident with bacteremic pneumococcal pneumonia within a Centers for Disease Control and Prevention Active Bacterial Core surveillance (ABCs) site hospital. The patient had received 23-valent pneumococcal polysaccharide vaccine and there was no evidence of concurrent or prior receipt of vancomycin in the previous year. Serotype 4/ST10172 IPD has shown increases within western ABCs sites, and the recent acquisition of a vanG element warrants close monitoring of this lineage.
Insights
A rare invasive pneumococcal disease case involved a vancomycin-resistant Streptococcus pneumoniae strain. This vanG-type resistant serotype 4/ST10172 isolate highlights the need for monitoring antimicrobial resistance in pneumococcal infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Invasive pneumococcal disease (IPD) remains a significant public health concern globally.
- Streptococcus pneumoniae serotype 4, particularly sequence type 10172 (ST10172), has shown increasing prevalence in certain regions.
- Emergence of antimicrobial resistance, including reduced susceptibility to vancomycin, poses a challenge to treatment strategies.
Purpose of the Study:
- To report a unique case of IPD caused by a vancomycin-resistant S. pneumoniae isolate.
- To characterize the specific serotype, sequence type, and resistance genes of the identified pathogen.
- To emphasize the clinical and public health implications of emerging resistance in IPD.
Main Methods:
- Case identification within a surveillance network (Centers for Disease Control and Prevention Active Bacterial Core surveillance - ABCs).
- Microbiological characterization of the S. pneumoniae isolate, including serotyping and multilocus sequence typing (MLST).
- Detection of antimicrobial resistance genes, specifically focusing on vancomycin resistance mechanisms (vanG).
Main Results:
- A single case of IPD was identified in a 66-year-old patient with bacteremic pneumococcal pneumonia.
- The causative agent was identified as S. pneumoniae serotype 4/ST10172, possessing vanG-type resistance genes.
- The isolate exhibited reduced susceptibility to vancomycin, despite the patient's vaccination history and lack of recent vancomycin exposure.
Conclusions:
- This case represents a novel finding of vanG-type vancomycin resistance in an S. pneumoniae serotype 4/ST10172 isolate causing IPD.
- The increasing prevalence of this specific serotype/ST lineage, coupled with acquired resistance, necessitates vigilant monitoring.
- Continued surveillance is crucial to track the spread of such resistant strains and inform treatment guidelines.
