title: Rise of multidrug-resistant non-vaccine serotype 15A Streptococcus pneumoniae in the United Kingdom, 2001 to 2014.
abstract: Conjugate vaccines have reduced pneumococcal disease in vaccinated children and unvaccinated adults, but non-vaccine serotypes are of concern, particularly if antibiotic resistant. We reviewed Streptococcus pneumoniae collected via: (i) the British Society for Antimicrobial Chemotherapy (BSAC) surveillances from 2001-2014; (ii) Public Health England's (PHE) invasive isolate surveillance from 2005-2014 and (iii) referral to PHE for resistance investigation from 2005-2014. Serotype 15A increased in all series, with many representatives showing triple resistance to macrolides, tetracyclines and penicillin. 15A was consistently among the 10 most prevalent serotypes from 2011 in PHE and BSAC invasive isolate/bacteraemia surveillance but never previously; 26-33% of these invasive 15A isolates had triple resistance. BSAC respiratory isolates were only serotyped in 2013/14 and 2014/15 (October to September); 15A was most prevalent serotype in both periods, comprising 9-11% of isolates, 38-48% of them with triple resistance. Serotype 15A represented 0-4% of S. pneumoniae referred to PHE for reference investigation annually until 2008 but rose to 29% (2013) and 32% (2014). Almost all multidrug-resistant 15A isolates were sequence type (ST) 63 variants, whereas susceptible 15A isolates were clonally diverse. The rise of serotype 15A suggests that pneumococcal conjugate vaccines will need ongoing adaptation.
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sheppard
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Norman K
authors.initials: NK
authors.lastname: Fry
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Shazad
authors.initials: S
authors.lastname: Mushtaq
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.affiliation: Southmead Hospital, Bristol, United Kingdom.|British Society for Antimicrobial Chemotherapy, Birmingham, United Kingdom.
authors.forename: Rosy
authors.initials: R
authors.lastname: Reynolds
authors.affiliation: LGC, Fordham, United Kingdom.
authors.forename: Regina
authors.initials: R
authors.lastname: Janes
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Pike
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Hill
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Maimuna
authors.initials: M
authors.lastname: Kimuli
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Staves
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Michel
authors.initials: M
authors.lastname: Doumith
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Harrison
authors.affiliation: Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, London, United Kingdom.|Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D018942:Macrolides / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D018571:Sentinel Surveillance; D065288:Serogroup; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D013754:Tetracyclines / Q000494:pharmacology; D018074:Vaccines, Conjugate / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D010406:Penicillins; D013754:Tetracyclines; D018074:Vaccines, Conjugate
keywords: Capsular serotypes; Pneumococcal conjugate vaccine; Streptococcus pneumoniae