title: Assessment of multidrug resistance, clonality and virulence in non-PCV-13 Streptococcus pneumoniae serotypes in Canada, 2011-13.
abstract: OBJECTIVE
  Serotype replacement in Streptococcus pneumoniae following the implementation of a new vaccine has been associated with the emergence of non-vaccine serotypes as prominent causes of invasive pneumococcal disease (IPD). The aim of this study was to characterize specific non-PCV-13 serotypes 15A, 22F, 33F and 35B from IPD, isolated in Canada post-PCV-13 introduction in 2010.
  
  
  METHODS
  Of 3802 IPD isolates collected from across Canada in 2011-13, 18.4% were found to be serotypes 15A, 22F, 33F and 35B. These 699 isolates were subjected to antimicrobial susceptibility testing, PFGE, MLST, molecular detection of pneumococcal pili and comparison with Pneumococcal Molecular Epidemiology Network (PMEN) clones.
  
  
  RESULTS
  This study demonstrated clonal spread of specific STs, including MDR ST63 and its Sweden(15A)-25-related variants, the increasingly common ST433 and a variant of piliated, penicillin-non-susceptible ST558, related to PMEN clone Utah(35B)-24 (ST377). New STs of serotype 33F were identified. Several potential capsular switching events were identified within these serotypes.
  
  
  CONCLUSIONS
  Non-PCV-13 serotype 22F is increasing in Canada through the rapid clonal expansion of ST433. Numerous new STs associated with serotype 33F indicate the potential divergence of the serotype. Serotypes 15A and 35B in Canada are related to international clones of S. pneumoniae.
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada umgoldea@myumanitoba.ca.
authors.forename: Alyssa R
authors.initials: AR
authors.lastname: Golden
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada Clinical Microbiology-Health Sciences Centre, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Adam
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada National Microbiology Laboratory-Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba R3E 3R2, Canada.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gilmour
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada.
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Baxter
authors.affiliation: National Microbiology Laboratory-Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba R3E 3R2, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Martin
authors.affiliation: Clinical Microbiology-Health Sciences Centre, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Nichol
authors.affiliation: National Microbiology Laboratory-Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba R3E 3R2, Canada.
authors.forename: Walter H B
authors.initials: WH
authors.lastname: Demczuk
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada Clinical Microbiology-Health Sciences Centre, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Hoban
authors.affiliation: Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada.
authors.forename: George G
authors.initials: GG
authors.lastname: Zhanel
mesh_terms: D002170:Canada / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D036781:Fimbriae Proteins / Q000235:genetics; D005838:Genotype; D006801:Humans; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D022242:Pneumococcal Vaccines / Q000276:immunology; D015995:Prevalence; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D014774:Virulence; D037521:Virulence Factors / Q000235:genetics*
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D037521:Virulence Factors; D036781:Fimbriae Proteins
keywords: MLST; S. pneumoniae; antimicrobial drug resistance; multilocus sequence typing; non-PCV-13 serotypes