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Journal of Clinical Microbiology, February 2007, p. 306-312, Vol. 45, No. 2
0095-1137/07/$08.00+0     doi:10.1128/JCM.01229-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Antibiotic-Resistant Invasive Pneumococcal Clones in Italy{triangledown}

Giovanni Gherardi,1 Loredana Fallico,2 Maria Del Grosso,3 Federica Bonanni,1 Fabio D'Ambrosio,3 Riccardo Manganelli,2 Giorgio Palù,2 Giordano Dicuonzo,1 and Annalisa Pantosti3*

Department of Laboratory Medicine and Microbiology, Università Campus Biomedico, Rome,1 Department of Histology, Microbiology, and Medical Biotechnologies, University of Padua and Clinical Microbiology and Virology Unit, University Hospital, Padua,2 Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy3

Received 15 June 2006/ Returned for modification 7 August 2006/ Accepted 8 November 2006

A total of 105 multiple-antibiotic-resistant invasive pneumococcal isolates recovered in Italy from 2001 to 2003 were genetically characterized. Of these, 40 were penicillin-nonsusceptible (PNSSP) and 65 were penicillin-susceptible (PSSP) Streptococcus pneumoniae strains. Among the PNSSP isolates, 8 and 11 different restriction profiles were obtained for the pbp2b and pbp2x genes, respectively. Clonal groups were established on the basis of analysis of both pulsed-field gel electrophoresis (PFGE) types and multilocus sequence typing (MLST). Several international clones, such as Spain23F-1/ST81, Spain6B-2/ST90, Spain9V-3/ST156, and Sweden15A-25/ST263, were identified among the PNSSP isolates. Other, smaller clones, such as the minor Spanish 19F clone/ST88 and Denmark14-32/ST230, were also found. Among the PSSP isolates, clones related to England14-9/ST9, Greece6B-22/ST273, and Portugal19F-21/ST177 were found. In addition, two large clones comprised nonvaccine serotypes. One, comprising serotype 3 isolates, corresponded to the clone Netherlands3-31/ST180; the other, comprising serotype 15B/C isolates, ST474, was not related to any previously described clone. Two small clusters related to the newly described clones Greece21-30/ST193 and Netherlands15B-37/ST199 included isolates with unrelated PFGE profiles. An unusual finding was the inability to obtain the MLST allelic profile for an isolate of serotype 19A, belonging to the Sweden15A-25/ST263 clone, due to a large deletion of the xpt gene. Capsular switching was observed among both PNSSP and PSSP isolates and involved also serotypes not included in the 7-valent pneumococcal conjugate vaccine (PCV7), such as serotypes 15B/C and 19A. Since antibiotic-resistant nonvaccine serotype clones are present in Italy, continuous monitoring of pneumococcal epidemiology should be carried out in the PCV7 era.

* Corresponding author. Mailing address: Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. Phone: (39) 064990 2852. Fax: (39) 064938 7112. E-mail: pantosti{at}iss.it.

{triangledown} Published ahead of print on 22 November 2006.

Journal of Clinical Microbiology, February 2007, p. 306-312, Vol. 45, No. 2
0095-1137/07/$08.00+0     doi:10.1128/JCM.01229-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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