Antimicrobial resistance of Streptococcus pneumoniae from invasive pneumococcal diseases in Latin American countries: a systematic review and meta-analysis

Front Public Health. 2024 Jan 22:12:1337276. doi: 10.3389/fpubh.2024.1337276. eCollection 2024.

Abstract

Background: Invasive pneumococcal disease has declined since pneumococcal conjugate vaccine introduction in Latin America and the Caribbean (LAC). However, serotype distribution and antimicrobial resistance patterns have changed.

Methods: We conducted a systematic review to evaluate the frequency of antimicrobial resistance of Streptococcus pneumoniae from invasive disease in LAC. Articles published between 1 January 2000, and 27 December 2022, with no language restriction, were searched in major databases and gray literature. Pairs of reviewers independently selected extracted data and assessed the risk of bias in the studies. The quality of antimicrobial resistance (AMR) studies was evaluated according to WHO recommendations (PROSPERO CRD42023392097).

Results: From 8,600 records identified, 103 studies were included, with 49,660 positive samples of S. pneumoniae for AMR analysis processed. Most studies were from Brazil (29.1%) and Argentina (18.4%), were cross-sectional (57.3%), reported data on AMR from IPD cases (52.4%), and were classified as moderate risk of bias (50.5%). Resistance to penicillin was 21.7% (95%IC 18.7-25.0, I2: 95.9), and for ceftriaxone/cefotaxime it was 4.7% (95%IC 3.2-6.9, I2: 96.1). The highest resistance for both penicillin and ceftriaxone/cefotaxime was in the age group of 0 to 5 years (32.1% [95%IC 28.2-36.4, I2: 87.7], and 9.7% [95%IC 5.9-15.6, I2: 96.9] respectively). The most frequent serotypes associated with resistance were 14 for penicillin and 19A for ceftriaxone/cefotaxime.

Conclusion: Approximately one-quarter of invasive pneumococcal disease isolates in Latin America and the Caribbean displayed penicillin resistance, with higher rates in young children. Ongoing surveillance is essential to monitor serotype evolution and antimicrobial resistance patterns following pneumococcal conjugate vaccine introduction.

Keywords: Latin America; Streptococcus pneumoniae; antimicrobial resistance; invasive pneumococcal disease; serotypes.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Cefotaxime
  • Ceftriaxone
  • Child
  • Child, Preschool
  • Drug Resistance, Bacterial
  • Humans
  • Infant
  • Infant, Newborn
  • Latin America / epidemiology
  • Penicillins
  • Pneumococcal Infections* / epidemiology
  • Pneumococcal Infections* / prevention & control
  • Pneumococcal Vaccines
  • Streptococcus pneumoniae*
  • Vaccines, Conjugate

Substances

  • Anti-Bacterial Agents
  • Ceftriaxone
  • Vaccines, Conjugate
  • Pneumococcal Vaccines
  • Penicillins
  • Cefotaxime

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported, in whole, by Pfizer Global Medical Grants (GMG), grant number: 76436251. The sponsor had no role in study design, data collection, data analysis, data interpretation, or report writing.