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Background   Streptococcus pneumoniae  is the main pathogen that causes respiratory infections in children younger than five years. The increasing incidence of macrolide- and tetracycline-resistant pneumococci among children has been a serious problem in China for many years. The molecular characteristics of erythromycin-resistant pneumococcal isolates that were collected from pediatric patients younger than five years in Beijing in 2010 were analyzed in this study.    Results  A total of 140 pneumococcal isolates were collected. The resistance rates of all isolates to erythromycin and tetracycline were 96.4% and 79.3%, respectively. Of the 135 erythromycin-resistant pneumococci, 91.1% were non-susceptible to tetracycline. In addition, 30.4% of the erythromycin-resistant isolates expressed both the  ermB  and  mef  genes, whereas 69.6% expressed the  ermB  gene but not the  mef  gene. Up to 98.5% of the resistant isolates exhibited the cMLS B  phenotype, and Tn 6002  was the most common transposon present in approximately 56.3% of the resistant isolates, followed by Tn 2010 , with a proportion of 28.9%. The dominant sequence types (STs) in all erythromycin-resistant  S. pneumoniae  were ST271 (11.9%), ST81 (8.9%), ST876 (8.9%), and ST320 (6.7%), whereas the prevailing serotypes were 19F (19.3%), 23F (9.6%), 14 (9.6%), 15 (8.9%), and 6A (7.4%). The 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) coverage of the erythromycin-resistant pneumococci among the children younger than five years were 45.2% and 62.2%, respectively. ST320 and serotype 19A pneumococci were common in children aged 0 to 2 years. CC271 was the most frequent clonal complex (CC), which accounts for 24.4% of all erythromycin-resistant isolates.    Conclusions  The non-invasive  S. pneumoniae  in children younger than five years in Beijing presented high and significant resistance rates to erythromycin and tetracycline. The expressions of  ermB  and  tetM  genes were the main factors that influence pneumococcal resistance to erythromycin and tetracycline, respectively. Majority of the erythromycin-resistant non-invasive isolates exhibited the cMLS B  phenotype and carried the  ermB ,  tetM ,  xis , and  int  genes, suggesting the spread of the transposons of the Tn 916  family. PCV13 provided higher serotype coverage in the childhood pneumococcal diseases caused by the erythromycin-resistant isolates better than PCV7. Further long-term surveys are required to monitor the molecular characteristics of the erythromycin-resistant  S. pneumoniae  in children.

Molecular characteristics of erythromycin-resistant Streptococcus pneumoniaefrom pediatric patients younger than five years in Beijing, 2010