title: Distribution of serotypes and antibiotic susceptibility patterns among invasive pneumococcal diseases in Saudi Arabia.
abstract: BACKGROUND
  Streptococcus pneumoniae causes life-threatening infections such as meningitis, pneumonia, and febrile bacteremia, particularly in young children. The increasing number of drug-resistant isolates has highlighted the necessity for intervening and controlling disease. To achieve this, information is needed on serotype distribution and patterns of antibiotic resistance in children.
  
  
  METHODS
  All cases of invasive pneumococcal disease (IPD) in children aged less than 15 yr recorded at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, were reviewed for serotyping and antibiotic susceptibility. Isolates were collected from 78 consecutive patients with IPD between 2009 and 2012. All collected isolates were subjected to serotyping by co-agglutination, sequential multiplex PCR, and single PCR sequetyping as previously described.
  
  
  RESULTS
  The most frequently isolated IPD serotypes were 23F, 6B, 19F, 18C, 4, 14, and 19A, which are listed in decreasing order and cover 77% of total isolates. The serotype coverage for the pneumococcal conjugate vaccine (PCV)7, PCV10, and PCV13 was 77%, 81%, and 90%, respectively. Results from sequential multiplex PCR agreed with co-agglutination results. All serotypes could not be correctly identified using single PCR sequetyping. Minimum inhibitory concentration showed that 50 (64%) isolates were susceptible to penicillin, whereas 70 (90%) isolates were susceptible to cefotaxime.
  
  
  CONCLUSIONS
  The most common pneumococcal serotypes occur with frequencies similar to those found in countries where the PCV has been introduced. The most common serotypes in this study are included in the PCVs. Addition of 23A and 15 to the vaccine would improve the PCV performance in IPD prevention.
authors.forename: Yazeed A
authors.initials: YA
authors.lastname: Al-Sheikh
authors.affiliation: Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. ; Medical and Molecular Genetics Research, Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Yazeed
authors.initials: Y
authors.lastname: A Al-Sherikh
authors.affiliation: Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Lakshmana
authors.initials: L
authors.lastname: K Gowda
authors.affiliation: Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: M Marie
authors.initials: MM
authors.lastname: Mohammed Ali
authors.affiliation: Department of Zoology and Biotechnology, Loyola College, Chennai, India. ; Department of Clinical Microbiology, Christian Medical College, Vellore, India.
authors.forename: James
authors.initials: J
authors.lastname: John
authors.affiliation: Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Dabwan
authors.initials: D
authors.lastname: Khaled Homoud Mohammed
authors.affiliation: Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Chikkabidare Shashidhar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D002439:Cefotaxime / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D006801:Humans; D007223:Infant; D008581:Meningitis / Q000175:diagnosis* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D060885:Multiplex Polymerase Chain Reaction; D010406:Penicillins / Q000494:pharmacology; D022242:Pneumococcal Vaccines / Q000276:immunology; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology; D017027:Protein Tyrosine Phosphatases / Q000235:genetics; D012189:Retrospective Studies; D012529:Saudi Arabia; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D010406:Penicillins; D022242:Pneumococcal Vaccines; C500440:CpsB protein, Streptococcus pneumoniae; D017027:Protein Tyrosine Phosphatases; D002439:Cefotaxime
keywords: Pneumococcal conjugate vaccine; Pneumococcus; Serotype; Vaccination