title: Susceptibility profiles and correlation with pneumococcal serotypes soon after implementation of the 10-valent pneumococcal conjugate vaccine in Brazil.
abstract: OBJECTIVE
  To evaluate the susceptibility patterns among Streptococcus pneumoniae recovered during the years 2010-2012 and to correlate these with serotypes.
  
  
  METHODS
  Pneumococci from invasive sites were serotyped by sequential multiplex PCR and/or Quellung reaction. Etest strips were used to determine the minimal inhibitory concentrations, and the Clinical and Laboratory Standards Institute (CLSI) guidelines were used for interpretation. Genetic determinants of macrolide resistance were assessed by PCR, and the occurrence of the D phenotype was analyzed following the recommendations of the CLSI.
  
  
  RESULTS
  One hundred fifty-nine S. pneumoniae were studied; most were recovered from blood and were associated with serotypes 14, 3, 4, 23F, 20, 7F, 12F, 19A, and 19F. Pneumococcal conjugate vaccine PCV7, PCV10, and PCV13 and 23-valent polysaccharide vaccine serotypes represented 38.2%, 48.7%, 64.5%, and 85.5%, respectively. β-Lactam non-susceptibility (non-meningitis) was basically related to serotype 19A. For meningitis, it was observed in 21.4% (serotypes 14, 3, 9V, 23F, and 24F). Resistance to erythromycin occurred in 8.2% and mefA was the most common macrolide genetic determinant. One isolate was resistant to levofloxacin. Non-susceptibility to trimethoprim-sulfamethoxazole was 37.7% and to tetracycline was 22.0%.
  
  
  CONCLUSIONS
  Our population of pneumococci represents a transition era, soon after the introduction of PCV10. Non-susceptible patterns were found to be associated with classical PCV serotypes (especially serotype 14), which is still highly prevalent, and non-PCV10 ones (19A), which may disseminate, occupying the biological niche left by the vaccine serotypes.
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mott
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: julianaca@ufcspa.edu.br.
authors.forename: Juliana
authors.initials: J
authors.lastname: Caierão
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rosa da Cunha
authors.affiliation: Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Leandro Reus
authors.initials: LR
authors.lastname: Rodrigues Perez
authors.affiliation: Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matusiak
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Katia Ruschel
authors.initials: KR
authors.lastname: Pilger de Oliveira
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: d'Azevedo
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Cícero
authors.initials: C
authors.lastname: Dias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004917:Erythromycin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D064704:Levofloxacin / Q000627:therapeutic use; D018942:Macrolides / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D013752:Tetracycline / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; D000900:Anti-Bacterial Agents; D018942:Macrolides; D022242:Pneumococcal Vaccines; D002981:Clindamycin; D004917:Erythromycin; D064704:Levofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013752:Tetracycline
keywords: Resistance; Serotypes; Streptococcus pneumoniae; Vaccines