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Journal of Clinical Microbiology, November 2000, p. 4137-4144, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Genetic Diversity and Clonal Patterns among Antibiotic-Susceptible and -Resistant Streptococcus pneumoniae Colonizing Children: Day Care Centers as Autonomous Epidemiological Units

Raquel Sá-Leão,1,2 Alexander Tomasz,2 Ilda Santos Sanches,1,3 Sónia Nunes,1 C. Rute Alves,1 António Brito Avô,4 Joana Saldanha,5 Karl G. Kristinsson,6 and Hermínia de Lencastre1,2,*

Instituto de Tecnologia Química e Biológica da Universidade Nova de Lisboa, Oeiras,1 Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica,3 and Gabinete de Medicina Pedagógica4 and Hospital de Sta. Maria,5 Lisbon, Portugal; The Rockefeller University, New York, New York2; and National University Hospital, Reykjavík, Iceland6

Received 11 April 2000/Returned for modification 1 July 2000/Accepted 15 August 2000

Characterization by antibiotype of the 1,096 Streptococcus pneumoniae recovered from 2,111 nasopharyngeal samples of children attending 16 day care centers (DCCs) in Lisbon, Portugal, and molecular typing of 413 drug-resistant pneumococci (DRPn) and 89 fully drug-susceptible pneumococci (DSPn) has allowed several conclusions. (i) There was an increase in the frequency of DRPn colonizing children in DCCs from 40% in 1996 to 45% in 1997 to 50% in 1998. (ii) Drug resistance spread by cross-transmission of DRPn clones. A few (8 out of 57) DRPn clones were repeatedly isolated from a large number of children in several DCCs and during each period of surveillance, suggesting the epidemic nature of these clones, which included lineages representing internationally spread S. pneumoniae clones. (iii) Dissemination of resistance determinants among pneumococci colonizing the nasopharynx occurred. Association of identical pulsed-field gel electrophoresis patterns with diverse antibiotypes among pneumococci colonizing children suggests that the high prevalence of DRPn involves not only cross-transmission of resistant strains but also dispersal of resistance genes through recombinational mechanisms. (iv) DCCs are autonomous epidemiological units. Among the 413 DRPn, 57 different lineages were detected; these lineages were dispersed among the 16 DCCs to produce unique microbiological profiles for each of the DCCs. Higher genetic diversity and less sharing of clonal types were observed among the DSPn.

* Corresponding author. Mailing address: The Rockefeller University, 1230 York Ave., New York, NY 10021. Phone: (212) 327-8278. Fax: (212) 327-8688. E-mail: lencash{at}mail.rockefeller.edu.

Journal of Clinical Microbiology, November 2000, p. 4137-4144, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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