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PubMed2002

Early formation of Streptococcus sobrinus biofilm on various dental restorative materials.

OBJECTIVES: To examine the formation of dental biofilm by Streptococcus sobrinus on different types of restorative materials, using a model consisting of host and bacterial constituents. METHODS: The adsorption pattern of saliva to the restorative material was determined by means of gel electrophoresis coupled with computerized densitometry techniques. The amount of salivary proteins adsorbed onto the surfaces was measured using the Bradford method. Sucrose-dependent bacterial adhesion to the saliva-coated restorative material was tested by radioactive-labelled Streptococcus sobrinus, and viable counts of these bacteria in the biofilm was determined using bacterial culture techniques. RESULTS: Different adsorption patterns by salivary proteins to restorative materials were recorded. Durafil and acrylic dental materials demonstrated the most affinity to salivary proteins. A surface dependent adhesion profile was recorded, showing a high affinity of albumin and amylase to Acrylic and Durafil materials. Bacterial accumulation was the highest with Fuji LC and Fuji GC, which also demonstrated the highest bacterial viability. CONCLUSIONS: Our study demonstrates the specificity of biofilm formation on different brands of dental restorative materials. Formation of a variety of dental biofilms has a significant impact on the progression of dental diseases in the oral cavity.

Acrylic Resins↗
PubMed2003

Conservation of the mosaic structure of the four internal transcribed spacers and localisation of the rrn operons on the Streptococcus pneumoniae genome.

The detection of heterogeneity of the 16S-23S ribosomal intergenic transcribed spacer (ITS) region has become rather common over the past years for identification and typing purposes of bacteria. The ITS not only varies in sequence and length, but also in number of alleles per genome and in their position on the chromosome together with the ribosomal clusters. The ITS characterisation has allowed discrimination of several species within a genus and variation in ITS sequences between the multiple rrn operons present within a genome may be as high or greater than between strains of the same species or subspecies. It is important to understand the variability of ITS sequences in a given genome to gain insights into bacterial physiology and taxonomy. The present study describes the possibility to type Streptococcus pneumoniae by PCR-ribotyping of the spacer region, the determination of the molecular structure of the ITS, and the determination of the number and localisation of rrn operons in this microorganism. Our results show that the genome of S. pneumoniae contains four ribosomal operons, showing the same genomic organisation among strains, each containing a single ITS allele of 270 bp. The ITS sequence presents a mosaic organisation of blocks highly conserved intra- and inter-species within the genus Streptococcus, giving no possibility for variations to arise.

Amino Acid Sequence↗
PubMed1996

The cpsABCDE genes involved in polysaccharide production in Streptococcus salivarius ssp. thermophilus strain NCBF 2393.

A 4074-bp EcoRI fragment of Streptococcus salivarius ssp. thermophilus (S. thermophilus) chromosomal DNA containing genes involved in exocellular polysaccharide (EPS) was identified and cloned. The nucleotide sequence of this fragment was determined and found to contain one partial and four complete open reading frames. These were designated cpsA, cpsB, cpsC, cpsD and cpsE and encoded proteins of > 130, 243, 230, 246 and 455 amino acids, respectively, that showed homology with the genes of the cps cluster, involved in polysaccharide biosynthesis, in Streptococcus pneumoniae Type 19F. The cpsA gene is predicted to encode a transcriptional regulator, while cpsC and cpsD are predicted to encode proteins involved in polysaccharide polymerization and export. The cpsE gene is likely to encode the phosphate-prenyl glycosyl-1-phosphate transferase catalyzing the first step in polysaccharide biosynthesis in S. thermophilus. Southern blot analysis revealed that cpsE is found only in polysaccharide producing strains of S. thermophilus.

Amino Acid Sequence↗
PubMed2000

Identification of a novel insertion sequence element in Streptococcus agalactiae. bspeller@imib.rwth-aachen.de.

