| Congresso Brasileiro de Microbiologia 2023 | Resumo: 1012-1 | ||||
Resumo:Pneumococcal antimicrobial resistance has been highlighted by the World Health Organization as a major public health problem, with emerging serotypes showing resistance to multiple antibiotics. The introduction of pneumococcal conjugate vaccines (PCVs) has been associated with an overall decrease in resistance, however there have been increases in the prevalence of resistant serotypes potentially causing diseases that are not the targets of vaccination. The objective of this study was to determine the resistance profile of Streptococcus pneumoniae isolates from pneumococcal disease in children and adults after the introduction of conjugate vaccines in Paraguay from 2018 to 2023. A total of 806 Streptococcus pneumoniae isolates from children and adults with pneumococcal disease were studied during the period 2018 to 2023. Antimicrobial susceptibility tests were performed using disk diffusion method with erythromycin (ERY), clindamycin (CLI), tetracycline (TET), trimethoprim-sulfamethoxazole (SXT), chloramphenicol (CHL), vancomycin (VAN) and minimal inhibitory concentration: penicillin G (PEN) and ceftriaxone (CRO), according to Clinical and Laboratory Standards Institute (CLSI) guidelines. In cases of meningitis (n=86) and non-meningitis (n=720), non-vaccine serotypes were found more frequently, 55.8% and 44.7% respectively, followed by serotype 19A with 20.9% and 27.8 % and serotype 3 with 17.4% and 16.0%. In meningitis, resistance rate to PEN 39.5%, ERY 29.1%, TET 39.5%, SXT 39.5%, CLI 22.1% and CHL 5.8% was observed. Resistance was not found to CRO and VAN. Serotype 19A presented the highest rate of resistance to PEN (100.0%), ERY (72.2%), CLI (66.7%) and SXT (61.1%) while serotype 3 had the highest rate. resistance to ETT (86.7%). In non-meningitis, resistance rate to PEN 0.4%, ERY 39.5%, TET 45.1%, SXT 28.6%, CLI 32.5% and CHL 2.2% was observed. Resistance was not found to CRO and VAN. Serotype 14 and 6A had the highest rate of resistance to ERY (87.5%), serotype 3 to TET (74.8%), 9V and 23F to SXT (100.0%), 19F to CLI (66.7%). Multiresistance in vaccine serotypes was 31.1% (131/421) associated more frequently with 19A, in non-vaccine serotypes 6.5% (24/370) associated more frequently with 15A, and in non-typeable serotypes 21.7%. (5/23). Strong serotype-specific antibiotic resistance was observed in Paraguay after the implementation of the vaccines. The emergence of multi-resistant serotypes compromises the success of vaccines and this effect deserves consideration in vaccine impact assessments and investments in coverage improvements.
Palavras-chave: Streptococcus pneumoniae, Pneumococcal disease, Antimicrobial resistance, Serotypes, Paraguay Agência de fomento:Ministerio de Salud Pública y Bienestar Social | |||||