title: Cephalosporin-resistant pneumococci and sickle cell disease.
abstract: Sickle cell anemia patients have 600 times the risk for invasive pneumococcal disease than their healthy peers. High-level cephalosporin resistance was described in the 1990s in healthy children from Tennessee, but its prevalence in sickle cell disease patients is unknown. Pneumococcal isolates from sickle cell disease patients from Tennessee were subjected to multilocus sequence typing to characterize antimicrobial drug-resistant strains. Twenty-one percent of strains were resistant to cefotaxime and penicillin. Of the 14 cephalosporin-resistant strains, 9 were sequence types previously described as highly cephalosporin resistant, while resistance was found for the first time in 3 clones: Maryland6B, ST660, and a novel clone, ST1753. High-level cephalosporin resistance exists in more settings than initially recognized, and its high prevalence in sickle cell disease patients may decrease the efficacy of third-generation cephalosporins in invasive pneumococcal disease.
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Miller
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Obert
authors.forename: Geli
authors.initials: G
authors.lastname: Gao
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: Patricia
authors.initials: P
authors.lastname: Flynn
authors.forename: Elaine
authors.initials: E
authors.lastname: Tuomanen
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications* / Q000382:microbiology; D018550:Cephalosporin Resistance / Q000235:genetics*; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D006801:Humans; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D011008:Pneumococcal Infections / Q000150:complications* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D016415:Sequence Alignment; D017422:Sequence Analysis, DNA; D013296:Streptococcus pneumoniae / Q000235:genetics*; D013714:Tennessee
chemical_list: D004269:DNA, Bacterial