Identification and molecular characterization of penicillin‐nonsusceptible Streptococcus pneumoniae isolates recovered from invasive infections in a pre‐pneumococcal vaccine era

BACKGROUND: Given the significant role of penicillin‐nonsusceptible Streptococcus pneumoniae in inducing severe infectious diseases, identifying serotypes and genotypes that can mediate antimicrobial resistance has become a pillar of treatment strategies. This study aims to determine the correlation between the minimum inhibitory concentration of antimicrobial agents and amino acid mutations in penicillin‐binding proteins. Moreover, molecular serotyping and multiple‐locus variable number tandem repeat analysis typing were first‐ever performed to characterize the invasive penicillin‐nonsusceptible S. pneumoniae isolates in Iran. METHODS: Of 149 isolates, antimicrobial susceptibility tests were performed against penicillin, ceftriaxone, and cefotaxime by the MIC Test Strip, and sequence analysis of the pbp genes was performed through PCR‐sequencing method. All penicillin‐nonsusceptible S. pneumoniae isolates were serotyped and genotyped by sequential multiplex PCR and multiple‐locus variable‐number tandem repeat analysis, respectively. RESULTS: Among pneumococcal isolates, 53 isolates were classified as penicillin‐nonsusceptible S. pneumoniae, of which 38 (71.7%) and 15 (28.3%) were resistant and intermediate to penicillin, respectively. Furthermore, ceftriaxone‐ and cefotaxime‐nonsusceptible pneumococci constituted 33 (62.2%) and 29 cases (54.7%), respectively. Of note, there were 8 and 41 different serotypes and multiple‐locus variable‐number tandem repeat analysis types, respectively. CONCLUSIONS: Due to the increasing resistance to antimicrobial agents, the most efficient approach to preventing pneumococcal infection mortality as vaccine‐preventable diseases is focusing on wide‐spectrum vaccination. Based on our findings, the 13‐valent pneumococcal conjugate vaccine could considerably reduce the incidence of invasive pneumococcal diseases due to the high rate of serotype coverage.