Antibiotic Resistance and Clonal Spread

Background: Decline of IPD caused by drug-resistant Streptococcus pneumoniae is an expected effect of conjugate vaccine introduction. Historically, drug-resistance has been associated to a limited number of serotypes, most included in vaccine formulas. We evaluated antibiotic-nonsusceptible IPD trends before and after PCV7 and PCV13 implementation in Uruguay. Multidrug-resistant isolates were further analyzed to identify emerging clones. Methods: Isolates from all IPD cases (2003-2012) were serotyped and tested for 9 antibiotics by disc-diffusion and for 4 by E-test. Predominant profiles were identified and PFGE and multilocus sequence typing (MLST) were used to explore genetic relationships. Results: We included 1887 cases of IPD in patients <5 years (n=742) and >5 years (n=1145). Rise in the number of isolates with penicillin MIC >0.06 μg/mL occurred during the pre-PCV period (2003-2007) from 17.5% to 41.9% among children <5 years. A decline to 12.9% was observed until 2011. However, by 2012, 40% of IPD isolates had penicillin MIC >0.06 and most were also multidrug-resistant. Antibiotic resistance was lower among IPD patients >5 years old and no significant changes has been observed over the period. Among multidrug-resistant isolates, one profile resistant to 5 antibiotics, was identified with increasing frequency (n=29), 20 were of serotype 24F and 9 of 24A. Preliminary results showed identical PFGE profiles for the 24F and 24A isolates (n=24), while 2 susceptible 24F isolates showed completely different profiles. Six isolates analyzed by MLST were ST230. Conclusion: A multidrug-resistant clone, of serotypes 24F/24A has emerged probably as a result of serotype replacement after conjugate vaccines introduction.


SEROTYPE DISTRIBUTION AND ANTIBIOTIC SUSCEPTIBILITIES OF STREPTOCOCCUS PNEUMONIAE ISOLATES IN ADULT PATIENTS WITH PNEUMOCOCCAL INFECTION OR CARRIAGE
Background and Aims: The objectives of this study were to investigate the serotypes and antimicrobial susceptibility of pneumococcal isolates from adult patients with pneumococcal infection or carriage during recent two years. Methods: Between July 2010 and February 2013, Streptococcus pneumoniae isolates from clinical samples among adult patients (≥18 years) were identified in Korea University Anam Hospital. A retrospective chart review was performed. Serotyping of pneumococcal isolates were performed using a multiplexed immunoassay for capsular polysaccharides in lysates of pneumococcal cultures, identifying 27 serotypes: 1, 2, 3, 4, 5, 6A, 6B, 6C, 6D, 7F, 8, 9N, 9V, 10A, 11A, 11E, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F. Antimicrobial susceptibility was determined using the MicroScan MICroSTREP plus panel. Results: During the study period, a total of 186 patients with pneumococcal infection (n=130, 69.9%) or carriage (n=56, 30.1%) were analyzed. Median age was 69 [interquartile range, 60-75] years and 121 patients (65.1%) were ≥ 65 years. Fifteen patients (8.1%) presented pneumococcal bacteremia. Of 137 (73.7%) pneumococcal isolates that were able to determine serotypes, the major serotypes included 19A (20.4%), 3 (18.2%), 11A/D/F (16.1%), and 19F (13.1%). PCV7 and PCV13 serotypes were 23.4% (32/137) and 67.2% (92/137), respectively. The nonsusceptibility rates of 48 isolates were 41.7% for penicillin, 83.3% for erythromycin, 31.3% for cefotaxime, 10.4% for levofloxacin, 77.1% for meropenem and 0% for vancomycin. Conclusion: In this study, non-PCV7 serotypes 3 and 19A that are included in PCV13 were prevalent in adult pneumococcal isolates. Background: Nasopharyngeal colonization of Streptococcal pneumoniae plays an important role in development of invasive pneumococcal disease (IPD). Streptococcus pneumoniae drug resistance pattern and serotype distribution data among hospitalized acute respiratory infection (ARI) and healthy children of are crucial for appropriate clinical management of IPD and pneumococcal vaccine introduction in Vietnam. Methods: S. pneumoniae isolated from