| Summary: | <p>Abstract</p> <p>Background</p> <p>Rates of resistance to macrolide antibiotics in <it>Streptococcus pneumoniae </it>are rising around the world due to the spread of mobile genetic elements harboring <it>mef</it>(E) and <it>erm</it>(B) genes and post-vaccine clonal expansion of strains that carry them.</p> <p>Results</p> <p>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 <it>mef</it>(E)/<it>erm</it>(B)-positive. All dual-positive isolates are multidrug-resistant clonal lineages of Taiwan<sup>19F</sup>-14, mostly multilocus sequence type 320, carrying the recently described transposon Tn<it>2010</it>. The remainder of the macrolide resistant <it>S. pneumoniae </it>collection includes 31% <it>mef</it>(E)-positive, and 9% <it>erm</it>(B)-positive strains.</p> <p>Conclusions</p> <p>The dual-positive, multidrug-resistant <it>S. pneumoniae </it>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.</p>
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