JAC Advance Access published online on October 29, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg469
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Antibiotic Resistance
Monitoring and Reference Laboratory, Specialist and Reference Microbiology Division, Health Protection
Agency, Colindale, London
NW9 5HT;
* Corresponding author. E-mail: alan.johnson{at}hpa.org.uk.
Received 12 June 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
Emergence of a fluoroquinolone-resistant strain
of
Streptococcus pneumoniae in England
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
5 Birmingham Health
Protection Agency Laboratory, Birmingham B9 5SS; Division of Immunity & Infection,
Medical School, University of Birmingham, Birmingham B15 2TT, UK
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