Gain and loss of bacterial pathogenicity is often associated with mobile genetic elements. A novel insertion sequence (IS) element designated ISSa4 was identified in Streptococcus agalactiae (group B streptococci). The 963bp IS element is flanked by 25bp perfect inverted repeats and led to the duplication of a 9bp target sequence at the insertion site. ISSa4 contains one open reading frame coding for a putative transposase of 287 aa and exhibits closest similarities to insertion elements of the IS982 family which has previously not been identified in streptococci. Analysis of different S. agalactiae strains showed that the copy number of ISSa4 in S. agalactiae varies significantly between strains. The S. agalactiae strain with the highest copy number of ISSa4 was nonhemolytic and harbored one copy inserted in cylB, which encodes the membrane-spanning domain of the putative hemolysin transporter (Spellerberg et al., 1999. Identification of genetic determinants for the hemolytic activity of Streptococcus agalactiae by ISS1 transposition. J. Bacteriol. 181, 3212-3219). Determination of the distribution of ISSa4 in different S. agalactiae strains revealed that ISSa4 could be detected only in strains isolated after 1996, which might indicate a recent acquisition of this novel insertion element by S. agalactiae.

Amino Acid Sequence↗
PubMed1999

Virulence of Streptococcus canis from canine streptococcal toxic shock syndrome and necrotizing fasciitis.

The recent recognition of streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) in dogs caused by Streptococcus canis highlights our lack of knowledge regarding the mechanisms of virulence of this organism. Fifteen isolates of S. canis from cases of canine STSS and/or NF were examined for the presence of 10 Streptococcus pyogenes-associated virulence genes by Southern hybridizations using gene probes generated by PCR. The isolates lacked DNA with homology to eight of the 10 gene probes (speA, speB, speC, mf, ssa, scp, hasA, ska) under low stringency conditions. Thirteen and 15 of 15 isolates hybridized with streptolysin O and M protein gene probes, respectively. Twelve of 15 S. canis isolates were resistant to phagocytosis in canine blood. Electron microscopy revealed the presence of proteinaceous cell surface fibrillae. These results suggest that S. canis possesses M proteins and encodes streptolysin O, but lacks some of the other recognized virulence genes with significant homology to those in S. pyogenes.

Amino Acid Sequence↗
PubMed2000

Antimicrobial activity and in vitro susceptibility test development for cefditoren against Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus species.

Cefditoren, a third generation orally administered aminothiazolyl cephalosporin, has demonstrated bactericidal activity against many Gram positive and negative bacterial pathogens and stability against clinically important beta-lactamases. Cefditoren was compared to cefaclor, cefixime, and penicillins against 1 435 recently isolated strains of streptococci (312 Streptococcus pneumoniae, 165 viridans group streptococci, 142 beta-haemolytic streptococci), Haemophilus influenzae (521 strains), and Moraxella catarrhalis (295 strains). Streptococcus pneumoniae and viridans group streptococci had penicillin nonsusceptible rates of 37.8 and 35.8%, respectively. Cefditoren (MIC(90) in microg/ml/% susceptible) activity against all tested H. influenzae (0.03/100) and M. catarrhalis (0.06-0.5/100) was comparable to cefixime and significantly greater than cefaclor. Cefditoren (MIC(90), 0.5 microg/ml) was 4- to 128-fold more active than comparison beta-lactams against the pneumoococci and was the most potent beta-lactam (including penicillin) versus beta-haemolytic streptococci. Cefditoren pharmacokinetics demonstrate a T(1/2) of 1.5-2 h and C(max) values of 2.8 and 4.6 microg/ml, respectively with 200 or 400 mg doses of cefditoren pivoxil; plasma concentrations exceed 1 microg/ml for 4 to 6 hours (33-50% of dosing interval). Consequently, a susceptible MIC of </= 1 microg/ml or </= 2 microg/ml was proposed with zone diameter correlates of >/= 18 and >/= 15 mm (5-microg disk) for all cited fastidious species tested. Categorical agreement between MIC and disk tests was 94.6 to 100% with a correlation coefficient (r) range of 0.50 to 0.90 for streptococci. H. influenzae intermethod comparison results using the same interpretive criteria were in complete agreement, but exhibited a low r = 0.39. Cefditoren clearly possesses the most potent activity among currently studied oral cephalosporins or penicillin against commonly isolated bacterial pathogens causing bronchitis, pneumonia, sinusitis, or pharyngitis and was active against nearly all penicillin-resistant streptococci at </= 0.5 microg/ml. Expanded clinical investigations seem warranted.

