Epidemiological Characterization of Streptococcus Pneumoniae using Multi Locus Sequence Typing Across India

Abstract

Invasive pneumococcal disease is one among the vaccine preventable invasive bacterial disease that attribute substantial mortality and morbidity in India. Preventive measures that are available currently needs adequate baseline data for decision making on execution as well as to monitor and assess the impact of these measures in India. Regardless of vaccines, that has varying efficacy based on the regions, antibiotics are the only shield against pneumococcal infections. However, irrational use of antibiotics against infections has led to increase in antimicrobial resistance. Being a commensal in the upper respiratory tract, S. pneumoniae are constantly exposed to antibiotics that are used against infections caused either by pneumococci or other organisms. S. pneumonia evolves under these selective pressures through recombination by transformation. In pneumococci recombination can take place via transformation and mobile genetic elements like transposons. Recombination can lead to change in the genotype subsequently the phenotype of the organism. Recombination can lead to development of penicillin resistance if that involves PBPs and additional resistance is spread by the transposons carrying macrolide resistance genes. Combined effect of all these mechanisms ascend pneumococci a potential pathogen and necessitates continuous phenotypic, genotypic and antimicrobial surveillance for effective treatment and prevention. This study contributes to the baseline phenotypic and MLST data of S. pneumonia combined with antimicrobial resistance of prevalent invasive Indian isolates in the prevacccine era. Though recently (2018), pneumococcal vaccines are roll out in selected 5 states with high pneumococcal burden, the isolates genotypically characterised in this study belong to the year 2012-2014. Study one carried out the epidemiologic characterization of S. pneumoniae involving serotyping and molecular typing by MLST. To summarize the pneumococcal evolution and antimicrobial resistance in India is mediated by the few resistant PMEN clones.