Spread of ceftriaxone non-susceptible pneumococci in South Korea

Long-term care facilities as a potential reservoir

Min Joo Choi, Ji Yun Noh, Hee-Jin Cheong, Woo Joo Kim, Min Ja Kim, Ye Seul Jang, Saem Na Lee, Eun Hwa Choi, Hoan Jong Lee, Joon-Young Song

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged 65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8–62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1–15.0) and renal diseases (OR 9.1, 95% CI 1.2–70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.

Original languageEnglish
Article numbere0210520
JournalPLoS One
Volume14
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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long term care
ceftriaxone
Republic of Korea
Ceftriaxone
South Korea
Long-Term Care
Streptococcus pneumoniae
odds ratio
confidence interval
Odds Ratio
Confidence Intervals
kidney diseases
serotypes
lungs
Genotype
Hospital beds
Pneumococcal Pneumonia
Immunization
Immunization Programs
Levofloxacin

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Spread of ceftriaxone non-susceptible pneumococci in South Korea : Long-term care facilities as a potential reservoir. / Choi, Min Joo; Noh, Ji Yun; Cheong, Hee-Jin; Kim, Woo Joo; Kim, Min Ja; Jang, Ye Seul; Lee, Saem Na; Choi, Eun Hwa; Lee, Hoan Jong; Song, Joon-Young.

In: PLoS One, Vol. 14, No. 1, e0210520, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged 65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8{\%}). Some of these cases also showed levofloxacin resistance (25{\%}, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95{\%} confidence interval [CI] 0.8–62.1) and patients with chronic lung (OR 4.1, 95{\%} CI 1.1–15.0) and renal diseases (OR 9.1, 95{\%} CI 1.2–70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4{\%} versus 13.3{\%}, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.",
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