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Streptococcal Infections and Treatments / Pneumonia and Respiratory Infections · Journal article
Journal of Infection and Public Health · August 1, 2026
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This is a retrospective genomic characterization of levofloxacin-resistant invasive Streptococcus pneumoniae serotype 23F isolates collected through South Korean surveillance from 2015 to 2024. The data show emergence of a dominant lineage (GPSC6) carrying concurrent quinolone resistance mutations and multiple antimicrobial resistance genes after 2020, but do not quantify clinical impact, treatment outcomes, or validate causality.
Retrospective surveillance study with whole-genome sequencing characterization. Invasive Streptococcus pneumoniae isolates, serotype 23F subset, collected through the KDCA surveillance system, Republic of Korea, 2015–2024.. Intervention: Whole-genome sequencing to characterize lineage and resistance determinants. n = 1,885. Republic of Korea.
Among 1,885 invasive pneumococcal isolates, 90 were levofloxacin resistant; of these, 29 were serotype 23F (serotype 23F represented 32.2% of resistant isolates) 68.9% (20/29) of serotype 23F isolates were levofloxacin resistant GPSC6 lineage first identified after 2020 and became predominant among levofloxacin-resistant serotype 23F isolates by 2022
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Clinicians and public health authorities in South Korea should be aware of emerging levofloxacin-resistant serotype 23F strains and consider serotype and resistance surveillance when selecting empirical therapy for invasive pneumococcal disease. However, this report provides descriptive epidemiology and resistance characterization only; it does not directly address clinical efficacy of treatment alternatives.
A descriptive surveillance report characterizing emerging resistance patterns and genomic lineages in a specific geographic region; lacks comparative analysis, mechanistic validation, or clinical outcome data to guide intervention.
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Clinicians and public health authorities in South Korea should be aware of emerging levofloxacin-resistant serotype 23F strains and consider serotype and resistance surveillance when selecting empirical therapy for invasive pneumococcal disease. However, this report provides descriptive epidemiology and resistance characterization only; it does not directly address clinical efficacy of treatment alternatives.
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Background Although serotype 23 F is included in the current pneumococcal conjugate vaccines (PCVs), its recent contribution to the emergence of levofloxacin-resistant invasive Streptococcus pneumoniae in South Korea remains unclear. Despite the inclusion of serotype 23 F in PCVs, recent increases in the abundance of levofloxacin-resistant isolates have been observed in South Korea. Methods Temporal trends, antimicrobial resistance profiles, and genomic characteristics of serotype 23 F isolates collected through the Infectious Diseases Surveillance System operated by the Korea Disease Control and Prevention Agency (KDCA) from 2015 to 2024 were analyzed. Whole-genome sequencing was performed to characterize lineage distribution, quinolone resistance-determining region (QRDR) mutations, antimicrobial resistance determinants, and penicillin-binding protein (PBP) allele combinations. Results Among the 1,885 invasive pneumococcal isolates, 90 were resistant to levofloxacin. Of these, 29 were serotype 23 F, and 68.9% (20/29) of the serotype 23 F isolates were levofloxacin resistant. Serotype 23 F was infrequently detected before 2020, but its contribution to levofloxacin-resistant invasive isolates became more apparent after 2021. WGS revealed that GPSC6 was first identified after 2020 and became the predominant lineage among levofloxacin-resistant serotype 23 F isolates by 2022. GPSC6 isolates exhibited concurrent gyrA and parC mutations and carried multiple resistance genes, including erm(B), tet(M), folA, and folP, and harbored uncharacterized PBP allele combinations. Conclusions These findings suggest that the recent increase in the levofloxacin-resistant serotype 23 F in South Korea is associated with the expansion of GPSC6 and highlight the value of lineage-level genomic surveillance within vaccine-type serotypes.
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