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2016 ; 29
(3
): 525-52
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English Wikipedia
Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus
pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective
#MMPMID27076637
Kim L
; McGee L
; Tomczyk S
; Beall B
Clin Microbiol Rev
2016[Jul]; 29
(3
): 525-52
PMID27076637
show ga
Streptococcus pneumoniae inflicts a huge disease burden as the leading cause of
community-acquired pneumonia and meningitis. Soon after mainstream antibiotic
usage, multiresistant pneumococcal clones emerged and disseminated worldwide.
Resistant clones are generated through adaptation to antibiotic pressures imposed
while naturally residing within the human upper respiratory tract. Here, a huge
array of related commensal streptococcal strains transfers core genomic and
accessory resistance determinants to the highly transformable pneumococcus.
?-Lactam resistance is the hallmark of pneumococcal adaptability, requiring
multiple independent recombination events that are traceable to nonpneumococcal
origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal
strains with elevated MICs of ?-lactams are most often resistant to additional
antibiotics. Basic underlying mechanisms of most pneumococcal resistances have
been identified, although new insights that increase our understanding are
continually provided. Although all pneumococcal infections can be successfully
treated with antibiotics, the available choices are limited for some strains.
Invasive pneumococcal disease data compiled during 1998 to 2013 through the
population-based Active Bacterial Core surveillance program (U.S. population base
of 30,600,000) demonstrate that targeting prevalent capsular serotypes with
conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010,
respectively) is extremely effective in reducing resistant infections.
Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand.