Susceptibility Profile of Drug-Resistant Streptococcus pneumoniae Based on ELR

The automated retrieval of antimicrobial susceptibility information via ELR expands public health surveillance without expending additional resources. This study presents the antimicrobial susceptibilities of drug-resistant Streptococcus pneumoniae in a local safety net hospital cohort and compares them with the susceptibilities found by the Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) program. Demographic characteristics and vaccine history of the patients are also reported. The study found one large difference in percentage susceptibility for one antimicrobial drug (penicillin), suggesting a need to develop regional antimicrobial profiles to better inform clinical decisions.

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Pre-detection history of extensively drug-resistant tuberculosis in KwaZulu-Natal, South Africa

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1906636116 ◽

2019 ◽

Vol 116 (46) ◽

pp. 23284-23291 ◽

Cited By ~ 1

Author(s):

Tyler S. Brown ◽

Lavanya Challagundla ◽

Evan H. Baugh ◽

Shaheed Vally Omar ◽

Arkady Mustaev ◽

...

Keyword(s):

Public Health ◽

Public Health Surveillance ◽

Health Surveillance ◽

Whole Genome ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Kwazulu Natal ◽

History Of

Antimicrobial-resistant (AMR) infections pose a major threat to global public health. Similar to other AMR pathogens, both historical and ongoing drug-resistant tuberculosis (TB) epidemics are characterized by transmission of a limited number of predominant Mycobacterium tuberculosis (Mtb) strains. Understanding how these predominant strains achieve sustained transmission, particularly during the critical period before they are detected via clinical or public health surveillance, can inform strategies for prevention and containment. In this study, we employ whole-genome sequence (WGS) data from TB clinical isolates collected in KwaZulu-Natal, South Africa to examine the pre-detection history of a successful strain of extensively drug-resistant (XDR) TB known as LAM4/KZN, first identified in a widely reported cluster of cases in 2005. We identify marked expansion of this strain concurrent with the onset of the generalized HIV epidemic 12 y prior to 2005, localize its geographic origin to a location in northeastern KwaZulu-Natal ∼400 km away from the site of the 2005 outbreak, and use protein structural modeling to propose a mechanism for how strain-specific rpoB mutations offset fitness costs associated with rifampin resistance in LAM4/KZN. Our findings highlight the importance of HIV coinfection, high preexisting rates of drug-resistant TB, human migration, and pathoadaptive evolution in the emergence and dispersal of this critical public health threat. We propose that integrating whole-genome sequencing into routine public health surveillance can enable the early detection and local containment of AMR pathogens before they achieve widespread dispersal.

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