Emerg Infect Dis. 2020 Apr;26(4):711-720. doi: 10.3201/eid2604.190717.
Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013-2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain-ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure.
耐抗菌药物的肺炎链球菌引起的侵袭性肺炎球菌病的发病率不断增加，包括日本的青霉素和美罗培南耐药血清型 15A-ST63 克隆。在 2013-2017 年期间，我们在台湾收集了 206 株侵袭性肺炎球菌分离株进行青霉素和美罗培南药敏试验。我们发现血清型 15B/C-ST83 和 15A-ST63 是最常见的青霉素和美罗培南耐药克隆。转化研究证实青霉素结合蛋白（PBP）2b 是美罗培南耐药的主要决定因素，而 PBP1a 是高水平耐药所必需的。在研究期间，血清型 15B/C-ST83 的发生率增加。所有 15B/C-ST83 分离株均表现出 ermB 大环内酯类耐药基因型。重组位点预测分析显示，与肺炎链球菌西班牙-ST81 基因组相比，15B/C-ST83 中有 12 个重组区。在疫苗和抗菌药物的选择压力下，肺炎球菌克隆迅速重组以获得生存优势并在局部扩张。在具有高抗菌压力的国家，15B/C-ST83 的传播令人警惕。
