Skip to main content
Top
Published in: BMC Infectious Diseases 1/2019

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

Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China

Authors: Jinjian Fu, Ling Li, Zhuoxin Liang, Shaolin Xu, Nan Lin, Peixu Qin, Xiaohua Ye, Eric McGrath

Published in: BMC Infectious Diseases | Issue 1/2019

Login to get access

Abstract

Background

The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children.

Methods

A retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types.

Results

The dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates.

Conclusion

The high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.
Literature
1.
go back to reference Pichichero ME. Ten-year study of the stringently defined otitis-prone child in Rochester. NY Pediatr Infect Dis J. 2016 Sep;35(9):1033–9.CrossRef Pichichero ME. Ten-year study of the stringently defined otitis-prone child in Rochester. NY Pediatr Infect Dis J. 2016 Sep;35(9):1033–9.CrossRef
2.
go back to reference Ngo CC, Massa HM, Thornton RB, Cripps AW. Predominant Bacteria detected from the middle ear fluid of children experiencing otitis media: a systematic review. PLoS One. 2016;11(3):e0150949.CrossRef Ngo CC, Massa HM, Thornton RB, Cripps AW. Predominant Bacteria detected from the middle ear fluid of children experiencing otitis media: a systematic review. PLoS One. 2016;11(3):e0150949.CrossRef
3.
go back to reference Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161–9.CrossRef Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010;304(19):2161–9.CrossRef
4.
go back to reference Shekelle PG, Takata G, Newberry SJ, Coker T, Limbos MA, Chan LS, et al. Management of Acute Otitis Media: update. Evid Rep Technol Assess (Full Rep). 2010 Nov;(198):1–426. Shekelle PG, Takata G, Newberry SJ, Coker T, Limbos MA, Chan LS, et al. Management of Acute Otitis Media: update. Evid Rep Technol Assess (Full Rep). 2010 Nov;(198):1–426.
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference Geng Q, Zhang T, Ding Y, Tao Y, Lin Y, Wang Y, et al. Molecular characterization and antimicrobial susceptibility of Streptococcus pneumoniae isolated from children hospitalized with respiratory infections in Suzhou. China PLoS One. 2014;9(4):e93752.CrossRef Geng Q, Zhang T, Ding Y, Tao Y, Lin Y, Wang Y, et al. Molecular characterization and antimicrobial susceptibility of Streptococcus pneumoniae isolated from children hospitalized with respiratory infections in Suzhou. China PLoS One. 2014;9(4):e93752.CrossRef
7.
go back to reference 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.CrossRef 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.CrossRef
8.
go back to reference Rodgers GL, Arguedas A, Cohen R, Dagan R. Global serotype distribution among Streptococcus pneumoniae isolates causing otitis media in children: potential implications for pneumococcal conjugate vaccines. Vaccine. 2009;27(29):3802–10.CrossRef Rodgers GL, Arguedas A, Cohen R, Dagan R. Global serotype distribution among Streptococcus pneumoniae isolates causing otitis media in children: potential implications for pneumococcal conjugate vaccines. Vaccine. 2009;27(29):3802–10.CrossRef
9.
go back to reference Cohen R, Varon E, Doit C, Schlemmer C, Romain O, Thollot F, et al. A 13-year survey of pneumococcal nasopharyngeal carriage in children with acute otitis media following PCV7 and PCV13 implementation. Vaccine. 2015;33(39):5118–26.CrossRef Cohen R, Varon E, Doit C, Schlemmer C, Romain O, Thollot F, et al. A 13-year survey of pneumococcal nasopharyngeal carriage in children with acute otitis media following PCV7 and PCV13 implementation. Vaccine. 2015;33(39):5118–26.CrossRef
10.
go back to reference Balsells E, Guillot L, Nair H, Kyaw MH. Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: a systematic review and meta-analysis. PLoS One. 2017;12(5):e0177113.CrossRef Balsells E, Guillot L, Nair H, Kyaw MH. Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: a systematic review and meta-analysis. PLoS One. 2017;12(5):e0177113.CrossRef
11.