Cefaclor↗
PubMed2003

Antimicrobial susceptibility profile among beta-haemolytic Streptococcus spp. collected in the SENTRY Antimicrobial Surveillance Program--North America, 2001.

The surveillance of antimicrobial resistance among beta-hemolytic Streptococcus spp. is an important health care concern due to the serious nature of the diseases that are caused by these pathogens and the emerging antimicrobial resistances. National and international studies have documented diverse rates of resistance to macrolide and lincosamide agents. The SENTRY Antimicrobial Surveillance Program evaluated the resistance rates of beta-hemolytic Streptococcus spp. to several drug classes including erythromycin and clindamycin during the 2001 study year. Twenty-five medical centers in North America contributed 787 isolates from serogroups A (SGA; 397 strains), B (SGB; 318 strains), G (SGG; 45 strains), C (SGC; 19 strains), and F (SGF; eight strains). Isolates were tested at a reference center by broth microdilution using NCCLS methods. A subset of isolates were characterized by molecular methods to determine the presence of erm and mef resistance mechanisms. All isolates were susceptible to beta-lactams, linezolid, vancomycin, chloramphenicol, quinupristin/dalfopristin, and fluoroquinolones. Garenoxacin (MIC(90,) 0.06 microg/ml) was the most potent fluoroquinolone tested. Tetracycline was inactive against SGB (14.8% susceptible) compared to SGC, SGG, SGF and SGA (48.9-85.6% susceptible). Resistance to erythromycin and clindamycin was highest among SGB isolates with M-phenotypes (mef) representing the majority (59.1%) of strains. Among isolates randomly selected for genotypic characterization, eight strains had mef (A), 16 had erm (A) [subclass erm (TR)], seven had erm (B) and one strain had erm (A) [subclass erm (TR)] and mef (A) present. These data when compared to previous SENTRY Program analysis showed macrolide resistance has remained stable over the last five years and M-phenotypes are the most prevalent expression of MLS(B) resistance in North America.

Anti-Bacterial Agents↗
PubMed1997

Reproducibility of broth microdilution and disk diffusion susceptibility tests of nine antimicrobial agents against Streptococcus pneumoniae ATCC 49619.

Collaborative studies documented the reproducibility of broth microdilution susceptibility tests of Streptococcus pneumoniae against nine antimicrobial agents and of disk diffusion tests with six of those drugs. Replicate tests of Streptococcus pneumoniae ATCC 49619 in five different laboratories led to the following provisional quality control limits: cefdinir--0.03 to 0.25 microgram/ml and 26 to 31 mm; cefetamet--0.5 to 2 micrograms/ml and 20 to 25 mm; ciprofloxacin--0.25 to 1 microgram/ml and 20 to 26 mm; clinafloxacin--0.03 to 0.125 microgram/ml and 28 to 34 mm; grepafloxacin--0.06 to 0.5 microgram/ml and 21 to 28 mm; PD131628--0.125 to 0.5 microgram/ml and 24 to 29 mm; clindamycin--0.03 to 0.12 microgram/ml; cefpodoxime--0.03 to 0.12 microgram/ml; and trospectomycin--1 to 4 microgram/ml (disk tests were not evaluate for the latter three drugs).

Anti-Bacterial Agents↗
PubMed1999

Antimicrobial activity of SCH27899 (Ziracin), a novel everninomicin derivative, tested against Streptococcus spp.: disk diffusion/etest method evaluations and quality control guidelines. The Quality Control Study Group.

