Clonally related penicillin-nonsusceptible Streptococcus pneumoniae serotype 14 from cases of meningitis in Salvador, Brazil

Active hospital-based surveillance in the city of Salvador, Brazil, from De cember 1995 through October 1998, identified 221 patients with confirmed pn eumococcal meningitis. Of these 221 patients, 29 (13%) had isolates with in termediate-level resistance to penicillin. Infection with these penicillin- nonsusceptible isolates was significantly associated with age of <2 years ( P < .0019), previous antibiotic use (P < .0006), and coresistance to trimet hoprim-sulfamethoxazole (P < .0000). Serotype 14 was the most prevalent ser otype (55.2%) of penicillin-nonsusceptible isolates. Strain typing by repet itive element BOX polymerase chain reaction (PCR) analysis showed that peni cillin-nonsusceptible serotype 14 isolates had closely related BOX PCR patt erns, whereas penicillin-susceptible serotype 14 isolates each had distinct , unrelated patterns. Penicillin-nonsusceptible serotype 14 isolates from S alvador and other Brazilian cities had similar BOX PCR patterns. These obse rvations indicate that in Brazil a large proportion of cases of penicillin- nonsusceptible pneumococcal meningitis appear to be caused by a closely rel ated group of serotype 14 strains that may have disseminated to widely sepa rate geographic areas.