Ann Lab Med 2019; 39(6): 537-544  https://doi.org/10.3343/alm.2019.39.6.537
Serotype Distribution and Antimicrobial Resistance of Invasive and Noninvasive Streptococcus pneumoniae Isolates in Korea between 2014 and 2016
Dong-Chul Park , Ph.D.1*, Si Hyun Kim , Ph.D.2*, Dongeun Yong , M.D.3, In Bum Suh , M.D.4, Young Ree Kim , M.D.5, Jongyoun Yi , M.D.6, Wonkeun Song , M.D.7, Sae Am Song , M.D.1, Hee-Won Moon , M.D.8, Hae Kyung Lee , M.D.9, Kyoung Un Park , M.D.10, Sunjoo Kim , M.D.11, Seok Hoon Jeong , M.D.3, Jaehyeon Lee , M.D.12, Joseph Jeong , M.D.13, Yu Kyung Kim , M.D.14, Miae Lee , M.D.15, Jihyun Cho , M.D.16, Jong-Wan Kim , M.D.17, Kyeong Seob Shin , M.D.18, Sang-Hyun Hwang , M.D.19, Jae-Woo Chung , M.D.20, Hye In Woo , M.D.21, Chae Hoon Lee , M.D.22, Namhee Ryoo , M.D.23, Chulhun L. Chang , M.D.6, Hyun Soo Kim , M.D.7, Jayoung Kim , M.D.24, Jong Hee Shin , M.D.25, Soo Hyun Kim , M.D.25, Mi-Kyung Lee , M.D.26, Seong Gyu Lee , M.D.27, Sook Jin Jang , M.D.28, Kyutaeg Lee , M.D.29, HunSuk Suh , M.D.30, Yong-Hak Sohn , M.D.31, Min-Jung Kwon , M.D.21, Hee Joo Lee , M.D.32, Ki Ho Hong , M.D.33, Kwang-Sook Woo , M.D.34, Chul Min Park , M.D.35, and Jeong Hwan Shin , M.D.1,36
1Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea; 2Department of Clinical Laboratory Science, Semyung University, Jecheon, Korea; 3Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea; 4Department of Laboratory Medicine, Kangwon National University College of Medicine, Chuncheon, Korea; 5Department of Laboratory Medicine, School of Medicine, Jeju National University, Jeju, Korea; 6Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea; 7Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea; 8Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea; 9Department of Laboratory Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 10Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea; 11Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, Korea; 12Department of Laboratory Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea; 13Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea; 14Department of Laboratory Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; 15Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Korea; 16Department of Laboratory Medicine, Wonkwang University College of Medicine, Iksan, Korea; 17Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea; 18Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Korea; 19Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea; 20Department of Laboratory Medicine, Dongguk University College of Medicine, Ilsan, Korea; 21Department of Laboratory Medicine and Genetics, Samsung Medical Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; 22Department of Laboratory Medicine, College of Medicine, Yeungnam University, Daegu, Korea; 23Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea; 24Department of Laboratory Medicine, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea; 25Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea; 26Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea; 27Department of Laboratory Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea; 28Department of Laboratory Medicine, College of Medicine, Chosun University, Gwangju, Korea; 29Department of Laboratory Medicine, Cheju Halla General Hospital, Jeju, Korea; 30Department of Laboratory Medicine, Daegu Catholic University School of Medicine, Daegu, Korea; 31Department of Laboratory Medicine, Eulji University School of Medicine, Daejeon, Korea; 32Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea; 33Department of Laboratory Medicine, Seoul Medical Center, Seoul, Korea; 34Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea; 35Department of Laboratory Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea; 36Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea
Corresponding author: Jeong Hwan Shin, M.D.
Department of Laboratory Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea
Tel: +82-51-890-6475 Fax: +82-51-890-8615 E-mail: jhsmile@inje.ac.kr

*These authors equally contributed to this study.
Received: January 28, 2019; Revised: April 14, 2019; Accepted: June 13, 2019; Published online: November 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea.
Methods: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern.
Results: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more seccommon in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively.
Conclusions: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.
Keywords: Streptococcus pneumoniae, Serotype, Antimicrobial resistance, Pneumococcal vaccine



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