To combat the increasing rates of penicillin resistance among pneumococci and viridans group streptococci, new Gram-positive active agents are needed to avoid the overuse of vancomycin. SCH27899 is an everninomicin derivative with strong activity against glycopeptide-resistant enterococci, oxacillin-resistant staphylococci, and penicillin-resistant streptococci. This study tests the in vitro activity of SCH27899 against 304 strains of streptococci and evaluates the quality of the agar dilution, broth microdilution, disk diffusion, and Etest methods for this antimicrobial agent. Quality-control (QC) ranges for SCH27899 are also proposed. SCH27899 broth microdilution MICs among the penicillin-susceptible and -resistant streptococci tested ranged from < or = 0.008-0.5 microgram/mL. Organism groups with their respective MIC90s were as follows: Streptococcus pneumoniae (100 strains) and beta-haemolytic streptococci (70 strains), 0.12 microgram/mL; Streptococcus bovis (10 strains), 0.25 microgram/mL; and viridans group streptococci (124 strains), 0.5 microgram/mL. Etest SCH27899 MICs correlated well with broth microdilution MICs (92% +/- one log2 dilution, 98% +/- two log2 dilutions). Agar dilution SCH27899 MICs correlated well with broth microdilution MICs, but a shift toward slightly higher agar dilution MICs was attributed to difficulties in reading trailing endpoints with this method. Three concentrations (2.5, 5, and 10 micrograms) of SCH27899 were used for the disk diffusion method with small inhibition zone diameters (range, 11 to 19 mm) and limited variation between diameters (+/- 2 mm) as a result, both products of this compound's high molecular weight and poor diffusion through agar mediums. Proposed control ranges for SCH27899 when testing S. pneumoniae ATCC 49619 from a nine-center (30 tests per center) quality-control trial are < or = 0.016 to 0.032 microgram/mL for Etest, and 0.008 to 0.032 microgram/mL for broth microdilution tests from an earlier study. Because of the limited diffusion ability and bacteriostatic nature of SCH27899, MICs should be read at 80% of inhibition with agar in vitro systems (Etest, agar dilution), and the disk diffusion method is not recommended.

Aminoglycosides↗
PubMed1993

[Fatal streptococcus A shock after thoracic surgery].

A 23-year-old man with relapsing pneumothorax underwent surgical removal of left apical lung bullae and pleural rubbing down. Forty-eight hours later, he suddenly developed a state of shock together with tachypnoea, oliguria, and a scarlet-like erythema of the face and trunk. Haemodynamic and other investigations led to the diagnosis of septic shock, although no portal of entry could be found. Despite antibiotics (vancomycin, gentamycin and pefloxacine) and symptomatic treatment, the patient's condition continued to worsen. He had a fever (40 degrees C) with abdominal tenderness. Exploratory laparotomy failed to disclose a septic foyer. On aspiration of the left thoracic cavity, a large pyothorax was found and 600 mls of pus were drained. Gram-positive cocci were found on staining and pefloxacine was replaced by mezlocillin. Nevertheless, the patient died within 24 h. Blood and pus cultures confirmed that the infection was due to a pyrogenic penicillin-sensitive group A Streptococcus. Similar cases have been described recently. Group A Streptococcus is suspected to cause severe infections with multiple organ failure, termed "toxic shock-like syndrome". The clinical similarity between the streptococcal and staphylococcal shocks calls for a precise bacteriological diagnosis, and treatment with antibiotics active on both germs.

Adult↗
PubMed2005

[Streptococcus pyogenes and Mycoplasma pneumoniae: pulmonary coinfection or serologic artefact?].

INTRODUCTION: How should Mycoplasma pneumoniae seroconversion be interpreted in a patient with community-acquired Streptococcus pyogenes pneumonia? CASE: A 21-year-old man with cerebral palsy was hospitalized with acute pneumonia and fever. The bronchoalveolar lavage fluid contained Streptococcus pyogenes, and serological testing for Mycoplasma pneumoniae was positive. At 4 weeks, measurements of anti-M. pneumoniae and antistreptolysin O antibodies were positive. DISCUSSION: Two hypotheses should be considered: the patient has either a coinfection of S. pyogenes and M. pneumoniae or a nonspecific antibody response during a severe S. pyogenes infection.

