Antimicrobial susceptibility of <i>Streptococcus pneumoniae</i> isolated from patients in the northeastern macroregion of São Paulo state, Brazil, 1998-2013

Medeiros, Marta Inês C.; Almeida, Samanta Cristine G.; Bokermann, Sérgio; Watanabe, Evandro; Guerra, Maria Luiza L. S.; Andrade, Denise de

doi:10.5935/1676-2444.20170029

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LABORATORY MEDICINE, Original article • J. Bras. Patol. Med. Lab. 53 (3) • May-Jun 2017 • https://doi.org/10.5935/1676-2444.20170029 copy

Antimicrobial susceptibility of Streptococcus pneumoniae isolated from patients in the northeastern macroregion of São Paulo state, Brazil, 1998-2013

Suscetibilidade antimicrobiana de Streptococcus pneumoniae isolados de pacientes na macrorregião nordeste do estado de São Paulo, Brasil, entre 1998 e 2013

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introdution:

There are reports worldwide about the increase in infections caused by Streptococcus pneumoniae resistant to antimicrobials.

Objective:

Evaluate the susceptibility profile of serotypes of Streptococcus pneumoniae associating them with pneumococcal invasive diseases (PID), as well as antimicrobial therapies.

Method:

This is a retrospective cross-sectional research involving secondary data from 1998 to 2013, in the northeastern macroregion of São Paulo state, Brazil, composed of Araraquara, Barretos, Franca and Ribeirão Preto regions, with 90 municipalities. At Instituto Adolfo Lutz (IAL), isolated strains from patients with PID were subjected to identification, serotyping and antimicrobial susceptibility testing.

Results:

From 796 strains analyzed, 14.8% (n = 118) were resistant to penicillin, being 3% (n = 24) with intermediate resistance and 11.8% (n = 94) with full resistance, especially in patients with meningitis. Moreover, resistance to ceftriaxone was 5.3%: 34 (4.3%) with intermediate resistance and 8 (1%) with full resistance. We point out that the greatest level of resistance profiles was observed against sulfamethoxazole/trimethoprim (SMT): 350 (49.4%). On the other hand, antimicrobial susceptibility was described above 90% to chloramphenicol: 99.6% (n = 696), erythromycin: 94.7% (n = 664), ceftriaxone: 94.7% (n = 754) and fully susceptible to vancomycin. Among the 18 most common serotypes, 9V and 14 showed less susceptibility to SMT, to penicillin and ceftriaxone; 19A to SMT and penicillin; 1 to SMT; 12F and 3 to chloramphenicol; 6A to SMT; 6B 23F to erythromycin and penicillin.

Conclusion:

Monitoring of Streptococcus pneumoniae antimicrobial resistance is essential to guide the appropriate empirical treatment of pneumococcal disease.

Key words:
Streptococcus pneumoniae; serotyping; antibacterial agents

Antimicrobial	Susceptibility profile	Period						Total		p-value
		1998/2002		2003/2010		2011/2013		Total
		n	%*	n	%*	n	%*	n	%*
Penicillin	Susceptible	200	90.1	397	82.9	81	85.3	678	85.2	0.044
	Intermediate	4	1.8	18	3.7	2	2.1	24	3
	Resistant	18	8.1	64	13.4	12	12.6	94	11.8
	Total	222	100	479	100	95	100	796	100
Ceftriaxone	Susceptible	213	98.6	445	93.5	87	91.6	745	94.7	0.012
	Intermediate	3	1.4	26	5.5	5	5.3	34	4.3
	Resistant	0	0	5	1.1	3	3.6	8	1
	Total	216	100	476	100	95	100	787	100
Chloramphenicol	Susceptible	143	99.3	460	99.8	93	98.9	696	99.6	-
	Intermediate	0	0	0	0	0	0	0	0
	Resistant	1	0.7	1	0.2	1	1.1	3	0.4
	Total	144	100	461	100	94	100	699	100
Erythromycin	Susceptible	137	94.5	440	95.2	87	92.6	664	94.7	0.564
	Intermediate	0	0	1	0.2	0	0	1	0.1
	Resistant	8	5.5	21	4.6	7	7.4	36	5.1
	Total	145	100	462	100	94	100	701	100
SMT	Susceptible	64	44.1	197	42	68	72.3	329	46.5	< 0.001
	Intermediate	9	6.2	19	4.1	1	1.1	29	4.1
	Resistant	72	49.7	253	53.9	25	26.6	350	49.4
	Total	145	100	469	100	94	100	708	100

Serotype	Susceptible		Intermediate		Resistant		Total
Serotype	n	%*	n	%*	n	%*	n	%*
14	90	11.3	19	2.4	36	4.5	145	18.2
3	73	9.2	0	0	0	0	73	9.2
19F	35	4.4	1	0.1	10	1.3	46	5.8
1	43	5.4	0	0	0	0	43	5.4
6A	33	4.4	0	0	6	0.8	39	4.9
6B	29	3.6	2	0.3	7	0.9	38	4.8
23F	24	3	2	0.3	11	1.4	37	4.6
9V	24	3	0	0	10	1.3	34	4.3
18C	33	4.4	0	0	0	0	33	4.1
19A	24	3	0	0	9	1.1	33	4.1
12F	28	3.5	0	0	0	0	28	3.5
4	24	3	0	0	0	0	24	3
7F	21	2.6	0	0	0	0	21	2.6
5	17	2.1	0	0	0	0	17	2.1
11A	15	1.9	0	0	0	0	15	1.9
22F	15	1.9	0	0	0	0	15	1.9
8	12	1.5	0	0	0	0	12	1.5
9N	10	1.3	0	0	0	0	10	1.3
Others^ 29, 10F, 11A, 11C, 12A, 13, 15A, 15B, 15C, 16F, 17A, 17F, 18A, 18B, 18F, 20, 21, 23A, 23B, 24F, 25A, 28A, 31, 34, 35B, 35F, 37, 38, 42, 6B/D, 6C, 7C, Pool G.	128	16.1	0	0	5	0.6	133	16.7
Total	678	85.2	24	3	94	11.8	796	100

Antimicrobial	PID	Susceptible		Intermediate		Resistant		Total
Antimicrobial	PID	n	%*	n	%*	n	%*	n	%*
	Meningitis	271	34	-	-	93	11.7	364	45.7
	Pneumonia	336	42.2	21	2.6	1	0.1	358	45
Penicillin	Bacterium/sepsis	47	5.9	2	0.3	0	0	49	6.2
	Others^ abscess, arthritis, peritonitis, pancreatitis, cirrhosis, surgical site infection, and appendicitis.	24	3	1	0.1	0	0	25	3.1
	Total	678	85.2	24	3	94	11.8	796	100
	Meningitis	330	41.9	23	2.9	8	1	361	45.8
	Pneumonia	343	43.6	11	1.4	0	0	354	45
Ceftriaxone	Bacterium/sepsis	48	6.1	0	0	0	0	48	6.1
	Others^ abscess, arthritis, peritonitis, pancreatitis, cirrhosis, surgical site infection, and appendicitis.	24	3	0	0	0	0	24	3
	Total	745	94.7	34	4.3	8	1	787	100

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E-mail: jbpml@sbpc.org.br

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[1] CORRESPONDING AUTHOR: Marta Inês Cazentini Medeiros. Rua Minas, 877; Campos Elíseos; CEP: 14085-410; Ribeirão Preto-SP, Brasil; e-mail: micmedeiros@ial.sp.gov.br