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BMC Pediatrics
Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Streptococci | Research article

Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis

Authors: Jinjian Fu, Rongsong Yi, Yongjiang Jiang, Shaolin Xu, Peixu Qin, Zhuoxin Liang, Jichang Chen

Published in: BMC Pediatrics | Issue 1/2019

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Abstract

Background

To summarize information about invasive pneumococcal disease (IPD) among children in mainland China.

Methods

Sixteen eligible studies were included in this systematic review and the random effect model was used to estimate the pool prevalence of IPD.

Results

The most predominant serotypes circulating in children were 19F (27.7, 95% confidence interval (95% CI): 17.7–37.6%), 19A (21.2%, 16.4–26.1%), 14 (16.5%, 12.8–20.1%), 6B (8.6%, 5.2–10.8%) and 23F (7.3%, 5.2–9.5%). The serotype coverage of the available pneumococcal conjugate vaccines PCV7, PCV10, and PCV13 was 60.8% (52.5–69.4%), 65.1% (57.7–72.4%), and 90.0% (87.1–92.8%), respectively. The pooled antibiotic resistance rates of Streptococcus pneumoniae revealed a resistance to penicillin prevalence rate of 32.0% (12.1–51.9%). Approximately 94.4% (90.7–98.1%) and 92.3% (87.4–97.3%) of isolates were resistant to erythromycin and clindamycin. eBURST analysis revealed great diversity among isolates, with 102 sequence types (STs) for 365 isolates. The major predominant clonal complexes (CCs) were CC271 (43.6%, 159/365), CC876 (13.4%, 49/365), CC81 (5.2%, 19/365), and CC90 (4.1%, 15/365). Long-term and regional surveillance of S. pneumoniae is necessary.

