title: High clonal diversity in erythromycin-resistant Streptococcus pneumoniae invasive isolates in Madrid, Spain (2000-07).
abstract: OBJECTIVE
  Erythromycin resistance in Streptococcus pneumoniae is still increasing worldwide. All 78 erythromycin-resistant S. pneumoniae isolates collected from blood cultures in our hospital (2000-07) were studied and the population structure was analysed by using different mathematical diversity indexes.
  
  
  METHODS
  Erythromycin resistance determinants were screened by PCR. The population structure, including multilocus sequence typing, was analysed by using quantitative clonal diversity (diversity ratio, Simpson, Selander-Levin and Shannon mathematical indexes).
  
  
  RESULTS
  The leading resistance gene was erm(B) (74.3% of the isolates), followed by the erm(B) plus mef(A) combination (17.9%) and mef(A) alone (7.7%). The most frequent serotypes were 14 (18%), 19A (15.4%) and 6B (11.5%). A polyclonal structure was detected in resistant strains, including the Spain(9V)-3, Spain(6B)-2 and Denmark(14)-32 international clones. Both genetic diversity and genetic distribution were high, particularly among clones containing erm(B) and erm(B) plus mef(A) determinants.
  
  
  CONCLUSIONS
  The resistance determinants erm(B) and the combination of erm(B) plus mef(A) were observed within multiple S. pneumoniae bacteraemic clones. The preservation of a polyclonal structure might provide a suitable background for further evolution of antibiotic resistance.
authors.affiliation: Servicio de Microbiología, Hospital Ramón y Cajal y CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Elia Gómez G
authors.initials: EG
authors.lastname: de la Pedrosa
authors.forename: Fernando
authors.initials: F
authors.lastname: Baquero
authors.forename: Elena
authors.initials: E
authors.lastname: Loza
authors.forename: José-María
authors.initials: JM
authors.lastname: Nadal-Serrano
authors.forename: Asunción
authors.initials: A
authors.lastname: Fenoll
authors.forename: Rosa
authors.initials: R
authors.lastname: Del Campo
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology*; D014644:Genetic Variation; D006761:Hospitals; D006801:Humans; D008565:Membrane Proteins / Q000235:genetics; D008780:Methyltransferases / Q000235:genetics; D017720:Molecular Epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D016133:Polymerase Chain Reaction / Q000379:methods; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; C117866:MefA protein, Streptococcus; D008565:Membrane Proteins; D004917:Erythromycin; C111078:ErmTR protein, bacteria; D008780:Methyltransferases