Antimicrobial resistance of Streptococcus pneumoniae in adults with community-acquired pneumonia in Kazan before and during the COVID-19 pandemic

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: Diseases caused by Streptococcus pneumoniae remain one of the leading causes of infectious disease–related mortality in Russia and worldwide. The COVID-19 pandemic, accompanied by increased use of antibacterial agents for the treatment of respiratory tract infections, has affected both the spectrum of pathogens and the trends of antimicrobial resistance. However, findings vary across different regions.

AIM: The study aimed to investigate trends in the frequency of pneumococcus strains resistant to antimicrobial agents in adults with community-acquired pneumonia in Kazan from 2019 to 2022.

METHODS: It was a retrospective observational study of pneumococcal antimicrobial resistance using data from the Laboratory Diagnostic Center of the Republican Clinical Infectious Diseases Hospital named after Professor A. F. Agafonov. Sputum samples from adults with community-acquired pneumonia were collected from 11 medical institutions in Kazan between 2019 and 2022. Antimicrobial resistance was determined by the disk diffusion method and interpreted according to the Russian guidelines Determination of Microorganism Susceptibility to Antimicrobial Agents. The frequency of resistant pneumococcus strains and changes in resistance profiles were assessed. In addition, a retrospective analysis of the incidence of bacterial pneumonia in Kazan from 2019 to 2024 was performed.

RESULTS: From 2019 to 2024, the incidence of bacterial community-acquired pneumonia among the adult population in Kazan increased from 76.8 per 100,000 population (95% CI, 71.3–82.3) to 88.3 per 100,000 (95% CI, 82.4–94.2) (p = 0.002). The highest and the lowest incidences were observed in 2024 and 2021, respectively. Among the 196 Streptococcus pneumoniae isolates studied, the proportions of resistant strains were as follows: penicillin, 38.3% (95% CI, 31.5–45.1); erythromycin, 26.0% (95% CI, 19.8–32.2); levofloxacin, 10.7% (95% CI, 6.1–15.3); clindamycin, 16.8% (95% CI, 11.5–22.1); tetracycline, 22.3% (95% CI, 14.1–28.5); and co-trimoxazole, 30.8% (95% CI, 24.3–37.3).

CONCLUSION: A high proportion of pneumococcus strains resistant to major classes of antibacterial agents was identified. During the peak years of the COVID-19 pandemic (2020–2022), no significant changes were observed in the frequency or resistance profiles of pneumococcus strains isolated from patients with community-acquired bacterial pneumonia compared with 2019.

Full Text

Restricted Access

About the authors

Gulshat R. Khasanova

Kazan State Medical University

Author for correspondence.
Email: gulshatra@mail.ru
ORCID iD: 0000-0002-1733-2576
SPIN-code: 6704-2840

MD, Dr. Sci. (Medicine), Professor

Russian Federation, 49 Butlerov st, Kazan, 420000

Sergey A. Semenov

Kazan State Medical University

Email: sergejsemenov596@gmail.com
ORCID iD: 0000-0003-3437-832X
SPIN-code: 8774-6450

MD

Russian Federation, Kazan

Elena F. Yumagulova

Republican Clinical Infectious Diseases Hospital named after Professor A.F. Agafonov

Email: Elena.Yumagulova@tatar.ru
ORCID iD: 0000-0003-4012-2371

MD

Russian Federation, Kazan

Marina N. Belova

Republican Clinical Infectious Diseases Hospital named after Professor A.F. Agafonov