pediatric ARI cases admitted to Khanh Hoa General Hospital from January 2008 through December 2008, and healthy children from the community (January and July 2008, 350 each) were collected. Drug resistance (MIC) and serotype were determined by conventional and molecular assays. Information on potential risk factors for S. pneumoniae carriage were collected and analyzed. Background and Aims: Acute Otitis Media (AOM) is one of the most common bacterial infections in children. Pneumococcal conjugate vaccine was introduced into China in 2008 and only some children were vaccinated. This study investigated the bacterial etiology of AOM and the antibiotic susceptibility, serotype distribution and clone spread of Streptococcus pneumoniae (Sp) in Suzhou, China. Methods: Since 2011, a surveillance study was conducted in Soochow-University-Affiliated-Children's-Hospital. All children with AOM and having middle-ear-effusion (MEF) were enrolled and cultured for bacterial pathogen, tested antibiotic susceptibility by E-test. Sp strains were identified serotype, macrolide-resistant genes and sequence types. Results: From January 2011 to December 2012, among the 168 episodes, 113 (67.3%) samples were positive for bacterial pathogens. The leading cause was Sp (43.5%), followed by Staphylococcus aureus (14.9%) and Haemophilus influenzae (7.7%). The Sp isolation rate decreased with age (p < 0.01).The resistant rate to erythromycin, tetracycline was up to 98.6%, and 57.5% isolates were non-susceptible to penicillin. Moreover, all Sp isolates were resistant to ≥3 types of antibiotics with a major multidrug resistance pattern of erythromycin/ co-trimoxazole/clindamycin/tetracycline. The most common serotypes were 19A (37.8%) and 19F (37.8%) . The coverage rate of PCV7 serotypes was 51.4% and of PCV13 was 100%. The macrolide resistance was mainly mediated by both ermB and mefA genes (89.2%). CC271 was the only clone complex (CC) and belong to PMEN14 clone. Conclusion: S. pneumoniae was a leading cause for AOM in children in Suzhou, China. Multidrug resistance among isolates was mainly due to the spread of PMEN14 CCs.

Acknowledgement:
Thanks to the support of Robert-Austrian-Research-Awards and National-Natural-Science-Foundation-of-China(81102166).

RARE PNEUMOCOCCAL/HAEMOPHILUS BASED BACTERIAL MENINGITIS AMONG HOSPITALIZED CHILDREN IN A TEACHING HOSPITAL
A.A. Adegoke 1 1 Microbiology, University of Uyo, Uyo, Nigeria A study on the incidence of bacterial meningitis among hospitalized children in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife was carried out using standard microbiological techniques. A sum of one hundred and thirty-five patients with the age range from 1 hour to 8 years was involved in the study and was placed in classes; the highest study class being 41.5 % ranged from 1 hour to 6 days, followed by age range 1 year to 4 years (25.9 %). Three of them (2.22%) showed positive presence of bacterial pathogens in their cerebral fluid (statistically non-significant (p ≥ 0.05) but medically important). These three positive patients were between the 1 month to <12 months (33.3%) and <4 years to 8 years (66.7%). Two isolates of Streptococcus pneumoniae recovered were resistant to ampicillin, chloramphenicol, streptomycin and gentamycin, cotrimoxazole but sensitive to ceftriazone, augmentin, cefixime and ofloxacin. At least one of the isolates was resistant to cloxacillin, cephalexin and ceftazidine. The only Haemophilus influenzae recovered was resistant to ampicillin, cloxacillin, chloramphenicol, streptomycin, cotrimoxazole, cefixime and erythromycin but sensitive to gentamycin, cephalexin, ceftrazidime, ceftriaxone, augmentin and ofloxacin. Multiple antibiotic resistance index (MARI) of S. pneumoniae (n = 2) were 0.57 and 0.43 while H. influenzae (n = 1) had MARI of 0.50. These showed the isolates to be of high risk sources and suggestive of prior antibiotic abuse. The incidence of meningitis is unusual in the study area and suggests the need for proactive health control measures against rare infections.

