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November 1986, Vol 140, No. 11 >
Article | November 1986

Clinical and Nasopharyngeal Isolates of Unusual Multiply Resistant Pneumococci FREE

Keith P. Klugman, MBBCh, PhD; Hendrik J. Koornhof, MBChB, FRCPath; Valerie Kuhnle, MT
[+] Author Affiliations

Accepted for publication June 23, 1986.

Reprint requests to Department of Medical Microbiology, South African Institute for Medical Research, PO Box 1038, 2000 Johannesburg, South Africa (Dr Klugman).


Am J Dis Child. 1986;140(11):1186-1190. doi:10.1001/archpedi.1986.02140250112045.
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• Routine surveillance of pneumococcal isolates for resistance to antibiotics has revealed the emergence of an unusual pattern of multiple antimicrobial resistance in South Africa. Thirty-nine pneumococcal isolates, including 21 from clinical specimens, showed resistance to tetracycline, erythromycin, clindamycin, trimethoprim, and a combination product of trimethoprim and sulfamethoxazole sodium (co-trimoxazole), yet susceptibility to penicillin G. Multiple resistance has to date been almost invariably associated with resistance to β-lactam antibiotics. A survey of nasopharyngeal carriage revealed carriage of an additional 21 isolates of multiply resistant pneumococci, representing 7.9% of children investigated in Johannesburg, but these organisms were not found in children in Soweto or four rural villages. We present the minimum inhibitory concentrations of 15 antimicrobial agents against 15 of these 21 strains. These findings are discussed in relation to exposure of these populations to antibiotics and to the treatment of local and systemic pneumococcal disease. Of all 60 isolates of multiply resistant pneumococci isolated to date, those fully characterized serologically belong to serotypes 6B, 14, or 19F.

(AJDC 1986;140:1186-1190)

