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Journal of Clinical Microbiology, December 2003, p. 5633-5639, Vol. 41, No. 12
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.12.5633-5639.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Molecular Epidemiology of Penicillin-Susceptible Non-ß-Lactam-Resistant Streptococcus pneumoniae Isolates from Greek Children

D. Bogaert,1 P. W. M. Hermans,1* I. N. Grivea,2 G. S. Katopodis,2 T. J. Mitchell,3 M. Sluijter,1 R. de Groot,1 N. G. Beratis,2 and G. A. Syrogiannopoulos2

Department of Pediatrics, Sophia Children's Hospital, Erasmus MC Rotterdam, 3000 DR Rotterdam, The Netherlands,1 Department of Pediatrics, General University Hospital, University of Patras School of Medicine, 26 504 Rion, Patras, Greece,2 Division of Infection and Immunity, IBLS, University of Glasgow, Glasgow, United Kingdom3

Received 12 March 2003/ Returned for modification 23 April 2003/ Accepted 15 September 2003

A total of 128 Streptococcus pneumoniae isolates that were susceptible to penicillin but resistant to non-ß-lactam agents were isolated from young carriers in Greece and analyzed by antibiotic susceptibility testing, serotyping, restriction fragment end labeling (RFEL), and antibiotic resistance genotyping. The serotypes 6A/B (49%), 14 (14%), 19A/F (11%), 11A (9%), 23A/F (4%), 15B/C (2%), and 21 (2%) were most prevalent in this collection. Of the isolates, 65% were erythromycin resistant, while the remaining isolates were tetracycline and/or trimethoprim-sulfamethoxazole resistant. Fifty-nine distinct RFEL types were identified. Twenty different RFEL clusters, harboring 2 to 19 strains each, accounted for 76% of all strains. Confirmatory multilocus sequence typing analysis of the genetic clusters showed the presence of three international clones (Tennessee23F-4, England14-9, and Greece6B-22) representing 30% of the isolates. The erm(B) gene was present in 70% of the erythromycin-resistant isolates, whereas 18 and 8% contained the mef(A) and mef(E) genes, respectively. The pneumococci representing erm(B), erm(A), and mef genes belonged to distinct genetic clusters. In total, 45% of all isolates were tetracycline resistant. Ninety-six percent of these isolates contained the tet(M) gene. In conclusion, penicillin-susceptible pneumococci resistant to non-ß-lactams are a genetically heterogeneous group displaying a variety of genotypes, resistance markers, and serotypes. This suggests that multiple genetic events lead to non-ß-lactam-resistant pneumococci in Greece. Importantly, most of these genotypes are capable of disseminating within the community.

* Corresponding author. Mailing address: Laboratory of Pediatrics, Room Ee1500, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Phone: 31-10-4088224. Fax: 31-10-4089486. E-mail: p.hermans{at}erasmusmc.nl.

Journal of Clinical Microbiology, December 2003, p. 5633-5639, Vol. 41, No. 12
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.12.5633-5639.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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