ISPPD-0349 Antibiotic Resistance and Clonal Spread
No conflict of interest pneumonia 2014 Volume 3 210 ISPPD-9 / pneumonia 2014 Mar 9-13;3:1-286 Background and Aims: Streptococcus pneumoniae is the most common cause of community-acquired respiratory tract infections such as otitis media, sinusitis, and pneumonia. Globally, pneumococcal diseases account for 1 to 2 million deaths anually in both extremes of age. This study was planned to estimate prevalence of pneumococcal pneumonia in pediatric patients and drug resistance pattern of the isolates. Methods: 250 nasopharyngeal aspirates and sputum samples were collected from clinically diagnosed cases on pneumonia. The samples were inoculated on sheep blood agar. The organism grown was identified with gram staining, hemolysis on sheep blood agar, bile solubility, and sensitivity to optochin. Demographic and clinical details such as age, sex, type of infection, underlying disease, and response to treatment, for all 250 patients were noted. Antibiotic testing was done for pencillin, tetracycline, erythromycin, ciprofloxacin, cotrimoxazole and results interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the 250 specimens, S. pneumoniae was isolated in 10 samples. 1 isolate was resistant to penicillin, 2 isolates were penicillin intermediate resistant and rest were sensitive to penicillin. 1 strain was MDR. 30 % resistance was seen with tetracycline and cotrimoxazole and 20% strains were erythromycin resistant. All patients responded to antimicrobial therapy and none of the patients died Conclusion: Increasing prevalence and emergence of antibiotic resistant among S. pneumoniae in the community set up is a matter of great concern and large scale studies are required to estimate prevalence, antibiotic resistance and serotypes of the isolates so that national guidelines can be formulated regarding prevention and treatment of pneumococcal pneumonia. Background and Aims: Dissemination of non-antimicrobial-susceptible clones was known as an important factor in the emergence and prevalence of resistance in pneumococcus. This study was to explore the molecular characteristics of pneumococci and the circulating clones in hospitalized children in Suzhou, China. Methods: Nasopharyngeal aspirates were collected from children less than 5 years old admitted to Suzhou-University-Affiliated-Children's-Hospital being respiratory infections. Pneumococcal isolates were serotyped by multiplex PCR. Antimicrobial susceptibility was tested by E-test. We detected macrolide resistance genes and performed multiloccus MLST on all isolates. Results: From July 2012 to July 2013, all the 175 pneumococcal isolates were resistant to erythromycin and clindamycin, 94.3% resistant to tetracycline and 39.4% non-susceptible to penicillin. Overall, 172 (98.3%) isolates were resistant to ≥3 types of antibiotics. The most common serotypes were 19F (28.6%), 6B (20.0%), 23F (17.7%), 19A (17.2%) and 14 (5.1%), 126 (72.0%) were included in PCV7serotypes and 156 (89.1%) in PCV13 serotypes. MLST resolved 175 isolates into 44 sequence types (STs), and 45.1% of STs derived from CC271 (PMEN14CCs), 13.7% from CC81 (PMEN1CCs) and 4.0% from CC242 (PMEN15CCs). The PMENCCs isolates indicated a higher non-susceptibility rate in β-lactams antibiotic, chloromycetin and co-trimoxazole than the non-PMENCCs isolates (p < 0.01). In addition, there was 80.0% of the PMENCCs isolates both expressed ermB and mefA/E genes whereas 71.2% of the non-PMENCCs isolates only expressed mefA/E (p < 0.01). Conclusion: The PMEN14 and PMEN1clones played a predominant role in the emergency and dissemination of multidrug-resistant strains in Suzhou. Considering the potential serotype replacement (19A), the introduction of PCV13 in children maybe a promising way to control the increasing trend of international clonal spread.

