Open Access Highly Accessed Research article

Dominance of multidrug resistant CC271 clones in macrolide-resistant Streptococcus pneumoniae in Arizona

Jolene R Bowers1*, Elizabeth M Driebe1, Jennifer L Nibecker1, Bette R Wojack2, Derek S Sarovich3, Ada H Wong4, Pius M Brzoska4, Nathaniel Hubert1, Andrew Knadler1, Lindsey M Watson3, David M Wagner3, Manohar R Furtado4, Michael Saubolle25, David M Engelthaler1 and Paul S Keim13

Author affiliations

1 Translational Genomics Research Institute, Flagstaff, AZ, USA

2 Laboratory Sciences of Arizona, Tempe, AZ, USA

3 Northern Arizona University, Flagstaff, AZ, USA

4 Life Technologies, Foster City, CA, USA

5 University of Arizona, Tucson, AZ, USA

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Citation and License

BMC Microbiology 2012, 12:12  doi:10.1186/1471-2180-12-12

Published: 18 January 2012



Rates of resistance to macrolide antibiotics in Streptococcus pneumoniae are rising around the world due to the spread of mobile genetic elements harboring mef(E) and erm(B) genes and post-vaccine clonal expansion of strains that carry them.


Characterization of 592 clinical isolates collected in Arizona over a 10 year period shows 23.6% are macrolide resistant. The largest portion of the macrolide-resistant population, 52%, is dual mef(E)/erm(B)-positive. All dual-positive isolates are multidrug-resistant clonal lineages of Taiwan19F-14, mostly multilocus sequence type 320, carrying the recently described transposon Tn2010. The remainder of the macrolide resistant S. pneumoniae collection includes 31% mef(E)-positive, and 9% erm(B)-positive strains.


The dual-positive, multidrug-resistant S. pneumoniae clones have likely expanded by switching to non-vaccine serotypes after the heptavalent pneumococcal conjugate vaccine release, and their success limits therapy options. This upsurge could have a considerable clinical impact in Arizona.