Increase in Penicillin and multidrug resistance in Streptococcus pneumoniae (1993-2016): report from a tertiary care hospital laboratory, Pakistan Authors Afia Zafar Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Farida Khurram Lalani National Institute of Health, NIH, Rawalpindi, Pakistan Ahmer Arif Longi Medicine Welcare Hospital, Dubai, UAE Mohammad Raheel Jajja Surgical Education Office, Emory University Hospital, Atlanta Maera Haider Department of Abdominal Imaging, Beth Israel Deaconess Medical Center, Boston, USA Salila Hashmi University of Calgary, Alberta Canada Erum Khan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Seema Irfan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Tabinda Hussain Northmead Family Medical Practice, Northmead, Australia Faisal Riaz Hussain Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Rumina Hasan Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Kauser Jabeen Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan DOI: https://doi.org/10.47391/JPMA.1178 Keywords: S. pneumoniae, Resistance, MDR, Penicillin, Revised CLSI Breakpoints Abstract Background: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. With the emergence of penicillin-resistant S. pneumoniae (PRSP), treatment has become challenging. The Clinical and Laboratory Standards Institute (CLSI) in 2008 revised its guidelines for S. pneumoniae and recommended separate penicillin breakpoints for meningeal and non-meningeal strains. Similar to penicillin’s, resistance to other classes of antibiotics has emerged globally. Objective: The objective of this study is to determine the trend of resistance to antimicrobials in S. pneumoniae infections and the impact of new CLSI guidelines on penicillin susceptibility among meningeal isolates. Methodology: Twenty-four years (1993-2016) data from S. pneumoniae isolates and their antimicrobial susceptibility was retrieved from the computerized database. Data was divided into two groups for analysis, pre-2008 and post 2008. Results: Penicillin resistance remained unchanged in non-meningeal isolates during both study periods. A significant rise in penicillin resistance in meningeal isolates was observed in the second period 2008-2016 (2.9% vs 36.2%). High resistance rates were observed for co-trimoxazole, tetracycline and erythromycin. Increased trend of multi-drug resistant (MDR) strains were also noted, from 11% in 1999 to 36% in 2016. Conclusion: The emergence of MDR strains is evident from our dataset. It seems like the rise in PRSP in meningeal isolates is due to revised CLSI guidelines. Overall low resistance to penicillin in non-meningeal isolates and no resistance to ceftriaxone is encouraging and will assist in drafting local guidelines. Cautious use of antimicrobials are essential to reduce further emergence of antimicrobial resistance in indigenous isolates. Author Biographies Farida Khurram Lalani, National Institute of Health, NIH, Rawalpindi, Pakistan Infection Prevention and Control Consultant, National Institute of Health Ahmer Arif Longi, Medicine Welcare Hospital, Dubai, UAE Consultant Mohammad Raheel Jajja, Surgical Education Office, Emory University Hospital, Atlanta Fellow Maera Haider, Department of Abdominal Imaging, Beth Israel Deaconess Medical Center, Boston, USA Salila Hashmi, University of Calgary, Alberta Canada Erum Khan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Professor Department of Pathology and Laboratory Medicine Seema Irfan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Associate Professor Department of Pathology and Laboratory Medivcine Tabinda Hussain, Northmead Family Medical Practice, Northmead, Australia Assistant Faisal Riaz Hussain, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Data Manager Department of Pathology and Laboratory Medicine Rumina Hasan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Professor Deaprtment of Pathology and Laboratory Medicine Kauser Jabeen, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan Associate Professor Department of Pathology and Laboratory Medicine Downloads Full Text Article Published 2022-01-05 How to Cite Afia Zafar, Lalani, F. K., Longi, A. A., Jajja, M. R., Haider, M. ., Hashmi, S. ., Khan, E. ., Irfan, S., Hussain, T. ., Hussain, F. R., Hasan, R., & Jabeen, K. . (2022). Increase in Penicillin and multidrug resistance in Streptococcus pneumoniae (1993-2016): report from a tertiary care hospital laboratory, Pakistan. Journal of the Pakistan Medical Association, 71(12), 2726–2730. https://doi.org/10.47391/JPMA.1178 More Citation Formats ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver Download Citation Endnote/Zotero/Mendeley (RIS) BibTeX Issue Vol. 71 No. 12 (2021): DECEMBER Section Original Article