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. 2023 Aug;12(8):2017-2037.
doi: 10.1007/s40121-023-00842-w. Epub 2023 Jul 13.

Highly Resistant Serotype 19A Streptococcus pneumoniae of the GPSC1/CC320 Clone from Invasive Infections in Poland Prior to Antipneumococcal Vaccination of Children

Weronika Puzia  1   2 , Jan Gawor  2 , Robert Gromadka  2 , Karolina Żuchniewicz  2 , Izabela Wróbel-Pawelczyk  1 , Patrycja Ronkiewicz  1 , Agnieszka Gołębiewska  1 , Waleria Hryniewicz  1 , Ewa Sadowy  3 , Anna Skoczyńska  4
Affiliations

Highly Resistant Serotype 19A Streptococcus pneumoniae of the GPSC1/CC320 Clone from Invasive Infections in Poland Prior to Antipneumococcal Vaccination of Children

Weronika Puzia et al. Infect Dis Ther. 2023 Aug.

Abstract

Introduction: The introduction of pneumococcal conjugate vaccines (PCV) into the national immunization programs (NIPs) has significantly reduced the number of pneumococcal infections. However, infections caused by isolates of non-vaccine serotypes (NVT) started spreading shortly thereafter and strains of NVT 19A have become the main cause of invasive pneumococcal disease burden worldwide. The aim of the study was to characterize serotype 19A invasive pneumococci of GPSC1/CC320 circulating in Poland before the introduction of PCV into the Polish NIP in 2017 and to compare them to isolates from other countries where PCVs were implemented much earlier than in Poland.

Methods: All the GPSC1/CC320 isolates were analyzed by serotyping, susceptibility testing, and whole genome sequencing followed by analyses of resistome, virulome, and core genome multilocus sequence typing (cgMLST), including comparative analysis with isolates with publicly accessible genomic sequences (PubMLST).

Results: During continuous surveillance the NRCBM collected 4237 invasive Streptococcus pneumoniae isolates between 1997 and 2016, including 200 isolates (4.7%) of serotype 19A. The most prevalent among 19A pneumococci were highly resistant representatives of Global Pneumococcal Sequence Cluster 1/Clonal Complex 320, GPSC1/CC320 (n = 97, 48.5%). Isolates of GPSC1/CC320 belonged to three sequence types (STs): ST320 (75.2%) ST4768 (23.7%), and ST15047 (1.0%), which all represented the 19A-III cps subtype and had complete loci for both PI-1 and PI-2 pili types. On the basis of the cgMLST analysis the majority of Polish GPSC1/CC320 isolates formed a group clearly distinct from pneumococci of this clone observed in other countries.

Conclusion: Before introduction of PCV in the Polish NIP we noticed an unexpected increase of serotype 19A in invasive pneumococcal infections, with the most common being representatives of highly drug-resistant GPSC1/CC320 clone, rarely identified in Europe both before and even after PCV introduction.

Keywords: Antibiotic-resistant pneumococci; Invasive pneumococcal infections; Pneumococcal conjugate vaccines; Pneumococcal serotype 19A; Streptococcus pneumoniae.

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Conflict of interest statement

Anna Skoczyńska has received unrestricted grants from Merck Sharp & Dohme and Pfizer paid directly to her home institution, non-financial support from Pfizer, and personal fees (for being on an advisory board and speaker fees) from Merck Sharp & Dohme and Pfizer. Weronika Puzia, Jan Gawor, Robert Gromadka, Karolina Żuchniewicz, Izabela Wróbel-Pawelczyk, Patrycja Ronkiewicz, Agnieszka Gołębiewska, Waleria Hryniewicz, and Ewa Sadowy have nothing to disclose.

Figures

Fig. 1
Fig. 1
Distribution of the clonal complexes (CC) among invasive S. pneumoniae of serotype 19A and percentage of 19A isolates among all pneumococci responsible for invasive infection in Poland, 1997–2016 (in the case when isolates were not assigned to any known CC, the sequence type (ST) was provided)
Fig. 2
Fig. 2
Distribution of the sequence types (STs) and clonal complexes (CCs) of S. pneumoniae of serotype 19A responsible for invasive infections among age groups of Polish patients, 1997–2016
Fig. 3
Fig. 3
Phylogenetic tree of 97 Polish GPSC1/CC320 S. pneumoniae isolates of serotype 19A, constructed based on cgSTs
Fig. 4
Fig. 4
Phylogenetic tree of 97 Polish GPSC1/CC320 S. pneumoniae isolates of serotype 19A clustered with 300 isolates of GPSC1/CC320 and serotype 19A from other countries with genomic sequences available in the PubMLST Pneumococcal Genome Library (date last accessed 3 April 2023). Tree was constructed based on cgSTs
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