Conclusions

Based on our pooled results showing that PCV13 coverage of the reported serotypes was 90% and that most serotypes contributed to the distribution of antibiotic-resistant isolates, implementation of PCV13 into the Chinese Expanded Program on Immunizations (EPI) would achieve health benefits in Chinese children.
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Literature
1.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Child health epidemiology reference group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375:1969–87.PubMedCrossRef
2.
Bryce J, Boschi-Pinto C, Shibuya K, et al. WHO child health epidemiology reference group. WHO estimates of the causes of death in children. Lancet. 2005;365:1147–52.PubMedCrossRef
3.
4.
O’Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, et al. Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374:893–902.PubMedCrossRef
5.
de Oliveira LH, Camacho LA, Coutinho ES, Martinez-Silveira MS, Carvalho AF, Ruiz-Matus C, et al. Impact and effectiveness of 10 and 13-valent pneumococcal conjugate vaccines on hospitalization and mortality in children aged less than 5 years in Latin American countries: a systematic review. PLoS One. 2016;11(12):e0166736.PubMedPubMedCentralCrossRef
6.
Moreira M, Castro O, Palmieri M, Efklidou S, Castagna S, Hoet B. A reflection on invasive pneumococcal disease and pneumococcal conjugate vaccination coverage in children in southern Europe (2009-2016). Hum Vaccin Immunother. 2016;20:0.
7.
Chalmers JD, Campling J, Dicker A, Woodhead M, Madhava H. A systematic review of the burden of vaccine preventable pneumococcal disease in UK adults. BMC Pulm Med. 2016;16(1):77.PubMedPubMedCentralCrossRef
8.
Yao KH, Yang YH. Streptococcus pneumoniae diseases in Chinese children: past, present and future. Vaccine. 2008;26(35):4425–33.PubMedCrossRef
9.
10.
Boulton ML, Ravi NS, Sun X, Huang Z, Wagner AL. Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005-2011: a retrospective cohort study. BMC Public Health. 2016;16:109.PubMedPubMedCentralCrossRef
11.
Hu S, Shi Q, Song S, Du L, He J, Chen CI, Caldwell R, Wang B, Roberts CS. Estimating the Cost-Effectiveness of the 7-Valent Pneumococcal Conjugate Vaccine in Shanghai, China. Value Health Reg Issues. 2014 May;3:197-204PubMedCrossRef
12.
Pan F, Han L, Huang W, Tang J, Xiao S, Wang C, et al. Serotype distribution, antimicrobial susceptibility, and molecular epidemiology of Streptococcus pneumoniae isolated from children in Shanghai, China. PLoS One. 2015;10(11):e0142892.PubMedPubMedCentralCrossRef
13.
14.
Deng X, Arya G, Memari N, Mackenzie R, MacMullin G, Low DE, et al. Genetic analysis of invasive pneumococcal isolates from children in Ontario, Canada, 2007-2012. Pediatr Infect Dis J. 2015;34(6):594–8.PubMedCrossRef
15.
16.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
17.
18.
19.
Xue L, Yao K, Xie G, Zheng Y, Wang C, Shang Y, et al. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates that cause invasive disease among Chinese children. Clin Infect Dis. 2010;50(5):741–4.PubMedCrossRef
20.
Ma X, Zhao R, Ma Z, Yao K, Yu S, Zheng Y, et al. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing invasive diseases from Shenzhen Children’s hospital. PLoS One. 2013;8(6):e67507.PubMedPubMedCentralCrossRef
21.
Liu C, Xiong X, Xu W, Sun J, Wang L, Li J. Serotypes and patterns of antibiotic resistance in strains causing invasive pneumococcal disease in children less than 5 years of age. PLoS One. 2013;8(1):e54254.PubMedPubMedCentralCrossRef
22.
Ding Y, Geng Q, Tao Y, Lin Y, Wang Y, Black S, et al. Etiology and epidemiology of children with acute otitis media and spontaneous otorrhea in Suzhou, China. Pediatr Infect Dis J. 2015;34(5):e102–6.PubMedCrossRef
23.
Kang LH, Liu MJ, Xu WC, Cui JJ, Zhang XM, Wu KF, et al. Molecular epidemiology of pneumococcal isolates from children in China. Saudi Med J. 2016;37(4):403–13.PubMedPubMedCentralCrossRef
24.
Liu CL, Zhao CJ, Liu YD, Wang H. Study of serotype distribution, antimicrobial resistance patterns and molecular epidemiology in 148 isolates of invasive Streptococcus pneumoniae. Natl Med J China. 2010;90(22):1565–70.
25.
Xu F, Chi FL, Tan H, Liu XM, Cao T, Pan W, et al. Study on serotype distribution in 48 isolates of invasive Streptococcus pneumoniae with which children infected. Chin J Biochem Pharm. 2012;33(6):909–11.
26.
Lu C. Serotype distribution in invasive Streptococcus pneumoniae from hospitalized pediatric patients. Int J Lab Med. 2015;36(7):990–2.
27.
Zhou K, Xie GJ, Wang XW, Xu F, Yao KH. Clinical characteristic of invasive pneumococcal disease and its serotype distribution. Chin J Nosocomiol. 2015;25(15):3392–4.
28.
Song XQ, Duan DR, Lai JX. Serotype and drug resistance of Streptococcus pneumoniae from preschool children with suppurative otitis media. Chin J Microecol. 2015;27(7):819–23.
29.
Wang YT, Guo YH, Wang Q, Jia ZY, Zhang WC, Sun YQ, et al. Serotype analysis of 43 strains of invasive Streptococcus pneumoniae isolated in Hebei Province, 2014. Chin J Vaccines Immun. 2016;22(1):6–9.
30.
Lyu S, Yao KH, Dong F, Xu BP, Liu G, Wang Q, et al. Vaccine serotypes of Streptococcus pneumoniae with high-level antibiotic resistance isolated more frequently seven years after the licensure of PCV7 in Beijing. Pediatr Infect Dis J. 2016;35(3):316–21.PubMedCrossRef
31.
Liu Y, Wang H, Chen M, Sun Z, Zhao R, Zhang L, et al. Serotype distribution and antimicrobial resistance patterns of Streptococcus pneumoniae isolated from children in China younger than 5 years. Diagn Microbiol Infect Dis. 2008;61(3):256–63.PubMedCrossRef
32.
Dong F, Zhen JH, Wang Y, Xu BP, Wang Q, Liu G, et al. Analysis of features of streptococcus pneumoniae isolated from the cultured bacteria sample in pediatric patients. Chin J Pract Pediatr. 2016;31(3):201–5.
33.
Li J, Ma LJ, Shi W, Zhou L, Xu WJ, Yao KH, et al. Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolated in hospitalized children. Chin J Lab Med. 2015;38(9):622–6.
34.
Miao DQ, Xu F, Li JQ, Liu JJ, Shao ZQ, Zhu T, et al. Serotype distribution of streptococcus pneumoniae from children's clinical isolates in Nanjing. China Med Eng. 2016;24(2):12–5.
35.
Chen Y, Deng W, Wang SM, Mo QM, Jia H, Wang Q, et al. Burden of pneumonia and meningi-tis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review. PLoS One. 2011;6:e27333.PubMedPubMedCentralCrossRef
36.
Johnson HL, Deloria-Knoll M, Levine OS, Stoszek SK, Freimanis Hance L, Reithinger R, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the pneumococcal global serotype project. PLoS Med. 2010;7(10):e1000348.PubMedPubMedCentralCrossRef
37.
Kim SH, Song JH, Chung DR, Thamlikitkul V, Yang Y, Wang H, ANSORP Study Group, et al. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian network for surveillance of resistant pathogens (ANSORP) study. Antimicrob Agents Chemother. 2012;56(3):1418–26.PubMedPubMedCentralCrossRef
38.
du Plessis M, Allam M, Tempia S, Wolter N, de Gouveia L, von Mollendorf C, Jolley KA, Mbelle N, Wadula J, Cornick JE, Everett DB, McGee L, Breiman RF, Gladstone RA, Bentley SD, Klugman KP, von Gottberg A. Phylogenetic analysis of invasive serotype 1 pneumococcus in South Africa, 1989 to 2013. J Clin Microbiol. 2016;54(5):1326–34.PubMedPubMedCentralCrossRef
39.
Brueggemann AB, Peto TE, Crook DW, Butler JC, Kristinsson KG, Spratt BG. Temporal and geographic stability of the serogroup-specific invasive disease potential of Streptococcus pneumoniae in children. J Infect Dis. 2004;190(7):1203–11.PubMedCrossRef
40.
Wang L, Fu J, Liang Z, Chen J. Prevalence and serotype distribution of nasopharyngeal carriage of Streptococcus pneumoniae in China: a meta-analysis. BMC Infect Dis. 2017;17(1):765.PubMedPubMedCentralCrossRef
41.
Feikin DR, Kagucia EW, Loo JD, Link-Gelles R, Puhan MA, Cherian T, et al. Serotype Replacement Study Group. Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites. PLoS Med. 2013;10(9):e1001517.PubMedPubMedCentralCrossRef
42.
Yu H, Yang W, Varma JK. To save children’s lives, China should adopt an initiative to speed introduction of pneumonia vaccines. Health Aff. 2012;31(11):2545–53.CrossRef
43.
Guevara M, Barricarte A, Torroba L, Herranz M, Gil-Setas A, Gil F, et al. Working Group for Surveillance of the Pneumococcal Invasive Disease in Navarra. Direct, indirect and total effects of 13-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in children in Navarra, Spain, 2001 to 2014: cohort and case-control study. Euro Surveill. 2016;21:14.CrossRef
44.
Zheng J, Cao L, Guo S, Wang LAK, Yu W, et al. Survey of the current situation of category 2 vaccines in Chinese children aged 1 to 2 years. Chin J Vaccine Immun. 2012;18(3):233–7 [In Chinese].
45.
Mo X, Gai Tobe R, Liu X, Mori R. Cost-effectiveness and health benefits of pediatric 23-valent pneumococcal polysaccharide vaccine, 7-valent pneumococcal conjugate vaccine and forecasting 13-valent pneumococcal conjugate vaccine in China. Pediatr Infect Dis J. 2016;35(11):e353–61.PubMedCrossRef
46.
Hu S, Shi Q, Chen CI, Caldwell R, Wang B, Du L, et al. Estimated public health impact of nationwide vaccination of infants with 7-valent pneumococcal conjugate vaccine (PCV7) in China. Int J Infect Dis. 2014;26:116–22.PubMedCrossRef
47.
Zhao C, Zhang F, Chu Y, Liu Y, Cao B, Chen M, et al. Phenotypic and genotypic characteristic of invasive pneumococcal isolates from both children and adult patients from a multicenter surveillance in China 2005-2011. PLoS One. 2013;8(12):e82361.PubMedPubMedCentralCrossRef
48.
Bowers JR, Driebe EM, Nibecker JL, Wojack BR, Sarovich DS, Wong AH, et al. Dominance of multidrug resistant CC271 clones in macrolide-resistant streptococcus pneumoniae in Arizona. BMC Microbiol. 2012;12:12.PubMedPubMedCentralCrossRef
49.
Messina AF, Katz-Gaynor K, Barton T, Ahmad N, Ghaffar F, Rasko D, et al. Impact of the pneumococcal conjugate vaccine on serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates in Dallas, TX, children from 1999 through 2005. Pediatr Infect Dis J. 2007;26(6):461–7.PubMedCrossRef
50.
Imai S, Ito Y, Ishida T, Hirai T, Ito I, Maekawa K, et al. Kansai community acquired pneumococcal pneumonia study group. High prevalence of multidrug-resistant pneumococcal molecular epidemiology network clones among Streptococcus pneumoniae isolates from adult patients with community-acquired pneumonia in Japan. Clin Microbiol Infect. 2009;15(11):1039–45.PubMedCrossRef
51.
Eun BW, Kim SJ, Cho EY, Lee J, Choi EH, Lee HJ. Genetic structure of Streptococcus pneumoniae isolated from children in a tertiary care university hospital, in Korea, 1995 to 2005. Diagn Microbiol Infect Dis. 2010;68(4):345–51.PubMedCrossRef
52.
Qian J, Yao K, Xue L, Xie G, Zheng Y, Wang C, et al. Diversity of pneumococcal surface protein A (PspA) and relation to sequence typing in Streptococcus pneumoniae causing invasive disease in Chinese children. Eur J Clin Microbiol Infect Dis. 2012;31(3):217–23.PubMedCrossRef
53.
He M, Yao K, Shi W, Gao W, Yuan L, Yu S, et al. Dynamics of serotype 14 Streptococcus pneumoniae population causing acute respiratory infections among children in China (1997-2012). BMC Infect Dis. 2015;15:266.PubMedPubMedCentralCrossRef
Metadata
Title
Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis
Authors
Jinjian Fu
Rongsong Yi
Yongjiang Jiang
Shaolin Xu
Peixu Qin
Zhuoxin Liang
Jichang Chen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1722-1

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