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Background  This study determined macrolide resistance genotypes in clinical isolates of  Streptococcus pneumoniae  from multiple medical centers in Lebanon and assessed the serotype distribution in relation to these mechanism(s) of resistance and the source of isolate recovery.    Methods  Forty four macrolide resistant and 21 macrolide susceptible  S. pneumoniae  clinical isolates were tested for antimicrobial susceptibility according to CLSI guidelines (2008) and underwent molecular characterization. Serotyping of these isolates was performed by Multiplex PCR-based serotype deduction using CDC protocols. PCR amplification of macrolide resistant  erm  (encoding methylase) and  mef  (encoding macrolide efflux pump protein) genes was carried out.    Results  Among 44 isolates resistant to erythromycin, 35 were resistant to penicillin and 18 to ceftriaxone. Examination of 44 macrolide resistant isolates by PCR showed that 16 isolates harbored the  erm (B) gene, 8 isolates harbored the  mef  gene, and 14 isolates harbored both the  erm (B) and  mef  genes. There was no amplification by PCR of the  erm (B) or  mef  genes in 6 isolates. Seven different capsular serotypes 2, 9V/9A,12F, 14,19A, 19F, and 23, were detected by multiplex PCR serotype deduction in 35 of 44 macrolide resistant isolates, with 19F being the most prevalent serotype. With the exception of serotype 2, all serotypes were invasive. Isolates belonging to the invasive serotypes 14 and 19F harbored both  erm (B) and  mef  genes. Nine of the 44 macrolide resistant isolates were non-serotypable by our protocols.    Conclusion  Macrolide resistance in  S. pneumoniae  in Lebanon is mainly through target site modification but is also mediated through efflux pumps, with serotype 19F having dual resistance and being the most prevalent and invasive.

Genotypes and serotype distribution of macrolide resistant invasive and non- invasive Streptococcus pneumoniae isolates from Lebanon