SURVEILLANCE OF ANTIBIOTIC RESISTANCE IN STREPTOCOCCUS PNEUMONIAE AT A TERTIARY CARE CENTRE IN NEW DELHI
V. Gupta 1 , N. Goel 1 , C. Wattal 1 1 Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India Introduction: Streptococcus pneumoniae is the most frequent isolate from clinical samples of respiratory tract infection, including acute exacerbations of chronic bronchitis and community-acquired pneumonia. The emergence of multiple drug-resistance has complicated the empirical treatment of pneumococcal infection S. pneumonia is a major infectious disease with millions of cases diagnosed every year worldwide. In the present study we evaluated the antimicrobial resistance pattern in the S. pneumoniae isolates obtained from a tertiary care centre in Delhi Methodology: All the subjects, of all age groups and sex, presenting at a tertiary care centre in Delhi were included in the study. A total of 41 S. pneumoniae isolates were obtained and investigated. All were subjected to disc diffusion testing and MIC testing by E-Test. Results: Susceptibility testing showed 100%, 97%, 95%, 97%, 100%, 68%, 49% sensitivity to penicillin, levofloxacin, erythromycin, clindamycin, chloramphenicol, cotrimoxazole and tetracycline, respectively. Maximum number of isolates have been obtained from blood (48.78%), followed by sputum (17.07%) and ET secretion (14.63%). Conclusion: Initial data from our study shows that all the S. pneumoniae isolates are uniformly sensitive to penicillin and chloramphenicol, with a low level resistance to quinolones and macrolides. The isolates are maximally resistant to cotrimoxazole and tetracycline. Background: The aim of this study was to determine the distribution of macrolide resistance phenotypes and genotypes among invasive and noninvasive erythromycin resistant S. pneumoniae isolates in Serbia. Methods: During 2010, a total of 297 macrolide resistant pneumococcal strains (45 invasive and 252 noninvasive) isolated throughout country were analyzed. Macrolide resistant phenotypes were determined using double disk test, MIC values by E test, while resistance genes were examined by PCR. Serotyping was performed for invasive isolates. Results: cMLS phenotype, characterized by high MICs values for both erythromycin (MIC 50 >256 µg/ml) and clindamycine (MIC 50 >256 µg/ml) was detected in 77% of all isolates, while the remaining 23% were assigned to the M phenotype, with lower level of resistance to erythromycin (MIC 50 =4 µg/ml) and susceptibility to clindamycine (MIC 50 =0.06 µg/ml). All M phenotype had the mefA gene and all MLS phenotype strains had the ermB gene. Nine MLS isolates possessed both ermB and mefA genes. No difference was found in distribution of macrolide resistance phenotypes and genotypes between invasive and noninvasive isolates. Co-resistance to penicillin and erythromycin was detected in 25% and 47% of invasive and noninvasive strains, respectively. Of 12 different serotypes detected among invasive strains, the most numerous were: 19F (n=15), 14 (n=11), 6A (n=6), 6B (n=3) and 23F (n=3). All isolates expressing 19F and 14 serotypes possessed ermB gene, while all 6A strains were mefA positive. Conclusion: Macrolide resistance among pneumococcal invasive and noninvasive isolates from Serbia is predominantly mediated by ermB genes. Nearly half of noninvasive isolates expressed co-resistance to penicillin and erythromycin. Objective: The aim of this study was to determine the genetic structure of 144 serotype 14 Streptococcus pneumonia from children with acute respiratory infections collected from 1997-2012 in China. Methods: PCR was used to detected the macrolide resistance genes ermB and mefA, as well as the sulfamethoxazole-trimethoprim resistance gene dhfr. Restriction fragment length polymorphism of the PBPs genes pbp1a, pbp2b and pbp2x and multilocus sequence typing (MLST) were used to investigate the relationship between the serotype 14 strains prevalent in China. Results: From 1997 to 2012, the percentage of serotype 14 increased. All the isolates were susceptible to amoxicillin-clavulanic acid, vancomycin