serotypes and factors associated with antimicrobial resistance in Invasive pneumococcal disease cases in Latvia, 2012-2022.

BACKGROUND

is a major cause of Invasive pneumococcal disease (IPD), including bacteremic pneumonia, septicemia, and meningitis. The introduction of pneumococcal conjugate vaccines (PCVs) has significantly reduced the incidence of IPD caused by vaccine-covered serotypes. However, serotype replacement and antimicrobial resistance remain concerns. In Latvia, vaccination against pneumococcal disease was introduced into the NIP in 2010 with PCV7, later transitioning to PCV10 in 2012 and to PCV15 in 2024. This study aims is to determine the changes in antimicrobial resistance and its association with PCV10 serotypes in Latvia.

MATERIALS AND METHODS

We conducted a population-based cross-sectional study using IPD surveillance data from Latvia over an 11-year period (2012-2022). IPD cases were defined according to the European Union case definition. Serotyping and antimicrobial susceptibility testing were performed on isolates from normally sterile sites. We analyzed the differences in IPD incidence, serotype distribution, and antimicrobial resistance using chi-square tests and multivariable logistic regression was used to determine associations between antimicrobial resistance and risk factors.

RESULTS

A total of 811 IPD cases were reported, with significant differences observed across the study period ( < 0.001). The most common serotypes were 3 and 19A. The proportion of IPD cases caused by PCV10 serotypes significantly decreased over the years, while cases caused by PCV13, PCV15, and PPPV23 serotypes increased. Antimicrobial susceptibility testing revealed resistance rates of 3.8% to penicillin, 5.4% to erythromycin, and 1.2% to cefotaxime/ceftriaxone. Erythromycin resistance showed significant variation over time ( = 0.016), decreasing from 7.1% in 2012 to 4.8% in 2022. Multivariable logistic regression indicated that IPD cases with PCV10 serotypes and meningitis were significantly associated with an increased likelihood of penicillin and erythromycin resistance.

CONCLUSION

The study highlights a decrease in erythromycin resistance in IPD cases over time and significant associations between PCV10 serotypes and meningitis in IPD cases and penicillin and erythromycin resistance. The findings underscore the importance of continuous surveillance of serotypes and antimicrobial resistance patterns to inform treatment guidelines and vaccination policies. Further research is needed to assess the long-term impact of the PCV15 vaccine on serotype distribution and resistance.