Adult↗
PubMed1999

Characteristics in adherence of streptococci and Staphylococcus aureus isolated from various infective skin lesions: serum IgA decreases adherence of Streptococcus pyogenes but not Staphylococcus aureus.

We characterized adherence of streptococci and Staphylococcus aureus strains isolated from various infective skin lesions in terms of hydrophobicity, negative charge, tube adherence, slime production, and influence on adherence to coverslips by plasma and serum immunoglobulins. High hydrophobicity was more frequently observed in Streptococcus pyogenes strains than in Streptococcus agalactiae strains (P < 0.01) and S. aureus strains (P < 0.001) and slime production was more frequently observed in S. agalactiae strains than in S. pyogenes strains (P < 0.05). Serum IgA decreased adherence to coverslips of S. pyogenes strains but not that of S. aureus strains.

Bacterial Adhesion↗
PubMed2003

Genetic analysis of Streptococcus agalactiae strains isolated from neonates and their mothers.

Streptococcus agalactiae or group B streptococcus (GBS) is the most common cause of neonatal sepsis and meningitis in neonates. One of the major questions is whether the GBS strains able to cause neonatal invasive disease have peculiar genetic features. A collection of S. agalactiae strains, isolated from cervix, vagina and rectum of 10 mothers and from throat, ear and umbilicus of their newborns was genetically characterized by pulsed-field gel electrophoresis (PFGE). This study demonstrated that the strains isolated from each mother and her child were all genetically identical but that the strains from the 10 mother/child pairs mutually were genetically heterogeneous and 10 different PFGE patterns were found. Although it has been suggested that PFGE would be able to identify virulence traits to direct decisions in antibiotic management, the heterogeneous feature of GBS strains does not support broad application.

DNA Fingerprinting↗
PubMed2006

Disseminated Streptococcus anginosus infection with empyema thoracis in a patient with sarcoma.

Streptococcus anginosus is a member of the normal flora of the oral cavity and a pathogen of thoracic infection. However, disseminated infection that was identified from different body fluids at the same time has never been reported. We report a 52-year-old man with advanced pulmonary sarcoma who developed neutropenia, bronchopleural fistula and thoracic empyema after chemotherapy. Viridans group Streptococcus was isolated from both empyema and urine, which was confirmed as S. anginosus according to the biochemical reaction profiles and 16S rRNA gene sequencing results. The patient recovered uneventfully after tube drainage and treatment with imipenem. Disseminated S. anginosus infection should be considered as a possible pathogen in immunocompromised patients with empyema and can be rapidly identified by 16S rRNA gene sequencing.

Anti-Bacterial Agents↗
PubMed2003

Virulence factor regulation and regulatory networks in Streptococcus pyogenes and their impact on pathogen-host interactions.

Streptococcus pyogenes (group A streptococcus, GAS) is a very important human pathogen with remarkable adaptation capabilities. Survival within the harsh host surroundings requires sensing potential on the bacterial side, which leads in particular to coordinately regulated virulence factor expression. GAS 'stand-alone' response regulators (RRs) and two-component signal transduction systems (TCSs) link the signals from the host environment with adaptive responses of the bacterial cell. Numerous putative regulatory systems emerged from GAS genome sequences. Only three RRs [Mga, RofA-like protein (RALP) and Rgg/RopB] and three TCSs (CsrRS/CovRS, FasBCAX and Ihk/Irr) have been studied in some detail with respect to their growth-phase-dependent activity and their influence on GAS-host cell interaction. In particular, the Mga-, RALP- and Rgg/RopB-regulated pathways display interconnected activities that appear to influence GAS colonization, persistence and spreading mechanisms, in a growth-phase-related fashion. Here, we have summarized our current knowledge about these RRs and TCSs to highlight the questions that should be addressed in future research on GAS pathogenicity.