and levofloxacin, 143 were resistant to erythromycin, all of which carried the ermB gene and 13 carried both mefA/E and ermB genes. The nonsusceptibility rate to cephalosporins increased from 1997-2012. All trimethoprim-resistant isolates contained the I100-L mutation. There were 30 sequence types (STs), among which ST876 was the most prevalent ST, followed by ST875. From 1997 to 2012, the percentage of CC876 increased from 0% in 1997-2000 to 96.4% in 2010-2012, whereas CC875 decreased from 84.2% to 0%. CC876 showed high nonsuscetibility rate to β-lactam antibiotics than CC875. Conclusion: The percentage of serotype 14 of S. pneumoniae increased from 1997-2012 in China. The increase of nonsusceptibility rate to β-lactam antibiotics is associated with the spread of resistance clone CC876 due to the selection of antibiotics.  Background: Pneumococcal conjugated vaccines (PCV) target a limited number of serotypes prevailing in the community. Vaccine introduction in several countries has shown a decreased incidence of invasive pneumococcal disease (IPD), however, also an increase of non-vaccine types. In Stockholm PCV7 was introduced in the childhood immunization program in October 2007 and PCV13 in January 2010. Methods: We collected IPD isolates from the Stocholm county during 2005-2012 and carriage isolates before and after vaccine introduction, and characterized them with serotyping, molecular typing and antibiotic susceptibility. Serotype diversity was calculated using Simpson index for IPD and carriage. Clinical information was collected for children with IPD. Results: We found a reduced incidence of IPD in vaccinated children, but an unaltered incidence in the elderly after vaccine introduction. There was a decreased incidence of septicaemia, and meningitis in children, however, the severity of disease was unchanged. Non-vaccine types increased in IPD in vaccinated and non-vaccinated populations. The serotype diversity increased in both IPD and childhood carriage. Conclusion: Vaccine introduction has beneficial effects on the incidence of vaccine type disease in children, however, the selective pressure leads to an increase of non-vaccine types both in disease and carriage and an expansion of prevaccine clones also in non-vaccinated age groups such as the elderly. An increased diversity of pneumococcal serotypes post vaccination suggests the potential of new emerging clones, which has impacts on future vaccine strategies. Background and Aims: The appearance of antibiotic resistance in Streptococcus pneumoniae has raised a global concern over the past three decades. This study was conducted to determine the antimicrobial susceptibility of S. pneumoniae isolated from patients in Children´s Medical Center Hospital during 2001 to 2011. Methods: During the 11 years period, a total of 194 S. pneumoniae isolates were collected in CMC Hospital. Time series analysis of the different antibiotics was performed. Results: Time series analysis of the 5 antibiotics of penicillin, erythromycin, chloramphenicol, ceftriaxone, and trimethoprim-sulfamethoxazole showed an overall decreasing trend for S. pneumoniae susceptibility during 2001 to 2011 and even forecasting prediction for 2016. The prevalence of susceptibility to penicillin decreased from 78% in 2001 to 32% in 2011. In the same time period, susceptibility to erythromycin declined from 75% (in 2001 to 35% in 2011 and susceptibility to chloramphenicol started to decrease from 94% to 55%. In addition, during these couple of years, susceptibility to ampicillin declined from 70% to 62%. Beside this, susceptibility to ceftriaxone started to fall from 100% to 87% and susceptibility to sulfametoxazole went down from 57% to 40%. This study identifies unstable patterns of resistance to available antimicrobial drugs during 11 years. Conclusion: Continued epidemiological surveillance appears to be prudent practice to guide effective chemotherapy. Moreover, it would be an important key to consider antimicrobial stewardship as an essential factor to prevent the development of antimicrobial resistance.

