Streptococcus pneumoniae: Pathogenesis, virulence factors, antimicrobial resistance mechanisms, and therapeutic strategies
Abstract
Background: Streptococcus pneumoniae is a Gram-positive, facultative anaerobic bacterium and a leading cause of community-acquired pneumonia, meningitis, bacteremia, and otitis media, responsible for an estimated 1.6 million deaths annually. Despite widespread polysaccharide and conjugate vaccine programs and decades of antibiotic therapy, pneumococcal disease continues to pose major public health challenges. These challenges are increasingly understood to reflect the organism's sophisticated capacity for adaptive recombination, allowing it to exploit every selective pressure applied through vaccination and antimicrobial treatment.
Objectives: This review aims to synthesize current understanding of pneumococcal molecular pathogenesis, virulence factor biology, vaccine evolution, antimicrobial resistance mechanisms, and novel therapeutic strategies, with explicit attention to unresolved questions and clinically consequential knowledge gaps that are inadequately addressed in existing literature.
Methods: A comprehensive review of the primary and review literature was conducted. The review encompassed pneumococcal colonization biology, capsule and protein virulence factor mechanisms, pilus structure and host-cell interactions, the evolutionary trajectory of conjugate vaccines from PCV7 to PCV21, global antimicrobial resistance surveillance data, and the pharmacology and clinical trial evidence for recently approved antibiotics. Particular attention was given to serotype…
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