Email: marina116bp@yandex.ru
ORCID iD: 0000-0001-9579-3370

MD

Russian Federation, Kazan

References

  1. Essential Programme on Immunization, Immunization, Vaccines and Biologicals. Pneumococcus: Vaccine Preventable Diseases Surveillance Standards [Internet]. Geneva: World Health Organization; 2018. [cited 2024 Jan 29]. Available from: https://cdn.who.int/media/docs/default-source/immunization/vpd_surveillance/vpd-surveillance-standards-publication/17-who-surveillancevaccinepreventable-17-pneumo-russian-r1.pdf?sfvrsn=5de986bf_10&download=true
  2. Mazur LI, Pyrkova SA, Kurshina MV, Bekeeva IYu. Assessment of the safety and influence of pneumococcal vaccine “Prevenar-13” on the incidence of pneumonia and otitis in children in the first five years of life. Medical & Pharmaceutical Journal “Pulse”. 2024;26(10):58–65. doi: 10.26787/nydha-2686-6838-2024-26-10-58-65 EDN: WVIOOE
  3. Avdeeva MG, Shubina GV, Ganzha AA, Zhuravleva EV. Community-acquired pneumonia in infectious hospital patients: the development of resistance to antimicrobials. Epidemiology and Infectious Diseases. 2018;23(3):108–113. doi: 10.18821/1560-9529-2018-23-3-108-113 EDN: LTBTJF
  4. CDC. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta: U.S. Department of Health and Human Services; 2022. doi: 10.15620/cdc:117915
  5. Stavar-Matei L, Mihailov OM, Nechita A, et al. Impact of COVID-19 on Pneumococcal Acute Otitis Media, Antibiotic Resistance, and Vaccination in Children. Infection and Drug Resistance. 2024;17:5567–5578. doi: 10.2147/idr.s496057 EDN: FTSBJS
  6. Almeida SCG, Lemos APS, Bierrenbach AL, et al. Serotype Distribution and Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae in COVID-19 Pandemic Era in Brazil. Microorganisms. 2024;12(2):401. doi: 10.3390/microorganisms12020401 EDN: RCDCRB
  7. Sempere J, Llamosí M, López Ruiz B, et al. Effect of Pneumococcal Conjugate Vaccines and SARS-CoV-2 on Antimicrobial Resistance and the Emergence of Streptococcus pneumoniae Serotypes with Reduced Susceptibility in Spain, 2004–20: A National Surveillance Study. The Lancet Microbe. 2022;3(10):e744–e752. doi: 10.1016/S2666-5247(22)00127-6 EDN: ZDFZYU
  8. Manzanal A, Vicente D, Alonso M, et al. Impact of the Progressive Uptake of Pneumococcal Conjugate Vaccines on the Epidemiology and Antimicrobial Resistance of Invasive Pneumococcal Disease in Gipuzkoa, Northern Spain, 1998–2022. Frontiers in Public Health. 2023;11:1238502. doi: 10.3389/fpubh.2023.1238502 EDN: IMYVQJ
  9. CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta: U.S. Department of Health and Human Services, CDC; 2019. doi: 10.15620/cdc:82532
  10. Hjálmarsdóttir M, Haraldsson G, Quirk SJ, et al. Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland. PLOS ONE. 2020;15(3):e0230332. doi: 10.1371/journal.pone.0230332 EDN: VMBHNH
  11. Kaur R, Pham M, Yu KOA, Pichichero ME. Rising Pneumococcal Antibiotic Resistance in the Post–13-Valent Pneumococcal Conjugate Vaccine Era in Pediatric Isolates From a Primary Care Setting. Clinical Infectious Diseases. 2020;72(5):797–805. doi: 10.1093/cid/ciaa157 EDN: DTGUJE
  12. Laboratory diagnostics of community-acquired pneumonia of pneumococcal etiology: Methodological recommendations. Moscow: Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing; 2017. (In Russ.) ISBN: 978-7508-1541-8 [cited 2024 Jan 29]. Available from: https://files.stroyinf.ru/Data2/1/4293743/4293743035.pdf
  13. Russian recommendations. Determination of the sensitivity of microorganisms to antimicrobial drugs. Version 2024-02. Smolensk: Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Smolensk State Medical University; 2024. (In Russ.) ISBN: 978-5-91812-253-2 [cited 2024 Jan 29]. Available from: https://www.antibiotic.ru/files/334/ocmap2024.pdf
  14. Savilov ED, Astafev VA, Zhdanov SN, Zarudnev EA. Epidemiological analysis methods of statistical processing of material. Novosibirsk: Nauka-Center; 2011. (In Russ.) ISBN: 978-5-9554-0024-2 Available from: https://rusneb.ru/catalog/000200_000018_RU_NLR_bibl_1850958/?ysclid=mcakhxh4cd210125207
  15. Agresti A, Coull BA. Approximate is Better than “Exact” for Interval Estimation of Binomial Proportions. The American Statistician. 1998;52(2):119–126. doi: 10.1080/00031305.1998.10480550 EDN: GSICPF
  16. State report “On the state of sanitary and epidemiological well-being of the population in the Republic of Tatarstan in 2022”. Kazan: Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing in the Republic of Tatarstan (Tatarstan); 2023. (In Russ.) [cited 2024 Jan 29]. Available from: https://fbuz16.ru/wp-content/uploads/2023/03/gosudarstvennyj-doklad-o-sostoyanii-sanitarno-epidemiologicheskogo-blagopoluchiya-naseleniya-v-respublike-tatarstan-v-2022-godu.pdf?ysclid=mcalku9pyi903183533
  17. State report “On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2023”. Мoscow: Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing; 2024. (In Russ.) [cited 2025 Mar 13]. Available from: https://ammicrob.ru/upload/medialibrary/ba3/2yoqtxicsk1hnltab9uw8biyg240z3j4.pdf
  18. Khasanova GR, Semenov SA. The Impact of the COVID-19 Pandemic on the Manifestations of the Epidemic Process of Community-Acquired Pneumonia. Medicinskij al’manah. 2025;(1):103–112. EDN: XBTDLF
  19. Temporary guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)”, Version 9. Moscow: Ministry of Health of the Russian Federation; 2020. (In Russ.) [cited 2025 Mar 13]. Available from: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/548/original/%D0%9C%D0%A0_COVID-19_%28v.9%29.pdf
  20. Kuzmenkov AYu, Vinogradova AG, Trushin IV, et al. AMRmap — antibiotic resistance surveillance system in Russia. Clinical Microbiology and Antimicrobial Chemotherapy. 2021;23(2):198–204. doi: 10.36488/cmac.2021.2.198-204 EDN: MCLEON
  21. Li L, Ma J, Yu Z, et al. Epidemiological characteristics and antibiotic resistance mechanisms of Streptococcus pneumoniae: An updated review. Microbiological Research. 2023;266:127221. doi: 10.1016/j.micres.2022.127221 EDN: FITBWY