REFERENCES

1 +
Frisch AW, Price AE, Myers GB:  Type VIII pneumococcus: Development of sulphadiazine resistance, transmission by cross infection and persistence in carriers . Ann Intern Med 1943;;18: 271-278.
2 +
Evans W, Hansman D:  Tetracycline-resistant pneumococcus . Lancet 1963;;1:451.
3 +
Turner GC:  Tetracycline-resistant pneumococci in a general hospital . Lancet 1963;;2:1292-1295.
4 +
Schaedler RW, Choppin PW, Zabriskie JB:  Pneumonia caused by tetracycline-resistant pneumococci . N Engl J Med 1964;;70:127-129.
5 +
Dixon JMS:  Pneumococcus resistant to erythromycin and lincomycin . Lancet 1967;;1:573.
6 +
Kislak JW:  Type 6 pneumococcus resistant to erythromycin and lincomycin N Engl J Med 1967;;276:852.
7 +
Jacobs MR, Koornhof HJ, Robins-Browne RM, et al:  Emergence of multiply resistant pneumococci . N Engl J Med 1978;;299:735-740.
8 +
Ward J, Koornhof HJ:  Antibiotic-resistant pneumococci , in Remington JS, Swartz MN (eds): Current Clinical Topics in Infectious Diseases . New York, McGraw-Hill International Book Co, 1980;, pp 265-287.
9 +
Radetsky MS, Istre GR, Johansen TL, et al:  Multiply resistant pneumococcus causing meningitis: Its epidemiology within a day care centre . Lancet 1981;;2:771-773.
10 +
Linares J, Garau J, Dominguez C, et al:  Antibiotic resistance and serotypes of Streptococcus pneumoniae from patients with community-acquired pneumococcal disease . Antimicrob Agents Chemother 1983;;23:545-547.
11 +
Latorre C, Juncosa T, Sanfeliu I:  Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae strains isolated in a children's hospital in Barcelona, Spain . Antimicrob Agents Chemother 1985;;28:357-359.
12 +
Simberkoff MS, Lukazewski M, Cross A, et al:  Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: A cluster of serotype 19A organisms in Brooklyn, New York . J Infect Dis 1986;;153:78-82.
13 +
Sondag JE, Morgens RK, Hoppe JE, et al:  Detection of pneumococci in respiratory secretions: Clinical evaluation of gentamicin blood agar . J Clin Microbiol 1977;;5:397-400.
14 +
Ellner PD, Stoessel CJ, Drakeford E, et al:  A new culture medium for medical microbiology . Am J Clin Pathol 1966;;45:504-505.
15 +
Performance Standards for Antimicrobial Disc Susceptibility Tests , publication No. ASM-2. Villanova, Pa, American Society of Microbiology, 1975;.
16 +
Klugman KP, Koornhof HJ, Kuhnle V, et al:  Meningitis and pneumonia due to novel multiply resistant pneumococci . Br Med J 1986;;29:730.
17 +
Robins-Browne RM, Kharsany AB, Koornhof HJ:  Antibiotic resistant pneumococci in hospitalized children . J Hyg Camb 1984;;93:9-16.
18 +
Klugman KP, Koornhof HJ, Wasas A, et al:  Carriage of penicillin resistant pneumococci . Arch Dis Child 1986;;61:377-381.
19 +
Hodges RG, McLeod CM:  Epidemic pneumococcal pneumonia: V. Final considerations of the factors underlying the epidemic . Am J Hyg 1946;;44:237-243.
20 +
Burke JP, Klein JO, Gezan HM, et al:  Pneumococcal bacteraemia . AJDC 1971;;121:353-359.
21 +
Jacobs NM, Lepdkachornsuk S, Metzger WI:  Pneumococcal bacteraemia in infants and children: A ten-year experience at the Cook County Hospital with special reference to the pneumococcal serotypes isolated . Pediatrics 1979;;64:296-300.
22 +
Siegel JD, Poziviak CS, Michaels RH:  Serotypically defined pneumococcal infections in children . J Pediatr 1979;;93:249-250.
23 +
Gary BM, Converse GM III, Dilton HC Jr:  Serotypes of S pneumoniae causing disease . J Infect Dis 1979;;140:979-983.
24 +
Bratton L, Teele DW, Klein JO:  Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital . J Pediatr 1977;;90: 703-706.
25 +
Austrian R:  Vaccines of pneumococcal capsular polysaccharide and the prevention of pneumococcal pneumonia , in Beers RF Jr, Basset EG, (eds): The Role of Immunological Factors in Infections, Allergic and Autoimmune Processes . New York, Raven Press, 1976;, pp 50-71.
26 +
Mufson MA, Kruss DM, Wasil RE, et al:  Capsular types and outcomes of bacteremic pneumococcal disease in the antibiotic era . Arch Intern Med 1974;;134:505-510.
27 +
Hayden-Smith SW: The Serological Response in Miners to Pneumococcal Polysaccharide Antigens and Their Role in Preventing Pneumonia, thesis. Johannesburg, South Africa, 1981.
28 +
Schaad UB, McCracken GH Jr, Loock CA, et al:  Pharmacokinetics and bacteriological efficacy of moxalactam, cefotaxime, cefoperazone and Rocephin in experimental bacterial meningitis . J Infect Dis 1981;;143:156-163.
29 +
Smith MD, Guild WR:  A plasmid in Streptococcus pneumoniae . J Bacteriol 1979;;137:735-739.
30 +
Shoemaker NB, Smith MD, Guild WR:  Organization and transfer of heterologous chloramphenicol and tetracycline resistance genes in pneumococcus . J Bacteriol 1979;;139:432-441.
31 +
Zighelboim S, Tomasz A:  Multiple antibiotic resistance in South African strains of Streptococcus pneumoniae: Mechanism of resistance to β-lactam antibiotics , in Quie PG, Kass EH (eds): The Pneumococcus and the Pneumococcal Vaccine . Chicago, University of Chicago Press, 1982;, pp 85-94.
32 +
Robins-Browne RM, Gaspar MN, Ward JI, et al:  Resistance mechanisms of multiply resistant pneumococci: Antibiotic degradation studies . Antimicrob Agents Chemother 1979;;15:470-474.

