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Antimicrobial Agents and Chemotherapy, November 2002, p. 3512-3517, Vol. 46, No. 11
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.11.3512-3517.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Emergence in Vietnam of Streptococcus pneumoniae Resistant to Multiple Antimicrobial Agents as a Result of Dissemination of the Multiresistant Spain23F-1 Clone

Christopher M. Parry,1,2* Nguyen Minh Duong,3 Jiaji Zhou,4 Nguyen Thi Hoang Mai,3 To Song Diep,3 Le Quoc Thinh,3 John Wain,1,2,{dagger} Nguyen Van Vinh Chau,3 David Griffiths,5 Nicholas P. J. Day,1,2 Nicholas J. White,1,2 Tran Tinh Hien,3 Brian G. Spratt,4 and Jeremy J. Farrar1,2

Wellcome Trust Clinical Research Unit,1 Centre for Tropical Diseases, Ho Chi Minh City, Vietnam,3 Department of Infectious Disease Epidemiology, Imperial College of Medicine, London W2 1PG,4 Centre for Tropical Medicine, Nuffield Department of Medicine,2 Oxford Vaccine Group, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom5

Received 25 March 2002/ Returned for modification 2 July 2002/ Accepted 30 July 2002

Surveillance for Streptococcus pneumoniae resistant to penicillin and other antimicrobial agents is necessary to define the optimal empirical antibiotic therapy for meningitis in resource-poor countries such as Vietnam. The clinical and microbiological features of 100 patients admitted to the Centre for Tropical Diseases in Ho Chi Minh City, Vietnam, between 1993 and 2002 with invasive pneumococcal disease were studied. A penicillin-nonsusceptible pneumococcus (MIC, >=0.1 µg/ml) was isolated from the blood or cerebrospinal fluid of 8% of patients (2 of 24) between 1993 and 1995 but 56% (20 of 36) during 1999 to 2002 (P < 0.0001). Pneumococcal isolates resistant to penicillin (MIC, >=2.0 µg/ml) increased from 0% (0 of 24) to 28% (10 of 36) (P = 0.002). Only one isolate was ceftriaxone resistant (MIC, 2.0 µg/ml). Penicillin-nonsusceptible pneumococci were isolated from 78% of children younger than 15 years (28 of 36) compared with 25% of adults (16 of 64) (P = 0.0001). Isolation of a penicillin-nonsusceptible pneumococcus in adults with meningitis was independently associated with referral from another hospital (P = 0.005) and previous antibiotic therapy (P = 0.025). Multilocus sequence typing showed that 86% of the invasive penicillin-resistant pneumococcus isolates tested (12 of 14) were of the Spain23F-1 clone. The serotypes of >95% of the penicillin-nonsusceptible pneumococci were included in the currently available pneumococcal vaccines. Our findings point to the recent introduction and spread of the Spain23F-1 clone of penicillin-resistant pneumococci in Vietnam. Simple clinical predictors can be used to guide empirical antibiotic therapy of meningitis. Pneumococcal vaccination may help to control this problem.

* Corresponding author. Present address: Department of Medical Microbiology and Genitourinary Medicine, Duncan Building, Daulby St., Liverpool L69 3GA, United Kingdom. Phone: 44 151 706 4381. Fax: 44 151 7065 805. E-mail: chrisparry3{at}btopenworld.com.

{dagger} Present address: Centre for Molecular Microbiology and Infection, Imperial College of Science, Technology and Medicine, South Kensington, London SW7 2AZ, United Kingdom.

Antimicrobial Agents and Chemotherapy, November 2002, p. 3512-3517, Vol. 46, No. 11
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.11.3512-3517.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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