title: Streptococcus pneumoniae Serotypes 9 and 14 Circulating in Brazil over a 23-Year Period Prior to Introduction of the 10-Valent Pneumococcal Conjugate Vaccine: Role of International Clones in the Evolution of Antimicrobial Resistance and Description of a Novel Genotype.
abstract: Antimicrobial-resistant pneumococcal strains have been detected worldwide since the 1960s. In Brazil, the first penicillin-nonsusceptible pneumococci (PNSP) were reported in the 1980s, and their emergence and dissemination have been mainly attributed to serogroup 9 and serotype 14 strains, especially those highly related to recognized international clones. In the present study, antimicrobial susceptibility testing and multilocus sequence typing were performed on 315 pneumococcal isolates belonging to serogroup 9 (n = 99) or serotype 14 (n = 216), recovered from patients or asymptomatic carriers between 1988 and 2011 in Brazil, in order to trace changes in antimicrobial resistance and genotypes prior to the full introduction of the pneumococcal conjugate vaccine in the country. Over the 23-year study period, the PNSP levels increased, and four clonal complexes (CC156, CC66, CC15, and CC5401) have played important roles in the evolution and dissemination of pneumococcal isolates belonging to serogroup 9 and serotype 14, as well as in the emergence of antimicrobial resistance, in the pre-pneumococcal-vaccination era. The earliest PNSP strains detected in this study belonged to serotype 9N/ST66 and were single locus variants of the international clone Tennessee14-18 ST67 (CC66). The first serotype 14 PNSP isolates were identified in 1990 and were related to the England14-9 ST9 (CC15) clone. Serotype 14 PNSP variants of the Spain9V-3 ST156 clone with elevated penicillin MICs and nonsusceptibility to other beta-lactams were detected in 1995 and showed an increasing trend over the years. The results also indicated that introduction of ST156 in our region was preceded by the emergence of trimethoprim-sulfamethoxazole resistance and by the dissemination of ST162. In addition to the presence of successful international clones, a novel regional serotype 14 genotype (CC5401) has emerged in 1996.
authors: Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Tatiana C A
authors: TC
authors: Pinto
authors: Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors: Fabíola C O
authors: FC
authors: Kegele
authors: Departamento de Microbiologia e Parasitologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
authors: Cícero A G
authors: CA
authors: Dias
authors: Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
authors: Rosana R
authors: RR
authors: Barros
authors: Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: José M
authors: JM
authors: Peralta
authors: Departamento de Microbiologia, Imunologia e Parasitologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: Vânia L C
authors: VL
authors: Merquior
authors: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors: Maria da Gloria
authors: MD
authors: Carvalho
authors: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors: Sopio
authors: S
authors: Chochua
authors: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.|Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors: Paulina
authors: P
authors: Hawkins
authors: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors: Lesley
authors: L
authors: McGee
authors: Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil lmt2@micro.ufrj.br.
authors: Lucia M
authors: LM
authors: Teixeira
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D058070:Asymptomatic Diseases; D001938:Brazil / Q000453:epidemiology; D002999:Clone Cells; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010403:Penicillin Resistance / Q000235:genetics; D010406:Penicillins / Q000494:pharmacology; D010802:Phylogeny; D058974:Phylogeography; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history* / Q000382:microbiology; D022242:Pneumococcal Vaccines; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D014481:United States / Q000453:epidemiology
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; D000900:Anti-Bacterial Agents; D010406:Penicillins; D022242:Pneumococcal Vaccines; D015662:Trimethoprim, Sulfamethoxazole Drug Combination