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J Med Microbiol 55 (2006), 567-574; DOI: 10.1099/jmm.0.46387-0
© 2006 Society for General Microbiology
ISSN 1473-5644

Increase in numbers of ß-lactam-resistant invasive Streptococcus pneumoniae in Brazil and the impact of conjugate vaccine coverage

Maria-Cristina C. Brandileone1, Silvana Tadeu Casagrande1, Maria-Luiza L. S. Guerra1, Rosemeire Cobo Zanella1, Ana-Lucia S. S. Andrade2 and José-Luis Di Fabio3

1 Bacteriology Branch, Adolfo Lutz Institute, Av. Dr. Arnaldo 355, CEP: 01246-902, São Paulo, SP, Brazil

2 Institute of Tropical Pathology and Public Health, Federal University of Goiás, Brazil

3 Technology and Health Service Delivery, Pan-American Health Organization, Washington, DC, USA

Correspondence
Maria-Cristina C. Brandileone
brandi{at}ial.sp.gov.br

Received 25 October 2005
Accepted 4 January 2006

A comprehensive investigation of invasive Streptococcus pneumoniae was carried out in Brazil as part of the programme of the national epidemiological surveillance system. The investigation provided data on the trends of resistance to antimicrobial agents. A total of 6470 isolates of S. pneumoniae collected in the country from 1993 to 2004 were tested. During this period of time, the number of penicillin-resistant strains rose from 10·2 to 27·9 %. The proportions of intermediate and high-level resistant strains in 1993, which were 9·1 and 1·1 %, respectively, rose to 22·0 and 5·9 % in 2004. Geometric mean MICs for penicillin increased after the year 2000, to 0·19 µg ml–1 in 2004; most of these isolates were from patients with pneumonia and from children under 5 years old, and belonged to serotype 14. There was a significant increase in the number of isolates belonging to serotypes included in the 7-valent conjugate vaccine from children under 5 years old: from 48·6 % in 1993 to 69·6 % in 2004, mainly related to an increase in the frequency of serotype 14 isolates. From 2000 to 2004, meningitis isolates showed higher resistance rates to cefotaxime (2·6 %) compared to non-meningitis isolates (0·7 %); percentages of isolates resistant to trimethoprim-sulfamethoxazole, tetracycline, erythromycin, chloramphenicol and rifampicin were 65, 14·6, 6·2, 1·3 and 0·7 %, respectively. No levoflaxin resistance was observed. Multidrug resistance was identified in 4·6 % of isolates, of which 3·8 % were resistant to three classes, 0·7 % to four classes and 0·1 % to five classes of antimicrobial agent. The study provides valuable information that may support empirical antimicrobial therapy for severe S. pneumoniae infections in Brazil, and emphasizes the need for conjugate pneumococcal vaccination.

Abbreviations: CI, confidence interval; GMC, geometric mean of MIC; IAL, Adolfo Lutz Institute; I, intermediate resistance; MDR, multidrug resistance; NSP, non-susceptible to penicillin; R, resistant; S, susceptible; SIREVA, Sistema Regional de Vacunas; 7-val, 7-valent; 9-val, 9-valent.




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