title: Distribution of capsular types and drug resistance patterns of invasive pediatric Streptococcus pneumoniae isolates in Teheran, Iran.
abstract: OBJECTIVE
  To explore the serotype distribution and drug resistance patterns of invasive pneumococcal isolates from children under 5 years of age.
  
  
  METHODS
  During a 32-month period, 585 clinical samples (including blood, cerebrospinal fluid (CSF), and synovial fluid) from children suspected of having meningitis, sepsis, pneumonia, or septic arthritis were analyzed using the BACTEC culture system. Positive cultures were examined using biochemical tests and lytA amplification for the identification of pneumococcal strains. The confirmed pneumococcal isolates were examined to determine capsular types using a modified sequential multiplex PCR and susceptibility to antimicrobial agents.
  
  
  RESULTS
  Fifty-three pneumococcal isolates were detected in the 585 clinical samples: 21 (39.6%) blood samples and 32 (60.4%) CSF samples. The most frequent serotype was 23F (24.5%), followed by serotypes 19F (18.9%), 19A (7.5%), and 9V (7.5%). Twenty-one percent of pneumococcal isolates were penicillin-non-susceptible and serotype 19A was significantly associated with resistance to penicillin.
  
  
  CONCLUSIONS
  This study indicated that the 13-valent pneumococcal conjugate vaccine (PCV13) could cover the majority of the invasive pneumococcal isolates. Drug-resistant and multidrug-resistant Streptococcus pneumoniae strains are circulating in Iran. Therefore, public immunization of infants using PCV13 is recommended to reduce the incidence of pneumococcal disease and pneumococcal-resistant strains in Teheran.
authors.affiliation: Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Houri
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: srtabatabaei@sbmu.ac.ir.
authors.forename: Sedigheh Rafiei
authors.initials: SR
authors.lastname: Tabatabaei
authors.affiliation: Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Yasaman
authors.initials: Y
authors.lastname: Saee
authors.affiliation: Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: fafallah@sbmu.ac.ir.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Fallah
authors.affiliation: Health Reference Laboratories, Research Center, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rahbar
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abdollah
authors.initials: A
authors.lastname: Karimi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001170:Arthritis, Infectious / Q000382:microbiology; D016667:Bacterial Capsules; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007114:Immunization; D015994:Incidence; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D018805:Sepsis / Q000382:microbiology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification* / Q000502:physiology
chemical_list: C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D010406:Penicillins; D022242:Pneumococcal Vaccines
keywords: Invasive pneumococcal disease; Multidrug-resistant; Pediatric infections; Serotype distribution; Streptococcus pneumoniae