ANTIBIOTIC SENSITIVITY PATTERN OF STREPTOCOCCUS PNEUMONIAE ISOLATED FROM THE NASOPHARYNX OF HEALTHY CHILDREN IN SOUTH INDIA
V. Raghavan 1 1

Microbiology, Kanchi Kamakoti Childs Trust Hospital, Chennai, India
Background: Invasive disease due to Streptococcus pneumoniae is one of the commonest causes of death among children under 5 years of age in developing countries. Nasopharyngeal colonization with S. pneumoniae precedes the invasive disease in some children and it will be clinically significant to determine the drug resistance pattern of serotypes colonised. Aims: To determine the antibiotic susceptibility pattern of S. pneumoniae isolated from the nasopharynx of children under 5 years of age. Methods: Antimicrobial susceptibility was tested for 45 isolates of pneumococcal isolates from the nasopharynx by Kirby Bauer method and results were interpreted as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines. Penicillin MIC was determined by "E" test for penicillin resistant strains. Results: Of the 45 S. pneumoniae isolates , all were sensitive to vancomycin and linezolid (100 %), 23 were sensitive to erythromycin (51%), 26 were sensitive to tetracycline (58%) , 44 were sensitive to Levofloxacin (98%), 29 were sensitive to clindamycin (66%) , 14 were sensitive to co-trimoxazole (33%), 39 were sensitive to chloramphenicol (87%), 40 were sensitive to penicillin (89%). Five strains were penicillin resistant (three stains with intermediate resistance and two with high resistance). Conclusion: Increase in penicillin resistance among S. pneumoniae is a disturbing trend. Further studies comparing the antimicrobial susceptibility pattern of invasive isolates and nasopharyngeal isolates of S. pneumoniae are required.

No conflict of interest
Background and Aims: Antimicrobial non-susceptibility among invasive has increased over the past decade in Finland. PCV10 (2+1) was introduced into the national infant vaccination programme in September, 2010. We studied non-susceptibility trends of PCV10 and non-PCV10 serotypes in 2010-2012. Methods: Invasive pneumococcal disease is nationally notifiable and the isolates are sent to the THL reference laboratory for characterisation. For this study, 2,391 isolates from 2010-2012 were serotyped by multiplex-PCR and/ or the Quellung reaction. Their antimicrobial susceptibility was tested by the agar dilution method. Results: Overall, the proportion of penicillin non-susceptible isolates increased from 23% (192/826) to 28% (213/768), while that of erythromycin non-susceptible decreased from 29% (237/826) to 23% (174/768). The PCV10 serotypes accounted for 73-92% and 76-88% of the penicillin and erythromycin non-susceptible isolates, respectively. Serotypes 19F, 19A, and 23F accounted for the highly penicillin-resistant (MIC≥8 mg/L) isolates (n=5). Among isolates from 0-2-year-olds, there was a reduction especially in the number of penicillin or erythromycin non-susceptible PCV10 serotype isolates. In 2010, the proportion of non-susceptible isolates from this age-group was 41% to penicillin and 58% to erythromycin, while in 2012, it was 24% and 33%, respectively. The proportion of penicillin non-susceptible isolates increased among ≥65-year-olds, accompanied with an increase in non-susceptible non-PCV10 serotypes, i.e. 6C and 19A. Conclusions: During the first two years after routine infant vaccination, penicillin non-susceptibility seemed to increase slightly, while erythromycin non-susceptibility seemed to decrease. Ongoing changes in the pneumococcal population emphasise the need for future surveillance to determine the impact of PCV10 on antimicrobial resistance. Background: Due to extreme weather and poor air quality, Mongolia is facing a huge problem of respiratory disease. Unfortunately antibiotic-resistant Streptococcus pneumoniae is increasing dramatically in recent years, therefore we conducted the study to identify the cause and serotype distribution. No data was available previously. Method: We collected samples and questionnaire of 115 patients under 5 years with respiratory tract infection, from 3 hospitals cross Mongolia since 2011. An antibiotics susceptibility was tested by the