JAC Advance Access originally published online on October 29, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 953-960
© 2003 The British Society for Antimicrobial Chemotherapy
Emergence of a fluoroquinolone-resistant strain of Streptococcus pneumoniae in England
1 Antibiotic Resistance Monitoring and Reference Laboratory and 2 the Respiratory and Systemic Infection Laboratory, Specialist and Reference Microbiology Division, Health Protection Agency, Colindale, London NW9 5HT; 3 Birmingham Health Protection Agency Laboratory, Birmingham B9 5SS; 4 Division of Immunity & Infection, Medical School, University of Birmingham, Birmingham B15 2TT, UK
Received 12 June 2003; returned 7 August 2003; revised 5 September 2003; accepted 9 September 2003
Objective: To determine the epidemiological relationship between pneumococci of serotype 9V, with reduced susceptibility to ciprofloxacin, penicillin and erythromycin, referred to the Reference Laboratory during 1997–2001.
Methods: Isolates were characterized by multilocus sequence typing (MLST), PFGE, and sequencing of parC and gyrA. Relevant clinical data were sought.
Results: Forty-eight isolates were received from nine laboratories in England, but 35 (73%) were from one laboratory in Birmingham, and were mostly from elderly patients receiving ofloxacin or ciprofloxacin for respiratory infections. There were two quinolone resistance phenotypes, with ciprofloxacin, moxifloxacin and gemifloxacin MICs of 8–32, 0.5–1 and 0.125–0.25 mg/L, and 64–256, 4–16 and 1–4 mg/L, respectively. Each of three isolates from the former group had mutations in parC, whereas each of nine isolates from the more resistant group had mutations in both parC and gyrA. Several also had increased quinolone efflux. Typing of 27 quinolone-resistant isolates showed that eight were indistinguishable from the epidemic Spain9V-3 (ST156) clone, while the remainder belonged to a novel but related type (ST609), that differed from Spain9V-3 at 2/7 alleles (2 bp changes in aroE and 1 bp change in gdh). Both MLST types were represented among isolates with high- and low-level quinolone resistance. Three of five serotype 9V isolates from Birmingham, with reduced susceptibility to penicillin and erythromycin, and ciprofloxacin MICs of 1–2 mg/L, belonged to MLST type ST609, while another was indistinguishable from the Spain9V-3 clone. Review of records of 32 patients from Birmingham indicated that some isolates were nosocomial, whereas others were acquired in the community.
Conclusions: In the late 1990s, a quinolone-resistant strain, clonally related to Spain9V-3, emerged in England, principally in Birmingham.
Keywords: Streptococcus pneumoniae, MLST, quinolone resistance
* Corresponding author. Tel: +44-208-200-4400 ext. 4237; Fax: +44-208-358-3292; E-mail: alan.johnson{at}hpa.org.uk
Present address. University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
¶ Present address. Wells Healthcare, Speldhurst Place, Speldhurst Road, Tunbridge Wells TN4 0JB, UK.
Present address. Wells Healthcare, Speldhurst Place, Speldhurst Road, Tunbridge Wells TN4 0JB, UK.
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