Bacterial Proteins↗
PubMed2001

Comparative analysis of outcome and clinical features in children with pleural empyema caused by penicillin-nonsusceptible and penicillin-susceptible Streptococcus pneumoniae.

OBJECTIVE: To describe the clinical characteristics of pleural empyema in children caused by Streptococcus pneumoniae nonsusceptible to penicillin and compare their clinical outcome with pleural empyemas caused by penicillin-susceptible organisms. METHODS: Records of 109 children with complicated pleural effusions between January 1996 and December 1998 were retrospectively reviewed. RESULTS: Pathogens were recovered in 45 of these cases. Streptococcus pneumoniae represented 71% of the isolates, with 20 (62%) and 12 (38%) of the strains proving susceptible and nonsusceptible to penicillin, respectively. The average age for children with penicillin-nonsusceptible infections was 18.3 months compared with an average age of 40.9 months for those with penicillin-susceptible infections (P = 0.03). Previous antibiotic treatment was more frequent in children with penicillin-nonsusceptible organisms (P = 0.05). No significant differences were found between the two groups for gender, underlying diseases, duration of fever and tachypnea, need of surgical treatment, bacteremia incidence, mean duration of therapy, or length of hospital stay. CONCLUSIONS: Pleural empyemas caused by penicillin-nonsusceptible S. pneumoniae appear to be associated with younger age and previous antibiotic treatment. By contrast, the outcome was not influenced by the penicillin susceptibility of the pneumococcus strains.

Bacteremia↗
PubMedDate not supplied

Nasopharyngeal carriage and antimicrobial resistance in isolates of Streptococcus pneumoniae and Haemophilus influenzae type b in children under 5 years of age in Botswana.

OBJECTIVES: A prospective survey was conducted to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae type b in children under 5 years of age in Botswana and to determine the antibiotic resistance patterns of these organisms to commonly used antimicrobial agents. METHODS: Children 2 months to 5 years of age (n = 249) were recruited from outpatient clinics in Gaborone and Francistown, and 29 were sampled from the pediatric wards at Princess Marina (Gaborone) and Nyangabgwe (Francistown) Hospitals. Nasopharyngeal specimens were collected and the carriage and antibiotic resistance of S. pneumoniae and H. influenzae type b were determined. Analyses of risk factors associated with carriage and resistance were performed. RESULTS: Streptococcus pneumoniae was isolated from 69% of the outpatient children in Gaborone and 85% of the children in Francistown; the carriage rate in hospitalized children was 36% and 33% in Gaborone and Francistown, respectively. Approximately half of the isolates at both sites were resistant to at least one antibiotic, the most common being cotrimoxazole and penicillin. Resistance to three or more antibiotics (multiple resistance) was found in less than 10% of the isolates. Most penicillin resistance at both sites was at the intermediate level; however, almost 20% of the isolates demonstrated high-level resistance to cotrimoxazole. The most prevalent serogroups or serotypes of antibiotic-resistant isolates were 14, 19F, 19A, 6A, 6B, and 4. No risk factors for antibiotic resistance were identified. Haemophilus influenzae type b was isolated from 8% of the children in Gaborone and from 3% of the children in Francistown. Almost a third of the isolates were resistant to ampicillin. CONCLUSIONS: The high levels of antibiotic resistance in pneumococci isolated from children in Botswana suggest that the clinical management of meningitis and otitis media with a b-lactam antibiotic may fail in a significant proportion of cases and that empiric first-line use of cefotaxime or ceftriaxone for meningitis and higher dose amoxicillin (90 mg/kg/day) for otitis media is recommended. The levels of penicillin resistance in this study would not impact on the management of pneumonia with amoxicillin.

Anti-Bacterial Agents↗
PubMed1999

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania.

OBJECTIVES: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children. METHODS: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. RESULTS: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. CONCLUSIONS: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.

Anti-Bacterial Agents↗