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Effect of pneumococcal conjugate vaccines and SARS-CoV-2 on antimicrobial resistance and the emergence of Streptococcus pneumoniae serotypes with reduced susceptibility in Spain, 2004-20: a national surveillance study.
Sempere, Julio; Llamosí, Mirella; López Ruiz, Beatriz; Del Río, Idoia; Pérez-García, Covadonga; Lago, Darío; Gimeno, Mercedes; Coronel, Pilar; González-Camacho, Fernando; Domenech, Mirian; Yuste, Jose.
  • Sempere J; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
  • Llamosí M; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • López Ruiz B; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • Del Río I; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • Pérez-García C; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • Lago D; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • Gimeno M; Scientific Department, Meiji Pharma Spain, Madrid, Spain.
  • Coronel P; Scientific Department, Meiji Pharma Spain, Madrid, Spain.
  • González-Camacho F; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
  • Domenech M; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Genetics, Physiology and Microbiology, University Complutense Madrid, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. Electronic addre
  • Yuste J; Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. Electronic address: jyuste@isciii.es.
Lancet Microbe ; 3(10): e744-e752, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1967563
ABSTRACT

BACKGROUND:

Epidemiological studies are necessary to explore the effect of current pneumococcal conjugate vaccines (PCVs) against antibiotic resistance, including the rise of non-vaccine serotypes that are resistant to antibiotics. Hence, epidemiological changes in the antimicrobial pattern of Streptococcus pneumoniae before and during the first year of the COVID-19 pandemic were studied.

METHODS:

In this national surveillance study, we characterised the antimicrobial susceptibility to a panel of antibiotics in 3017 pneumococcal clinical isolates with reduced susceptibility to penicillin during 2004-20 in Spain. This study covered the early and late PCV7 periods; the early, middle, and late PCV13 periods; and the first year of the COVID-19 pandemic, to evaluate the contribution of PCVs and the pandemic to the emergence of non-vaccine serotypes associated with antibiotic resistance.

FINDINGS:

Serotypes included in PCV7 and PCV13 showed a decline after the introduction of PCVs in Spain. However, an increase in non-PCV13 serotypes (mainly 11A, 24F, and 23B) that were not susceptible to penicillin promptly appeared. A rise in the proportion of pneumococcal strains with reduced susceptibility to ß-lactams and erythromycin was observed in 2020, coinciding with the emergence of SARS-CoV-2. Cefditoren was the ß-lactam with the lowest minimum inhibitory concentration (MIC)50 or MIC90 values, and had the highest proportion of susceptible strains throughout 2004-20.

INTERPRETATION:

The increase in non-PCV13 serotypes associated with antibiotic resistance is concerning, especially the increase of penicillin resistance linked to serotypes 11A and 24F. The future use of PCVs with an increasingly broad spectrum (such as PCV20, which includes serotype 11A) could reduce the impact of antibiotic resistance for non-PCV13 serotypes. The use of antibiotics to prevent co-infections in patients with COVID-19 might have affected the increased proportion of pneumococcal-resistant strains. Cefotaxime as a parenteral option, and cefditoren as an oral choice, were the antibiotics with the highest activity against non-PCV20 serotypes.

FUNDING:

The Spanish Ministry of Science and Innovation and Meiji-Pharma Spain. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumococcal Infections / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Humans Country/Region as subject: Europa Language: English Journal: Lancet Microbe Year: 2022 Document Type: Article Affiliation country: S2666-5247(22)00127-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumococcal Infections / COVID-19 Drug Treatment Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Humans Country/Region as subject: Europa Language: English Journal: Lancet Microbe Year: 2022 Document Type: Article Affiliation country: S2666-5247(22)00127-6