Lima Jailton L C, da Silva Amanda B, Cabral Amanda S, de Miranda Filipe M, da Silva Lívia D, da Silva André R A, Teixeira Lúcia M, Neves Felipe P G
Instituto Biomédico, Universidade Federal Fluminense, Alameda Barros Terra, s/n, São Domingos, Niterói, RJ 24020-150, Brazil.
Faculdade de Medicina, Universidade Federal Fluminense, Rua Des, Athayde Parreiras, 100, Fátima, Niterói, RJ 24070-090, Brazil.
Vaccine. 2025 Jan 25;45:126588. doi: 10.1016/j.vaccine.2024.126588. Epub 2024 Dec 14.
The introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) for nationwide childhood immunization in 2010 led to a significant reduction in colonization and invasive pneumococcal disease (IPD) by vaccine serotypes in young. However, non-vaccine serotypes have emerged, and serotype 19A is now the leading cause of IPD in Brazil.
We analyzed 32 serotype 19A isolates of Streptococcus pneumoniae recovered from children and adults who attended different health facilities in the state of Rio de Janeiro, Brazil, between 2010 and 2023. The capsular types of the isolates were determined by sequential multiplex PCR or by cpsB gene sequencing. All isolates were subjected to antimicrobial susceptibility testing and MLST.
Of the 32 serotype 19A isolates, 29 (90.6 %) isolates were recovered from children aged ≤5 years and three (9.4 %) isolates were recovered from adults. Nineteen (59.4 %) isolates were associated with colonization, and 13 (40.6 %) isolates were from diseases. All isolates were susceptible to chloramphenicol, levofloxacin, linezolid, rifampin, and vancomycin. The highest frequencies of non-susceptibility (intermediate + resistant) were observed for sulfamethoxazole-trimethoprim (n = 30; 93.8 %), penicillin (n = 24; 75 %), and erythromycin (n = 23; 71.9 %). Twenty-two (68.8 %) isolates were multidrug resistant (MDR). MICs for penicillin among penicillin-non-susceptible pneumococci (PNSP) ranged from 0.12 to 8.0 μg/mL. MICs for erythromycin ranged from 0.064 to >256 μg/mL. MICs for ceftriaxone ranged from 0.023 to 4 μg/mL. The most common genetic lineages were ST733 (n = 7; 21.9 %), mostly found before and in the early years of PCV10 introduction, and CC320 (n = 25; 78.1 %), mostly found in the late-PCV10 period. All 25 isolates within CC320 were PNSP and mostly (n = 22; 88 %) MDR.
We observed a shift in antimicrobial susceptibility profiles and genetic lineages after long-term use of PCV, mostly PCV10, for routine childhood immunization, characterized by clonal expansion of the MDR lineage CC320.
2010年10价肺炎球菌结合疫苗（PCV10）在全国范围内用于儿童免疫接种，使得疫苗血清型在幼儿中的定植和侵袭性肺炎球菌病（IPD）显著减少。然而，非疫苗血清型出现了，目前19A血清型是巴西IPD的主要病因。
我们分析了2010年至2023年间从巴西里约热内卢州不同卫生机构就诊的儿童和成人中分离出的32株肺炎链球菌19A血清型菌株。通过连续多重PCR或cpsB基因测序确定菌株的荚膜类型。所有菌株均进行抗菌药物敏感性测试和多位点序列分型（MLST）。
在32株19A血清型菌株中，29株（90.6%）从5岁及以下儿童中分离得到，3株（9.4%）从成人中分离得到。19株（59.4%）菌株与定植有关，13株（40.6%）菌株来自疾病患者。所有菌株对氯霉素、左氧氟沙星、利奈唑胺、利福平和万古霉素敏感。对复方磺胺甲恶唑（n = 30；93.8%）、青霉素（n = 24；75%）和红霉素（n = 23；71.9%）的非敏感性（中介+耐药）频率最高。22株（68.8%）菌株为多重耐药（MDR）。青霉素不敏感肺炎球菌（PNSP）中青霉素的最低抑菌浓度（MIC）范围为0.12至8.0μg/mL。红霉素的MIC范围为0.064至>256μg/mL。头孢曲松的MIC范围为0.023至4μg/mL。最常见的遗传谱系是ST733（n = 7；21.9%），大多在PCV10引入之前及引入初期发现，以及CC320（n = 25；78.1%），大多在PCV10使用后期发现。CC320内的所有25株菌株均为PNSP，且大多（n = 22；88%）为MDR。
在长期使用PCV（主要是PCV-10）进行儿童常规免疫接种后，我们观察到抗菌药物敏感性谱和遗传谱系发生了变化，其特征是多重耐药谱系CC320的克隆性扩张。
