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Journal of Clinical Microbiology, October 2006, p. 3524-3528, Vol. 44, No. 10
0095-1137/06/$08.00+0     doi:10.1128/JCM.00558-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Vancomycin-Tolerant Streptococcus pneumoniae in Korea

Heungsup Sung,1 Hee Bong Shin,1 Mi-Na Kim,1* Kyungwon Lee,2 Eui-Chong Kim,3 Wonkeun Song,4 Seok Hoon Jeong,5 Wee-Gyo Lee,6 Yeon-Joon Park,7 and George M. Eliopoulos8

Department of Laboratory Medicine, University of Ulsan and Asan Medical Center,1 Department of Laboratory Medicine, Yonsei University and Severance Hospital,2 Department of Laboratory Medicine, Seoul National University Hospital,3 Department of Laboratory Medicine, Hallym University and Kangnam Sacred Heart Hospital,4 Department of Laboratory Medicine, Catholic University and Kangnam St. Mary's Hospital, Seoul,7 Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan,5 Department of Laboratory Medicine, Ajou University Hospital, Suwon, Republic of Korea,6 Department of Medicine, Harvard University and Beth Israel Deaconess Medical Center, Boston, Massachusetts8

Received 15 March 2006/ Returned for modification 25 April 2006/ Accepted 31 May 2006

A nationwide surveillance study was undertaken to monitor antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in Korea, with a special focus on vancomycin tolerance. For the 6-month period from March to August 2002, clinical isolates of S. pneumoniae were collected from 11 university hospitals and 1 reference laboratory. One-hundred eighty-eight isolates were measured for lysis rates after exposure to vancomycin for 4 h. Two vancomycin-tolerant S. pneumoniae (VTSP) strains, S3 and H8, were isolated from sputum cultures of two patients, who had stayed in intensive-care units of different hospitals with long-term antibiotic therapy and were not treated for pneumococcal pneumonia. The penicillin, cefotaxime, and vancomycin MICs for S3 were 8 µg/ml, >16 µg/ml, and 0.5 µg/ml, and those for H8 were 2 µg/ml, 2 µg/ml, and 0.5 µg/ml, respectively. While S3 belonged to serotype 23F and was autolysin defective, H8 belonged to serotype 13F and had intact autolysin. These strains were not clonally related as determined by pulsed-field gel electrophoresis of chromosomal DNA. In agreement with previous reports, both isolates showed pairing of TIGR4 vex2 with R6 pep27 and had two identical amino acid substitutions, Q441K in vncS and N25D in vex2. These findings indicate that two VTSP strains have emerged independently in Korea, suggesting a prevalence rate of 1.1%. The emergence of VTSP would be a serious threat in Korea, where there are significant rates of penicillin resistance in S. pneumoniae. Monitoring of the prevalence of VTSP and further investigation of the clinical relevance of VTSP are warranted.

* Corresponding author. Mailing address: Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-dong, Songpa-ku, Seoul 138-736, Korea. Phone: 82-2-3010-4511. Fax: 82-2-478-0884. E-mail: mnkim{at}amc.seoul.kr.

Journal of Clinical Microbiology, October 2006, p. 3524-3528, Vol. 44, No. 10
0095-1137/06/$08.00+0     doi:10.1128/JCM.00558-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.





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