disk diffusion method. Results: A total 96 (84%) were positive for S. pneumoniae and 25 serotypes were detected. Among the isolates, serotype 19A was the commonest, followed by 1, 23B, 6B, 13. The resistance levels to penicillin, erythromycin, tetracycline, trimethoprim-sulfamethoxazole and ciprofloxacin were 85%, 79%, 68%, 31%, and 6.8%, respectively. Multidrug resistance was detected in 29% of them and the most prevalent serotypes were 19A, 19F, 13 and 6B. Surprisingly, 76% of total patient's parents were answered that before coming to hospital they have already tried antibiotic treatment according to a pharmacist choice. Conclusion: A high prevalence of penicillin-resistance is found, and it is no longer considered a drug of choice. Other alternative antibiotics such as erythromycin, ciprofloxacin, and tetracycline also showed resistance against the isolates. Antibiotic misuse and inappropriate dosage might facilitate the spread of multidrug-resistant strains. We urgently need an antibiotic restriction law to restraint the indiscrete use of antibiotics and limit the selling without prescription. Most important, is the need to provide a better understanding of drug-resistant infections in the community Background and Aims: The Food and Drug Administration (USA) approved of the use of PCV-13 to prevent IPD in adults aged ≥50 years. To predict the potential benefit of PCV-13, we evaluated for serotype coverage over pneumococci. Methods: 157 isolates from normally sterile sites were obtained from adult patients aged 50-89 years from 16 hospitals during 2005-2012. They were serotyped by Quellung reaction, using group and factor sera of Pneumotest kits. 88 isolates were obtained during 2009-2012. Results: The rates of PCV-13 serotype coverage for pneumococci from sterile sites of the elderly Thai patients were 53.7% (95% CI, 38.4% to 68.9%), 58.5% (95% CI, 43.5% to 73.6%), 53.3% (95% CI, 38.8% to 67.9%) and 70% (95% CI, 53.6% to 86.4%) for patients aged 50-60, 61-70, 71-80 and >80 years, respectively. The overall coverage rate of PCV-13 was 58% (95% CI, 50.2% to 65.7%). The five most common serotypes, accounting for 46.5% of all, were serotypes 6B (16.6%), 19A (8.9%), 18C (5.1%), 23F (4.5%) and 3, 4, 7F (3.8% each). For isolates during 2009-2012, the overall coverage rate of PCV-13 was also 58% and covered 52%, 63%, 52% and 72% for the patients aged 50-69, 61-70, 71-80 and >80 years, respectively. The most common serotypes were 6B (28%), 19A (16%), 18C (12%), and 23F (10%). Interestingly, patients aged >80 years had the highest coverage of PCV-13. Conclusion: Our results help to evaluate the effectivenes of PCV-13 and to monitor changes in serotypes in Thailand. Background and Aims: Septicemia remains a serious cause of morbidity and mortality in critically ill patients worldwide. We studied antibiotic susceptibility pattern of bacterial isolates including Streptococcus pneumoniae in patients admitted with community acquired septicemia and those who developed nosocomial septicemia during their stay in the hospital. Methods: Venous blood, 5 ml from adults and 3 ml from children was collected aseptically for blood culture. Organisms were identified and subjected to antibiotic susceptibility testing to relevant antibiotics. Results: A total of 7147 adults and children were studied. Among these 1040 patients had positive blood culture. Gram negative bacteria were responsible for the majority of infections. Community acquired septicaemia was seen in 556 (53.4%) patients while septicaemia of nosocomial origin was recorded in 484 (46.5%). Blood culture was positive in 26 (2.5%) patients -19 (73%) childern and 7 (27%) adults for S. pneumoniae infection. S. pneumoniae was sensitive to penicillin and erythromycin in 19 ( 73%) patients while cloxacillin, gentamicin and netilmicin in 23 (88.4%) and cofotaxime in 26 (100%) patients. Conclusions: This study highlights the rising level of drug resistance amongst the bacterial isolates including S. pneumoniae from blood and hence the need to update and formulate newer drug policies.There is need for controlling of spread of these resistant strains before they reach an alarming level in the region.

