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Multicentric Analysis of Erythromycin Resistance Determinants in Invasive Streptococcus pneumoniae; Associated Serotypes and Sequence Types in India

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Abstract

Streptococcus pneumoniae is the major cause of childhood pneumonia and related deaths in India. Widespread use of erythromycin for the treatment of pneumonia has led to the emergence of erythromycin resistance. Despite this increase in erythromycin resistance, there are very little data on resistance determinants from India. Hence, we aimed to perform the molecular characterization of erythromycin-resistant invasive pneumococcal isolates in India. In this study, 250 erythromycin-resistant invasive isolates obtained from four Indian hospitals between 2014 and 2019 were included. The isolates were reconfirmed by standard CDC protocols, followed by detection of erm(B), mef(A/E) genes, and screening for mutations in 23S rRNA, ribosomal proteins L4 and L22. Among the 250 erythromycin-resistant isolates, 46% (n = 114) and 35% (n = 87) carried the mef(A/E) gene and erm(B) gene, respectively; both genes were present in 8% (n = 20) of the isolates and 12% (n = 29) of the studied strains did not bear any of them. The major mutations associated with erythromycin resistance in 23S rRNA, such as A2060C, A2061G, and C2613G, were absent. The predominant serotypes were 19F, 14, 23F, 6A, 6B, 19A, and 9V. The major clonal complexes were CC320, followed by CC230 and CC63. The predominant gene was mef(A/E), and most of the serotypes were PCV13 (54%). This study contributes to the baseline understanding of the erythromycin resistance determinants associated with the serotypes and sequence types (ST) of Indian invasive S. pneumoniae.

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Funding

No funding was received toward this study.

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Authors and Affiliations

  1. Department of Clinical Microbiology, Christian Medical College, Vellore, 632004, TN, India

    Rosemol Varghese, Jones Lionel Daniel, Ayyanraj Neeravi, Pavithra Baskar, Binesh Lal Yesudhasan & Balaji Veeraraghavan

  2. The CHILDS Trust Medical Research Foundation, Chennai, TN, India

    Anand Manoharan

  3. Kanchi Kamakoti CHILDS Trust Hospital, Chennai, TN, India

    Balasubramanian Sundaram

  4. Department of Microbiology, Maulana Azad Medical College, New Delhi, Delhi, India

    Vikas Manchanda

  5. Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, Delhi, India

    Karnika Saigal

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  1. Rosemol Varghese
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  2. Jones Lionel Daniel
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  4. Pavithra Baskar
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  10. Balaji Veeraraghavan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by RV, AN, JLK, and PB. RV wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Balaji Veeraraghavan.

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All the authors declare that they have no conflict of interest.

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The institutional ethical committee of Christian Medical College has approved the study. (Institutional Review Board Min.No:8200).

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Varghese, R., Daniel, J.L., Neeravi, A. et al. Multicentric Analysis of Erythromycin Resistance Determinants in Invasive Streptococcus pneumoniae; Associated Serotypes and Sequence Types in India. Curr Microbiol 78, 3239–3245 (2021). https://doi.org/10.1007/s00284-021-02594-7

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