go back to reference Weil-Olivier C, van der Linden M, de Schutter I, Dagan R, Mantovani L. Prevention of pneumococcal diseases in the post-seven valent vaccine era: a European perspective. BMC Infect Dis. 2012;12:207.CrossRef Weil-Olivier C, van der Linden M, de Schutter I, Dagan R, Mantovani L. Prevention of pneumococcal diseases in the post-seven valent vaccine era: a European perspective. BMC Infect Dis. 2012;12:207.CrossRef
12.
go back to reference Hu J, Sun X, Huang Z, Wagner AL, Carlson B, Yang J, et al. Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12-18 months in Shanghai, China: a cross-sectional study. BMC Infect Dis. 2016;16:149.CrossRef Hu J, Sun X, Huang Z, Wagner AL, Carlson B, Yang J, et al. Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12-18 months in Shanghai, China: a cross-sectional study. BMC Infect Dis. 2016;16:149.CrossRef
13.
go back to reference 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.CrossRef 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.CrossRef
14.
go back to reference Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twenty-sixth informational supplement M100-S19. Wayne, PA, USA: CLSI; 2016. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twenty-sixth informational supplement M100-S19. Wayne, PA, USA: CLSI; 2016.
15.
go back to reference Ahn JG, Choi SY, Kim DS, Kim KH. Enhanced detection and serotyping of Streptococcus pneumoniae using multiplex polymerase chain reaction. Korean J Pediatr. 2012;55(11):424–9.CrossRef Ahn JG, Choi SY, Kim DS, Kim KH. Enhanced detection and serotyping of Streptococcus pneumoniae using multiplex polymerase chain reaction. Korean J Pediatr. 2012;55(11):424–9.CrossRef
16.
go back to reference Malhotra-Kumar S, Lammens C, Piessens J, Goossens H. Multiplex PCR for simultaneous detection of macrolide and tetracycline resistance determinants in streptococci. Antimicrob Agents Chemother. 2005;49(11):4798–800.CrossRef Malhotra-Kumar S, Lammens C, Piessens J, Goossens H. Multiplex PCR for simultaneous detection of macrolide and tetracycline resistance determinants in streptococci. Antimicrob Agents Chemother. 2005;49(11):4798–800.CrossRef
17.
go back to reference Shakrin NN, Masri SN, Taib NM, Nordin SA, Jamal F, Desa MN. Genotypic characterization of Malaysian human isolates of Streptococcus pneumoniae from carriage and clinical sources. Comp Immunol Microbiol Infect Dis. 2014;37(5–6):347–54.CrossRef Shakrin NN, Masri SN, Taib NM, Nordin SA, Jamal F, Desa MN. Genotypic characterization of Malaysian human isolates of Streptococcus pneumoniae from carriage and clinical sources. Comp Immunol Microbiol Infect Dis. 2014;37(5–6):347–54.CrossRef
18.
go back to reference Enright MC, Spratt BG. A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology. 1998;144(Pt 11):3049–60.CrossRef Enright MC, Spratt BG. A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology. 1998;144(Pt 11):3049–60.CrossRef
19.
go back to reference Scally M, Schuenzel EL, Stouthamer R, Nunney L. Multilocus sequence type system for the plant pathogen Xylella fastidiosa and relative contributions of recombination and point mutation to clonal diversity. Appl Environ Microbiol. 2005;71(12):8491–9.CrossRef Scally M, Schuenzel EL, Stouthamer R, Nunney L. Multilocus sequence type system for the plant pathogen Xylella fastidiosa and relative contributions of recombination and point mutation to clonal diversity. Appl Environ Microbiol. 2005;71(12):8491–9.CrossRef
20.
go back to reference 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.CrossRef 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.CrossRef
21.
go back to reference Zhao C, Li Z, Zhang F, Zhang X, Ji P, Zeng J, et al. Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016. BMC Infect Dis. 2017;17(1):804.CrossRef Zhao C, Li Z, Zhang F, Zhang X, Ji P, Zeng J, et al. Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016. BMC Infect Dis. 2017;17(1):804.CrossRef
22.
go back to reference Li QH, Yao KH, Yu SJ, Ma X, He MM, Shi W, et al. Spread of multidrug-resistant clonal complex 271 of serotype 19F Streptococcus pneumoniae in Beijing, China: characterization of serotype 19F. Epidemiol Infect. 2013;141(12):2492–6.CrossRef Li QH, Yao KH, Yu SJ, Ma X, He MM, Shi W, et al. Spread of multidrug-resistant clonal complex 271 of serotype 19F Streptococcus pneumoniae in Beijing, China: characterization of serotype 19F. Epidemiol Infect. 2013;141(12):2492–6.CrossRef