ANTIBIOTIC SUSCEPTIBILITY PATTERN OF BLOOD ISOLATES WITH SPECIAL REFERENCE TO STREPTOCOCCUS
No conflict of interest pneumonia 2014 Volume 3 220 ISPPD-9 / pneumonia 2014 Mar 9-13;3:1-286 Background and Aims: Invasive pneumococcal disease (IPD) is a leading cause of morbidity and mortality worldwide, especially in China. The epidemiology data of IPD in China are very limited. Therefore, this study aimed to assess the antimicrobial susceptibilities of Streptococcus pneumoniae isolated from IPD patients in both children and adults in China. Methods: From 2010 to 2013, S. pneumoniae isolated from sterile sites in patients with clinical signs and symptoms of IPD were collected. All isolates were sent to the clinical microbiology lab of Peking Union Medical College Hospital for testing of antimicrobial susceptibilities of 16 antibiotics against all the strains using Etest®. Results: A total of 114 isolates were collected from 18 hospitals in China, with 55 isolates (48.2%) from children (<18 years) and 59 isolates from adults (≥18 years). Among these isolates, 78 (68.4%) were collected from blood, 18 (15.8%) from cerebrospinal fluid, 15 (13.2%) from pleural fluid, 2 (1.6%) from joint fluid and 1 (0.9%) from lung tissue. In the 18 isolates from meningitis patients, only 11.7% were penicillin-susceptible S. pneumoniae (PSSP), whereas in the 96 isolates of non-meningitis isolates, 91.7% were PSSP. The most susceptible agents against all the isolates were moxifloxacin, linezolid and vancomycin (100% susceptible), followed by ertapenem and levofloxacin (99% susceptible). Erythromycin, azithromycin and clindamycin show poor activities (>94% resistant) against S. pneumoniae. Conclusion: S. pneumoniae isolated from meningitis patients were highly resistant to β-lactams, but isolates from bacteremia, pneumonia and arthritis patients were still frequently susceptible to penicillin in China. Background and Aims: The prevalence of, and risk factors for, colonisation by antimicrobial resistant pneumococci were explored as part of a longitudinal study of Streptococcus pneumoniae colonisation in a cohort of refugees from the Thailand-Myanmar border. Methods: 234 mother-infant pairs were followed from birth for 24 months. Nasopharyngeal swabs were taken at monthly visits and cultured following the WHO pneumococcal carriage protocol. Antimicrobial susceptibilities were determined by disk diffusion +/-Etest (CLSI breakpoints). Pneumococci were termed multi-drug resistant (MDR) if resistant to ≥3 of chloramphenicol, erythromycin, penicillin (MIC ≥0.12 µg/mL), tetracycline, co-trimoxazole. MLST genotyping was done for a proportion of isolates. Results: 2,050 pneumococci were analysed (one isolate/serotype carriage episode). 40.0% of infant isolates were penicillin non-susceptible (PNS) and 34.6% were MDR. PCV13 serotypes were more likely to be MDR (p < 0.001). However, 80.5% of non-typeable isolates were PNS and 38.5% were MDR. The proportion of antimicrobial resistant isolates was greater in infants compared to mothers (MDR: 34.6% vs. 26.9%, p = 0.001; PNS 40.0% vs. 34.3%, p = 0.02). The presence of other young children in the house was associated with a greater risk of acquisition of both MDR and PNS pneumococci in infants (p < 0.001). Acquisition of another pneumococcal serotype at the preceding NPS was protective against acquisition of a drug resistant pneumococcus (p < 0.001) Conclusion: Antimicrobial resistant pneumococci were frequently carried by infants and their mothers in this rural Asian refugee population: PCV13 serotypes predominated. Non-typeable pneumococci were also frequently resistant and these isolates may provide a persistent reservoir of resistance genes in the population.