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References

1 +
Frisch AW, Price AE, Myers GB:  Type VIII pneumococcus: Development of sulphadiazine resistance, transmission by cross infection and persistence in carriers . Ann Intern Med 1943;;18: 271-278.
2 +
Evans W, Hansman D:  Tetracycline-resistant pneumococcus . Lancet 1963;;1:451.
3 +
Turner GC:  Tetracycline-resistant pneumococci in a general hospital . Lancet 1963;;2:1292-1295.
4 +
Schaedler RW, Choppin PW, Zabriskie JB:  Pneumonia caused by tetracycline-resistant pneumococci . N Engl J Med 1964;;70:127-129.
5 +
Dixon JMS:  Pneumococcus resistant to erythromycin and lincomycin . Lancet 1967;;1:573.
6 +
Kislak JW:  Type 6 pneumococcus resistant to erythromycin and lincomycin N Engl J Med 1967;;276:852.
7 +
Jacobs MR, Koornhof HJ, Robins-Browne RM, et al:  Emergence of multiply resistant pneumococci . N Engl J Med 1978;;299:735-740.
8 +
Ward J, Koornhof HJ:  Antibiotic-resistant pneumococci , in Remington JS, Swartz MN (eds): Current Clinical Topics in Infectious Diseases . New York, McGraw-Hill International Book Co, 1980;, pp 265-287.
9 +
Radetsky MS, Istre GR, Johansen TL, et al:  Multiply resistant pneumococcus causing meningitis: Its epidemiology within a day care centre . Lancet 1981;;2:771-773.
10 +
Linares J, Garau J, Dominguez C, et al:  Antibiotic resistance and serotypes of Streptococcus pneumoniae from patients with community-acquired pneumococcal disease . Antimicrob Agents Chemother 1983;;23:545-547.
11 +
Latorre C, Juncosa T, Sanfeliu I:  Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae strains isolated in a children's hospital in Barcelona, Spain . Antimicrob Agents Chemother 1985;;28:357-359.
12 +
Simberkoff MS, Lukazewski M, Cross A, et al:  Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: A cluster of serotype 19A organisms in Brooklyn, New York . J Infect Dis 1986;;153:78-82.
13 +
Sondag JE, Morgens RK, Hoppe JE, et al:  Detection of pneumococci in respiratory secretions: Clinical evaluation of gentamicin blood agar . J Clin Microbiol 1977;;5:397-400.
14 +
Ellner PD, Stoessel CJ, Drakeford E, et al:  A new culture medium for medical microbiology . Am J Clin Pathol 1966;;45:504-505.
15 +
Performance Standards for Antimicrobial Disc Susceptibility Tests , publication No. ASM-2. Villanova, Pa, American Society of Microbiology, 1975;.
16 +
Klugman KP, Koornhof HJ, Kuhnle V, et al:  Meningitis and pneumonia due to novel multiply resistant pneumococci . Br Med J 1986;;29:730.
17 +
Robins-Browne RM, Kharsany AB, Koornhof HJ:  Antibiotic resistant pneumococci in hospitalized children . J Hyg Camb 1984;;93:9-16.
18 +
Klugman KP, Koornhof HJ, Wasas A, et al:  Carriage of penicillin resistant pneumococci . Arch Dis Child 1986;;61:377-381.
19 +
Hodges RG, McLeod CM:  Epidemic pneumococcal pneumonia: V. Final considerations of the factors underlying the epidemic . Am J Hyg 1946;;44:237-243.
20 +
Burke JP, Klein JO, Gezan HM, et al:  Pneumococcal bacteraemia . AJDC 1971;;121:353-359.
21 +
Jacobs NM, Lepdkachornsuk S, Metzger WI:  Pneumococcal bacteraemia in infants and children: A ten-year experience at the Cook County Hospital with special reference to the pneumococcal serotypes isolated . Pediatrics 1979;;64:296-300.
22 +
Siegel JD, Poziviak CS, Michaels RH:  Serotypically defined pneumococcal infections in children . J Pediatr 1979;;93:249-250.
23 +
Gary BM, Converse GM III, Dilton HC Jr:  Serotypes of S pneumoniae causing disease . J Infect Dis 1979;;140:979-983.
24 +
Bratton L, Teele DW, Klein JO:  Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital . J Pediatr 1977;;90: 703-706.
25 +
Austrian R:  Vaccines of pneumococcal capsular polysaccharide and the prevention of pneumococcal pneumonia , in Beers RF Jr, Basset EG, (eds): The Role of Immunological Factors in Infections, Allergic and Autoimmune Processes . New York, Raven Press, 1976;, pp 50-71.
26 +
Mufson MA, Kruss DM, Wasil RE, et al:  Capsular types and outcomes of bacteremic pneumococcal disease in the antibiotic era . Arch Intern Med 1974;;134:505-510.
27 +
Hayden-Smith SW: The Serological Response in Miners to Pneumococcal Polysaccharide Antigens and Their Role in Preventing Pneumonia, thesis. Johannesburg, South Africa, 1981.
28 +
Schaad UB, McCracken GH Jr, Loock CA, et al:  Pharmacokinetics and bacteriological efficacy of moxalactam, cefotaxime, cefoperazone and Rocephin in experimental bacterial meningitis . J Infect Dis 1981;;143:156-163.
29 +
Smith MD, Guild WR:  A plasmid in Streptococcus pneumoniae . J Bacteriol 1979;;137:735-739.
30 +
Shoemaker NB, Smith MD, Guild WR:  Organization and transfer of heterologous chloramphenicol and tetracycline resistance genes in pneumococcus . J Bacteriol 1979;;139:432-441.
31 +
Zighelboim S, Tomasz A:  Multiple antibiotic resistance in South African strains of Streptococcus pneumoniae: Mechanism of resistance to β-lactam antibiotics , in Quie PG, Kass EH (eds): The Pneumococcus and the Pneumococcal Vaccine . Chicago, University of Chicago Press, 1982;, pp 85-94.
32 +
Robins-Browne RM, Gaspar MN, Ward JI, et al:  Resistance mechanisms of multiply resistant pneumococci: Antibiotic degradation studies . Antimicrob Agents Chemother 1979;;15:470-474.

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