23.
go back to reference Ip M, Ang I, Liyanapathirana V, Ma H, Lai R. Genetic analyses of penicillin binding protein determinants in multidrug-resistant Streptococcus pneumoniae serogroup 19 CC320/271 clone with high-level resistance to third-generation cephalosporins. Antimicrob Agents Chemother. 2015;59(7):4040–5.CrossRef Ip M, Ang I, Liyanapathirana V, Ma H, Lai R. Genetic analyses of penicillin binding protein determinants in multidrug-resistant Streptococcus pneumoniae serogroup 19 CC320/271 clone with high-level resistance to third-generation cephalosporins. Antimicrob Agents Chemother. 2015;59(7):4040–5.CrossRef
24.
go back to reference Coffey TJ, Daniels M, McDougal LK, Dowson CG, Tenover FC, Spratt BG. Genetic analysis of clinical isolates of Streptococcus pneumoniae with high-level resistance to expanded-spectrum cephalosporins. Antimicrob Agents Chemother. 1995 Jun;39(6):1306–13.CrossRef Coffey TJ, Daniels M, McDougal LK, Dowson CG, Tenover FC, Spratt BG. Genetic analysis of clinical isolates of Streptococcus pneumoniae with high-level resistance to expanded-spectrum cephalosporins. Antimicrob Agents Chemother. 1995 Jun;39(6):1306–13.CrossRef
25.
go back to reference Del Grosso M, Northwood JG, Farrell DJ, Pantosti A. The macrolide resistance genes erm(B) and mef(E) are carried by Tn2010 in dual-gene Streptococcus pneumoniae isolates belonging to clonal complex CC271. Antimicrob Agents Chemother. 2007;51(11):4184–6.CrossRef Del Grosso M, Northwood JG, Farrell DJ, Pantosti A. The macrolide resistance genes erm(B) and mef(E) are carried by Tn2010 in dual-gene Streptococcus pneumoniae isolates belonging to clonal complex CC271. Antimicrob Agents Chemother. 2007;51(11):4184–6.CrossRef
26.
go back to reference Li Y, Tomita H, Lv Y, Liu J, Xue F, Zheng B, et al. Molecular characterization of erm(B)- and mef(E)-mediated erythromycin-resistant Streptococcus pneumoniae in China and complete DNA sequence of Tn2010. J Appl Microbiol. 2011;110(1):254–65.CrossRef Li Y, Tomita H, Lv Y, Liu J, Xue F, Zheng B, et al. Molecular characterization of erm(B)- and mef(E)-mediated erythromycin-resistant Streptococcus pneumoniae in China and complete DNA sequence of Tn2010. J Appl Microbiol. 2011;110(1):254–65.CrossRef
27.
go back to reference 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.CrossRef 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.CrossRef
28.
go back to reference Ramos V, Parra EL, Duarte C, Moreno J. Characterization of Streptococcus pneumoniae invasive serotype 19A isolates recovered in Colombia. Vaccine. 2014;32(7):755–8.CrossRef Ramos V, Parra EL, Duarte C, Moreno J. Characterization of Streptococcus pneumoniae invasive serotype 19A isolates recovered in Colombia. Vaccine. 2014;32(7):755–8.CrossRef
29.
go back to reference Ardanuy C, Rolo D, Fenoll A, Tarrago D, Calatayud L, Liñares J. Emergence of a multidrug-resistant clone (ST320) among invasive serotype 19A pneumococci in Spain. J Antimicrob Chemother. 2009;64(3):507–10.CrossRef Ardanuy C, Rolo D, Fenoll A, Tarrago D, Calatayud L, Liñares J. Emergence of a multidrug-resistant clone (ST320) among invasive serotype 19A pneumococci in Spain. J Antimicrob Chemother. 2009;64(3):507–10.CrossRef
30.
go back to reference Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: worldwide epidemiology. Expert Rev Vaccines. 2017;16(10):1007–27.CrossRef Isturiz R, Sings HL, Hilton B, Arguedas A, Reinert RR, Jodar L. Streptococcus pneumoniae serotype 19A: worldwide epidemiology. Expert Rev Vaccines. 2017;16(10):1007–27.CrossRef
31.
go back to reference Shin J, Baek JY, Kim SH, Song JH, Ko KS. Predominance of ST320 among Streptococcus pneumoniae serotype 19A isolates from 10 Asian countries. J Antimicrob Chemother. 2011;66(5):1001–4.CrossRef Shin J, Baek JY, Kim SH, Song JH, Ko KS. Predominance of ST320 among Streptococcus pneumoniae serotype 19A isolates from 10 Asian countries. J Antimicrob Chemother. 2011;66(5):1001–4.CrossRef
32.
go back to reference 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. 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.
33.
go back to reference Calatayud L, Ardanuy C, Cercenado E, Fenoll A, Bouza E, Pallares R, et al. Serotypes, clones, and mechanisms of resistance of erythromycin-resistant Streptococcus pneumoniae isolates collected in Spain. Antimicrob Agents Chemother. 2007;51(9):3240–6.CrossRef Calatayud L, Ardanuy C, Cercenado E, Fenoll A, Bouza E, Pallares R, et al. Serotypes, clones, and mechanisms of resistance of erythromycin-resistant Streptococcus pneumoniae isolates collected in Spain. Antimicrob Agents Chemother. 2007;51(9):3240–6.CrossRef
34.
go back to reference Rice LB. Tn916 family conjugative transposons and dissemination of antimicrobial resistance determinants. Antimicrob Agents Chemother. 1998;42(8):1871–7.CrossRef Rice LB. Tn916 family conjugative transposons and dissemination of antimicrobial resistance determinants. Antimicrob Agents Chemother. 1998;42(8):1871–7.CrossRef
35.
go back to reference Yatim MM, Masri SN, Desa MN, Taib NM, Nordin SA, Jamal F. Determination of phenotypes and pneumococcal surface protein A family types of Streptococcus pneumoniae from Malaysian healthy children. J Microbiol Immunol Infect. 2013 Jun;46(3):180–6.CrossRef Yatim MM, Masri SN, Desa MN, Taib NM, Nordin SA, Jamal F. Determination of phenotypes and pneumococcal surface protein A family types of Streptococcus pneumoniae from Malaysian healthy children. J Microbiol Immunol Infect. 2013 Jun;46(3):180–6.CrossRef
36.
go back to reference Hotomi M, Togawa A, Kono M, Ikeda Y, Takei S, Hollingshead SK, et al. PspA family distribution, antimicrobial resistance and serotype of Streptococcus pneumoniae isolated from upper respiratory tract infections in Japan. PLoS One. 2013;8(3):e58124.CrossRef Hotomi M, Togawa A, Kono M, Ikeda Y, Takei S, Hollingshead SK, et al. PspA family distribution, antimicrobial resistance and serotype of Streptococcus pneumoniae isolated from upper respiratory tract infections in Japan. PLoS One. 2013;8(3):e58124.CrossRef
37.
go back to reference Golden AR, Rosenthal M, Fultz B, Nichol KA, Adam HJ, Gilmour MW, et al. Characterization of MDR and XDR Streptococcus pneumoniae in Canada, 2007-13. J Antimicrob Chemother. 2015;70(8):2199–202.CrossRef Golden AR, Rosenthal M, Fultz B, Nichol KA, Adam HJ, Gilmour MW, et al. Characterization of MDR and XDR Streptococcus pneumoniae in Canada, 2007-13. J Antimicrob Chemother. 2015;70(8):2199–202.CrossRef
38.
go back to reference Zähner D, Gudlavalleti A, Stephens DS. Increase in pilus islet 2-encoded pili among Streptococcus pneumoniae isolates, Atlanta, Georgia, USA. Emerg Infect Dis. 2010;16(6):955–62.CrossRef Zähner D, Gudlavalleti A, Stephens DS. Increase in pilus islet 2-encoded pili among Streptococcus pneumoniae isolates, Atlanta, Georgia, USA. Emerg Infect Dis. 2010;16(6):955–62.CrossRef
39.
go back to reference Wierzbowski AK, Karlowsky JA, Adam HJ, Nichol KA, Hoban DJ. Zhanel GG; Canadian antimicrobial resistance Alliance. Evolution and molecular characterization of macrolide-resistant Streptococcus pneumoniae in Canada between 1998 and 2008. J Antimicrob Chemother. 2014;69(1):59–66.CrossRef Wierzbowski AK, Karlowsky JA, Adam HJ, Nichol KA, Hoban DJ. Zhanel GG; Canadian antimicrobial resistance Alliance. Evolution and molecular characterization of macrolide-resistant Streptococcus pneumoniae in Canada between 1998 and 2008. J Antimicrob Chemother. 2014;69(1):59–66.CrossRef
40.
go back to reference Moschioni M, Donati C, Muzzi A, Masignani V, Censini S, Hanage WP, et al. Streptococcus pneumoniae contains 3 rlrA pilus variants that are clonally related. J Infect Dis. 2008;197(6):888–96.CrossRef Moschioni M, Donati C, Muzzi A, Masignani V, Censini S, Hanage WP, et al. Streptococcus pneumoniae contains 3 rlrA pilus variants that are clonally related. J Infect Dis. 2008;197(6):888–96.CrossRef
Metadata
Title
Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China
Authors
Jinjian Fu
Ling Li
Zhuoxin Liang
Shaolin Xu
Nan Lin
Peixu Qin
Xiaohua Ye
Eric McGrath
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2019
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-019-3795-8

Other articles of this Issue 1/2019

BMC Infectious Diseases 1/2019 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.