ArticleProceedings of the National Academy of Sciences of the United States of America2007
Heteroresistance to penicillin in Streptococcus pneumoniae.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Global trends and research profile of antibiotic heteroresistance: a bibliometric and visual analysis.Frontiers in microbiology · 2026Pooled it
- Biological puzzles solved by usingJournal of bacteriology · 2024Review
- Inducible Mega-Mediated Macrolide Resistance Confers Heteroresistance in Streptococcus pneumoniae.Antimicrobial agents and chemotherapy · 2023Article
- AmiA and AliA peptide ligands are secreted by Klebsiella pneumoniae and inhibit growth of Streptococcus pneumoniae.Scientific reports · 2022Article
- Host Cell Oxidative Stress Promotes Intracellular Fluoroquinolone Persisters of Streptococcus pneumoniae.Microbiology spectrum · 2022Article
- Application of Droplet Digital PCR to Detection ofInfection and drug resistance · 2022Review
- Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis.Frontiers in cellular and infection microbiology · 2021Review
- Unstable Mechanisms of Resistance to Inhibitors of Escherichia coli Lipoprotein Signal Peptidase.mBio · 2020Article
- Antimicrobial Susceptibility Testing for Polymyxins: Challenges, Issues, and Recommendations.Journal of clinical microbiology · 2019Review
- Inhibiting the copper efflux system in microbes as a novel approach for developing antibiotics.PloS one · 2019Article
- Determination of azithromycin heteroresistantGut pathogens · 2019Article
- A comparison of Sensititre™ Anaerobe MIC plate with ATB ANA® test for the routine susceptibility testing of common anaerobe pathogens.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018Article
- Inhibiting Bacterial Drug Efflux Pumps via Phyto-Therapeutics to Combat Threatening Antimicrobial Resistance.Frontiers in microbiology · 2018Review
- Stress-Adaptive Responses Associated with High-Level Carbapenem Resistance in KPC-ProducingJournal of pathogens · 2018Article
- Cryptic Microheteroresistance Explains Mycobacterium tuberculosis Phenotypic Resistance.American journal of respiratory and critical care medicine · 2017Article
- Mycobacterium tuberculosis Subculture Results in Loss of Potentially Clinically Relevant Heteroresistance.Antimicrobial agents and chemotherapy · 2017Article
- Article
- Efflux Pump Overexpression Contributes to Tigecycline Heteroresistance inFrontiers in cellular and infection microbiology · 2017Article
- Within-host evolution of bacterial pathogens.Nature reviews. Microbiology · 2016Review
- Microscale insights into pneumococcal antibiotic mutant selection windows.Nature communications · 2015Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Heteroresistance to beta-lactam antibiotics has been mainly described for staphylococci, for which it complicates diagnostic procedures and therapeutic success. This study investigated whether heteroresistance to penicillin exists in Streptococcus pneumoniae. Population analysis profile (PAP) showed the presence of subpopulations with higher penicillin resistance in four of nine clinical pneumococcal strains obtained from a local surveillance program (representing the multiresistant clones ST179, ST276, and ST344) and in seven of 16 reference strains (representing the international clones Spain(23F)-1, Spain(9V)-3, Spain(14)-5, Hungary(19A)-6, South Africa(19A)-13, Taiwan(23F)-15, and Finland(6B)-12). Heteroresistant strains had penicillin minimal inhibitory concentrations (MICs) (for the majority of cells) in the intermediate- to high-level range (0.19-2.0 mug/ml). PAP curves suggested the presence of subpopulations also for the highly penicillin-resistant strains Taiwan(19F)-14, Poland(23F)-16, CSR(19A)-11, and CSR(14)-10. PAP of bacterial subpopulations with higher penicillin resistance showed a shift toward higher penicillin-resistance levels, which reverted upon multiple passages on antibiotic-free media. Convergence to a homotypic resistance phenotype did not occur. Comparison of two strains of clone ST179 showed a correlation between the heteroresistant phenotype and a higher-penicillin MIC and a greater number of altered penicillin-binding proteins (PBP1a, -2b, and -2x), respectively. Therefore, heteroresistance to penicillin occurs in international multiresistant clones of S. pneumoniae. Pneumococci may use heteroresistance to penicillin as a tool during their evolution to high penicillin resistance, because it gives the bacteria an opportunity to explore growth in the presence of antibiotics before acquisition of resistance genes.
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