Viteri-Dávila Carolina, Morales-Jadán Diana, Creel Aidan, Jop Vidal Ana G, Boldo Xavier M, Rivera-Olivero Ismar A, Bautista-Muñoz Consuelo, Alibayov Babek, Garcia-Bereguiain Miguel Ángel, Vidal Jorge E
One Health Research Group, Universidad de Las Américas, Quito, Ecuador.
Summer Undergraduate Research Experience Program, School of Graduate Studies in the Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi.
Am J Trop Med Hyg. 2024 Jul 30;111(4):756-764. doi: 10.4269/ajtmh.23-0913. Print 2024 Oct 2.
Macrolide antibiotics are recommended for the treatment of pneumococcal pneumonia and invasive pneumococcal disease (IPD). Prior to 2000, ∼10% of Streptococcus pneumoniae strains isolated from IPD cases in Latin American countries were resistant to macrolides. The mechanism of resistance to macrolides was associated mainly with the efflux pump known as the macrolide efflux genetic assembly, since most pneumococcal strains carried the mef(A/E) gene, whereas <6% strains carried both the methylase gene ermB and mef(A/E). In the first decade of this century, a significant increase in the prevalence of macrolide resistance was observed in pneumococcal strains in both Mexico and Peru. Approximately 30% of S. pneumoniae strains in these countries were already resistant to erythromycin, while the prevalence in Colombia, Argentina, and Brazil remained below 10%. During the last decade, we have been experiencing a worrisome increase in pneumococcal strains carrying resistance to macrolides, with a prevalence of up to 80% for resistance to erythromycin. The mechanism for disseminating macrolide resistance has evolved. Currently, more than 55% of invasive S. pneumoniae macrolide-resistant strains carry both the ermB and the mef(A/E)/mel genes. Lessons learned from the current macrolide resistance crisis in Latin America can inform interventions in other regions.
大环内酯类抗生素被推荐用于治疗肺炎球菌肺炎和侵袭性肺炎球菌病（IPD）。2000年之前，从拉丁美洲国家IPD病例中分离出的肺炎链球菌菌株约有10%对大环内酯类耐药。对大环内酯类的耐药机制主要与被称为大环内酯外排基因组合的外排泵有关，因为大多数肺炎球菌菌株携带mef(A/E)基因，而携带甲基化酶基因ermB和mef(A/E)的菌株不到6%。在本世纪的第一个十年，墨西哥和秘鲁的肺炎球菌菌株对大环内酯类的耐药率显著上升。这些国家约30%的肺炎链球菌菌株已对红霉素耐药，而哥伦比亚、阿根廷和巴西的耐药率仍低于10%。在过去十年中，我们一直面临着携带大环内酯类耐药性的肺炎球菌菌株令人担忧的增加，对红霉素的耐药率高达80%。大环内酯类耐药性传播的机制已经演变。目前，超过55%的侵袭性肺炎链球菌大环内酯类耐药菌株同时携带ermB和mef(A/E)/mel基因。从拉丁美洲目前的大环内酯类耐药危机中吸取的教训可为其他地区的干预措施提供参考。
