title: Persistence and complex evolution of fluoroquinolone-resistant Streptococcus pneumoniae clone.
abstract: Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006-2011 in a post-acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Amos
authors.initials: A
authors.lastname: Adler
authors.forename: Samira
authors.initials: S
authors.lastname: Masarwa
authors.forename: Rotem
authors.initials: R
authors.lastname: Edgar
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Nurith
authors.initials: N
authors.lastname: Porat
authors.forename: Tali
authors.initials: T
authors.lastname: Kotlovsky
authors.forename: Nikolay
authors.initials: N
authors.lastname: Polivkin
authors.forename: Irina
authors.initials: I
authors.lastname: Weinberg
authors.forename: Avraham
authors.initials: A
authors.lastname: Lazary
authors.forename: Nissim
authors.initials: N
authors.lastname: Ohana
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D005075:Biological Evolution; D002648:Child; D003428:Cross Infection; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D024841:Fluoroquinolones / Q000494:pharmacology*; D006761:Hospitals; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D062486:Public Health Surveillance; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Streptococcus pneumoniae; antimicrobial drug resistance; bacteria; clonal evolution; fluoroquinolones; long-term acute care hospital
references.citation: Mt Sinai J Med. 1976 Nov-Dec;43(6):699-709
references.pmid: 13297
references.citation: MMWR Morb Mortal Wkly Rep. 1997 Jan 24;46(3):60-2
references.pmid: 9026712
references.citation: MMWR Recomm Rep. 1997 Apr 4;46(RR-8):1-24
references.pmid: 9132580
references.citation: Clin Infect Dis. 2009 Nov 1;49(9):1318-25
references.pmid: 19814624
references.citation: J Infect Dis. 1995 Apr;171(4):890-6
references.pmid: 7706816
references.citation: Clin Infect Dis. 2001 Aug 15;33(4):517-22
references.pmid: 11462189
references.citation: Ann Clin Microbiol Antimicrob. 2004 May 10;3:7
references.pmid: 15134581
references.citation: Antimicrob Agents Chemother. 2011 May;55(5):2469-71
references.pmid: 21383091
references.citation: J Am Geriatr Soc. 2003 Nov;51(11):1520-5
references.pmid: 14687379
references.citation: Lancet Infect Dis. 2011 Feb;11(2):119-30
references.pmid: 21272792
references.citation: Infect Control Hosp Epidemiol. 1998 Nov;19(11):851-3
references.pmid: 9831942
references.citation: N Engl J Med. 1998 Jun 25;338(26):1861-8
references.pmid: 9637804
references.citation: J Infect Dis. 2004 Dec 15;190(12):2154-61
references.pmid: 15551214
references.citation: Infect Control Hosp Epidemiol. 2005 Mar;26(3):248-55
references.pmid: 15796275
references.citation: Microbiology (Reading). 1998 Nov;144 ( Pt 11):3049-3060
references.pmid: 9846740
references.citation: Clin Infect Dis. 1999 Sep;29(3):580-5
references.pmid: 10530451
references.citation: J Infect Dis. 2001 Jul 1;184(1):66-72
references.pmid: 11398111
references.citation: BMJ. 2010 Mar 08;340:c1004
references.pmid: 20211953
references.citation: Clin Infect Dis. 2005 May 1;40(9):1288-97
references.pmid: 15825031
references.citation: Clin Infect Dis. 2001 Mar 1;32(5):701-7
references.pmid: 11229837
references.citation: Antimicrob Agents Chemother. 2004 Sep;48(9):3305-11
references.pmid: 15328089
references.citation: Clin Infect Dis. 2003 Jul 15;37(2):230-7
references.pmid: 12856216
references.citation: Infect Control Hosp Epidemiol. 2003 Nov;24(11):848-52
references.pmid: 14649774
references.citation: CMAJ. 2009 Jan 6;180(1):48-58
references.pmid: 19124790
references.citation: J Infect Dis. 1998 Mar;177(3):707-13
references.pmid: 9498451
references.citation: J Antimicrob Chemother. 2011 Mar;66(3):476-86
references.pmid: 21193474
references.citation: J Infect. 2010 Jul;61(1):21-7
references.pmid: 20381524
references.citation: Clin Infect Dis. 2005 Jan 15;40(2):225-35
references.pmid: 15655739
references.citation: Respir Med. 2008 Sep;102(9):1287-95
references.pmid: 18602805
references.citation: J Clin Microbiol. 2011 Apr;49(4):1369-75
references.pmid: 21270219