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184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates
BACKGROUND: In 2013, the Clinical and Laboratory Standards Institute recommended inducible clindamycin resistance (ICR) testing on macrolide-resistant Streptococcus pneumoniae isolates, which arises due to the ermB gene. Ribosomal methylation by ermB confers resistance to macrolides (high-level resi...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644426/ http://dx.doi.org/10.1093/ofid/ofab466.184 |
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author | Olarte, Liset Swanson, Douglas S Tabakh, Jennifer E Banerjee, Dithi Selvarangan, Rangaraj |
author_facet | Olarte, Liset Swanson, Douglas S Tabakh, Jennifer E Banerjee, Dithi Selvarangan, Rangaraj |
author_sort | Olarte, Liset |
collection | PubMed |
description | BACKGROUND: In 2013, the Clinical and Laboratory Standards Institute recommended inducible clindamycin resistance (ICR) testing on macrolide-resistant Streptococcus pneumoniae isolates, which arises due to the ermB gene. Ribosomal methylation by ermB confers resistance to macrolides (high-level resistance), lincosamides and streptogramin B. The goal of our study is to characterize the prevalence of ICR among pediatric pneumococcal isolates. METHODS: We identified erythromycin-resistant(R) (minimum inhibitory concentration [MIC] ≥ 1 µg/mL) and clindamycin-susceptible(S) (MIC ≤ 0.25 µg/mL) pneumococcal isolates from pediatric patients seen at Children’s Mercy Hospital from 2007 to 2017. Determination of ICR was achieved via disk approximation (D-zone test) with standard erythromycin (15 µg) and clindamycin (2 µg) disks. Isolates with high-level erythromycin resistance (MIC ≥ 32µg/mL) were also tested for ermB gene by PCR. Positive and negative controls were used for D-zone test and ermB PCR. RESULTS: We identified 289 erythromycin-R pneumococcal isolates; of those 194 (67.1%) were clindamycin-S (Figure 1). One-hundred and sixty-nine isolates were available for ICR testing, 166 (98%) isolates represented non-invasive disease samples. Median age of patients with erythromycin-R and clindamycin-S isolates was 19 (range 0.1 – 180) months. None of the isolates expressed ICR based on the D-zone test. Thirteen of those isolates (7.7%) expressed high-level erythromycin-R (MIC range 32-128 µg/mL); all were negative for ermB. The most common serotypes/serogroups among erythromycin-R and clindamycin-S isolates were: 15 (n=22), 35B (n=19), 11 (n=16), 6 (n=16), 19A (n=14) and 33 (n=12). [Image: see text] CONCLUSION: Erythromycin-R and clindamycin-S pneumococcal isolates did not express ICR and isolates with high-level erythromycin-R did not carry ermB. Multicenter studies are needed to determine if ICR testing is required for macrolide-resistant pneumococcal isolates in the PCV13 era. DISCLOSURES: Liset Olarte, MD, MSc, GSK (Research Grant or Support)Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support) Douglas S. Swanson, MD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support) |
format | Online Article Text |
id | pubmed-8644426 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-86444262021-12-06 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates Olarte, Liset Swanson, Douglas S Tabakh, Jennifer E Banerjee, Dithi Selvarangan, Rangaraj Open Forum Infect Dis Oral Abstracts BACKGROUND: In 2013, the Clinical and Laboratory Standards Institute recommended inducible clindamycin resistance (ICR) testing on macrolide-resistant Streptococcus pneumoniae isolates, which arises due to the ermB gene. Ribosomal methylation by ermB confers resistance to macrolides (high-level resistance), lincosamides and streptogramin B. The goal of our study is to characterize the prevalence of ICR among pediatric pneumococcal isolates. METHODS: We identified erythromycin-resistant(R) (minimum inhibitory concentration [MIC] ≥ 1 µg/mL) and clindamycin-susceptible(S) (MIC ≤ 0.25 µg/mL) pneumococcal isolates from pediatric patients seen at Children’s Mercy Hospital from 2007 to 2017. Determination of ICR was achieved via disk approximation (D-zone test) with standard erythromycin (15 µg) and clindamycin (2 µg) disks. Isolates with high-level erythromycin resistance (MIC ≥ 32µg/mL) were also tested for ermB gene by PCR. Positive and negative controls were used for D-zone test and ermB PCR. RESULTS: We identified 289 erythromycin-R pneumococcal isolates; of those 194 (67.1%) were clindamycin-S (Figure 1). One-hundred and sixty-nine isolates were available for ICR testing, 166 (98%) isolates represented non-invasive disease samples. Median age of patients with erythromycin-R and clindamycin-S isolates was 19 (range 0.1 – 180) months. None of the isolates expressed ICR based on the D-zone test. Thirteen of those isolates (7.7%) expressed high-level erythromycin-R (MIC range 32-128 µg/mL); all were negative for ermB. The most common serotypes/serogroups among erythromycin-R and clindamycin-S isolates were: 15 (n=22), 35B (n=19), 11 (n=16), 6 (n=16), 19A (n=14) and 33 (n=12). [Image: see text] CONCLUSION: Erythromycin-R and clindamycin-S pneumococcal isolates did not express ICR and isolates with high-level erythromycin-R did not carry ermB. Multicenter studies are needed to determine if ICR testing is required for macrolide-resistant pneumococcal isolates in the PCV13 era. DISCLOSURES: Liset Olarte, MD, MSc, GSK (Research Grant or Support)Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support) Douglas S. Swanson, MD, Merck (Research Grant or Support)Pfizer (Research Grant or Support)Sanofi (Research Grant or Support) Oxford University Press 2021-12-04 /pmc/articles/PMC8644426/ http://dx.doi.org/10.1093/ofid/ofab466.184 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Oral Abstracts Olarte, Liset Swanson, Douglas S Tabakh, Jennifer E Banerjee, Dithi Selvarangan, Rangaraj 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title | 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title_full | 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title_fullStr | 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title_full_unstemmed | 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title_short | 184. Inducible Clindamycin Resistance Testing on Pediatric Streptococcus pneumoniae Isolates |
title_sort | 184. inducible clindamycin resistance testing on pediatric streptococcus pneumoniae isolates |
topic | Oral Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644426/ http://dx.doi.org/10.1093/ofid/ofab466.184 |
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