{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:52:33Z","timestamp":1784307153637,"version":"3.55.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T00:00:00Z","timestamp":1652054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p><jats:italic>Streptococcus pneumoniae<\/jats:italic> upper respiratory infections and pneumonia are often treated with macrolides, but recently macrolide resistance is becoming an increasingly important problem. The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the National Immunization Program of Peru in 2015. This study aimed to evaluate the temporal evolution of macrolide resistance in <jats:italic>S. pneumoniae<\/jats:italic> isolates collected in five cross-sectional studies conducted before and after this vaccine introduction, from 2006 to 2019 in Lima, Peru. A total of 521 and 242 <jats:italic>S. pneumoniae<\/jats:italic> isolates recovered from nasopharyngeal swabs from healthy carrier children &amp;lt; 2 years old (2 carriage studies) and samples from normally sterile body areas from pediatric patients with invasive pneumococcal disease (IPD) (3 IPD studies), respectively, were included in this study. Phenotypic macrolide resistance was detected using the Kirby-Bauer method and\/or MIC test. We found a significant increase in macrolide resistance over time, from 33.5% to 50.0% in carriage studies, and from 24.8% to 37.5% and 70.8% in IPD studies. Macrolide resistance genes [<jats:italic>erm<\/jats:italic>(B) and <jats:italic>mef<\/jats:italic>(A\/E)] were screened using PCR. In carriage studies, we detected a significant decrease in the frequency of <jats:italic>mef<\/jats:italic>(A\/E) genes among macrolide-resistant <jats:italic>S. pneumoniae<\/jats:italic> strains (from 66.7% to 50.0%) after introduction of PCV13. The most common mechanism of macrolide-resistant among IPD strains was the presence of <jats:italic>erm<\/jats:italic>(B) (96.0%, 95.2% and 85.1% in the 3 IPD studies respectively). Macrolide resistance was more common in serotype 19A strains (80% and 90% among carriage and IPD strains, respectively) vs. non-serotype 19A (35.5% and 34.4% among carriage and IPD strains, respectively). In conclusion, <jats:italic>S. pneumoniae<\/jats:italic> macrolide resistance rates are very high among Peruvian children. Future studies are needed in order to evaluate macrolide resistance trends among pneumococcal strains, especially now after the COVID-19 pandemic, since azithromycin was vastly used as empiric treatment of COVID-19 in Peru.<\/jats:p>","DOI":"10.3389\/fcimb.2022.866186","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T08:04:04Z","timestamp":1652083444000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["Increase of Macrolide-Resistance in Streptococcus pneumoniae Strains After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Lima, Peru"],"prefix":"10.3389","volume":"12","author":[{"given":"Brayan E.","family":"Gonzales","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik H.","family":"Mercado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Pinedo-Bardales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Hinostroza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Chaparro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olguita","family":"Del \u00c1guila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda E.","family":"Castillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Saenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Reyes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa J.","family":"Ochoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0103293","article-title":"Carriage of Streptococcus pneumoniae and Other Respiratory Bacterial Pathogens in Low and Lower-Middle Income Countries: A Systematic Review and Meta-Analysis","volume":"9","author":"Adegbola","year":"2014","journal-title":"PloS One"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4861","DOI":"10.1016\/j.vaccine.2018.06.068","article-title":"Streptococcus pneumoniae Serotype 19A in Latin America and the Caribbean 2010-2015: A Systematic Review and a Time Series Analysis","volume":"36","author":"Agudelo","year":"2018","journal-title":"Vaccine"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines9010014","article-title":"Impact of Pneumococcal Vaccination in the Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children of the Murcia Region in Spain","volume":"9","author":"Alfayate Migu\u00e9lez","year":"2020","journal-title":"Vaccines"},{"key":"B4","first-page":"155","article-title":"The Impact of the 7-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage of Streptococcus pneumoniae in Infants of Ajlun Governorate in Jordan","volume":"11","author":"Al-Lahham","year":"2018","journal-title":"Jordan J. 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