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Incidence of community-acquired bacterial pneumonia in the adult population of Kazan in 2019–2024, per 100,000 adult population.

Download (809KB)
Indexing metadata
3. Fig. 2. Proportions of antibiotic-resistant pneumococcal strains in community-acquired pneumonia in Kazan in 2019–2022.

Download (836KB)
Indexing metadata
4. Fig. 3. Dynamics of changes in the proportions of pneumococcal strains with different antibiotic resistance profiles isolated from adult patients with community-acquired pneumonia in Kazan (2019–2022).

Download (827KB)
Indexing metadata
5. Fig. 4. Dynamics of changes in the proportions of the most common patterns of antibiotic resistance in pneumococci isolated from adult patients with community-acquired pneumonia in Kazan (2019–2022): Row 1 — strains resistant simultaneously to penicillin, erythromycin, clindamycin, tetracycline, and co-trimoxazole; Row 2 — strains resistant simultaneously to penicillin, tetracycline, and co-trimoxazole; Row 3 — strains resistant to co-trimoxazole; Row 4 — strains resistant simultaneously to penicillin and co-trimoxazole; Row 5 — strains resistant to penicillin.

Download (785KB)
Indexing metadata

Copyright (c) 2025 Eco-vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80652 от 15.03.2021 . Учредитель ООО "Эко-Вектор Ай-Пи" (ОГРН 1157847215338).