Increase in Penicillin and multidrug resistance in Streptococcus pneumoniae (1993-2016): report from a tertiary care hospital laboratory, Pakistan

Authors

  • Afia Zafar Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Farida Khurram Lalani National Institute of Health, NIH, Rawalpindi, Pakistan
  • Ahmer Arif Longi Medicine Welcare Hospital, Dubai, UAE
  • Mohammad Raheel Jajja Surgical Education Office, Emory University Hospital, Atlanta
  • Maera Haider Department of Abdominal Imaging, Beth Israel Deaconess Medical Center, Boston, USA
  • Salila Hashmi University of Calgary, Alberta Canada
  • Erum Khan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Seema Irfan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Tabinda Hussain Northmead Family Medical Practice, Northmead, Australia
  • Faisal Riaz Hussain Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Rumina Hasan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Kauser Jabeen Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

DOI:

https://doi.org/10.47391/JPMA.1178

Keywords:

S. pneumoniae, Resistance, MDR, Penicillin, Revised CLSI Breakpoints

Abstract

Background: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. With the emergence of penicillin-resistant S. pneumoniae (PRSP), treatment has become challenging. The Clinical and Laboratory Standards Institute (CLSI) in 2008 revised its guidelines for S. pneumoniae and recommended separate penicillin breakpoints for meningeal and non-meningeal strains. Similar to penicillin’s, resistance to other classes of antibiotics has emerged globally.

Objective: The objective of this study is to determine the trend of resistance to antimicrobials in S. pneumoniae infections and the impact of new CLSI guidelines on penicillin susceptibility among meningeal isolates.

Methodology: Twenty-four years (1993-2016) data from S. pneumoniae isolates and their antimicrobial susceptibility was retrieved from the computerized database. Data was divided into two groups for analysis, pre-2008 and post 2008.

Results: Penicillin resistance remained unchanged in non-meningeal isolates during both study periods. A significant rise in penicillin resistance in meningeal isolates was observed in the second period 2008-2016 (2.9% vs 36.2%). High resistance rates were observed for co-trimoxazole, tetracycline and erythromycin. Increased trend of multi-drug resistant (MDR) strains were also noted, from 11% in 1999 to 36% in 2016.

 Conclusion: The emergence of MDR strains is evident from our dataset. It seems like the rise in PRSP in meningeal isolates is due to revised CLSI guidelines. Overall low resistance to penicillin in non-meningeal isolates and no resistance to ceftriaxone is encouraging and will assist in drafting local guidelines. Cautious use of antimicrobials are essential to reduce further emergence of antimicrobial resistance in indigenous isolates.  

Author Biographies

Farida Khurram Lalani, National Institute of Health, NIH, Rawalpindi, Pakistan

Infection Prevention and Control Consultant, National Institute of Health 

 

 

 

 

 

Ahmer Arif Longi, Medicine Welcare Hospital, Dubai, UAE

Consultant 

 

Mohammad Raheel Jajja, Surgical Education Office, Emory University Hospital, Atlanta

 Fellow

Maera Haider, Department of Abdominal Imaging, Beth Israel Deaconess Medical Center, Boston, USA

 

 

Salila Hashmi, University of Calgary, Alberta Canada

 

 

Erum Khan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Professor 

Department of Pathology and Laboratory Medicine

Seema Irfan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Associate Professor 

Department of Pathology and Laboratory Medivcine

Tabinda Hussain, Northmead Family Medical Practice, Northmead, Australia

Assistant 

Faisal Riaz Hussain, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Data Manager 

Department of Pathology and Laboratory Medicine

Rumina Hasan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Professor 

Deaprtment of Pathology and Laboratory Medicine 

Kauser Jabeen, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan

Associate Professor

Department of Pathology and Laboratory Medicine 

Published

2022-01-05

Issue

Section

Original Article