and Health Sciences, Wayne State University and Detroit Receiving Hospital, Detroit, MI, USA

Size: px
Start display at page:

Download "and Health Sciences, Wayne State University and Detroit Receiving Hospital, Detroit, MI, USA"

Transcription

1 Journal of Antimicrobial Chemotherapy (2004) 54, Suppl. S1, i7 i15 DOI: /jac/dkh313 JAC Antimicrobial susceptibility of Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae collected from patients across the USA, in , as part of the PROTEKT US study Steven D. Brown 1 * and Michael J. Rybak 2 1 Clinical Microbiology Institute, 9725 SW Commerce Circle, Suite A1, Wilsonville, OR 97070; 2 Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and Detroit Receiving Hospital, Detroit, MI, USA Introduction Background: The PROTEKT US (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin in the United States) surveillance programme was started in 2000, to chart the emergence and spread of antimicrobial resistance among isolates of Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae from across the USA. Methods: In (Year 2 of PROTEKT US) 242 centres from 46 states and the territory of Puerto Rico submitted a total of S. pneumoniae, 4508 S. pyogenes and 3296 H. influenzae isolates from community-acquired respiratory tract infections (CARTIs). Susceptibility testing was performed and interpreted using NCCLS methodology and criteria. Results: Overall, 35.4% of S. pneumoniae were non-susceptible to penicillin (14.2% intermediate, MIC mg/l; 21.2% resistant, MIC >_2 mg/l) and 27.9% were resistant to erythromycin (MIC >_1 mg/l) (0.2% intermediate, MIC 0.5 mg/l). A total of 105 (1.0%) isolates were resistant to levofloxacin (MIC >_ 8 mg/l). More than 99.2% of isolates were susceptible to telithromycin (MIC <_ 1 mg/l) irrespective of penicillin and/or erythromycin resistance. All S. pyogenes isolates were susceptible to penicillin (MIC <_ 0.12 mg/l) and 5.7% were resistant to erythromycin (MIC >_ 1 mg/l) (0.3% intermediate, MIC 0.5 mg/l). The MIC 90 of telithromycin for S. pyogenes was 0.03 mg/l. A total of 27.5% of H. influenzae isolates were b-lactamase producers. Overall, 27.8% were resistant (MIC >_ 4 mg/l) and 1.1% were intermediate to ampicillin (MIC 2 mg/l). A total of 96.3% of H. influenzae isolates were susceptible to telithromycin (MIC <_4 mg/l). Conclusions: Antimicrobial resistance continues to be a problem in the USA. The ketolide telithromycin continues to show high activity against common CARTI pathogens, including those resistant to b-lactams and macrolides. Keywords: telithromycin, CARTIs, S. pneumoniae Antimicrobial resistance among community-acquired respiratory tract infection (CARTI) pathogens is a continuing problem in the USA as it is globally. 1 In this climate of antimicrobial resistance, surveillance studies have become increasingly important, with the focus on obtaining not only national but also regional and local data. The ongoing PROTEKT US (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin in the United States) surveillance study, which began in 2000, is designed to meet these needs, through the longitudinal monitoring of antimicrobial resistance among Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae isolates collected from CARTIs. Here, we report findings from the second year ( ) of PRO- TEKT US, charting susceptibility among isolates of these three bacterial species collected from the 242 centres across the USA. Materials and methods Bacterial isolate collection In the second year ( ) of PROTEKT US, bacterial isolates were submitted from 242 centres from 46 states and Puerto Rico. These states were distributed across the six regions of PROTEKT US (Figure 1). Each centre was requested to submit at least... *Corresponding author. Tel: ; Fax: ; SBrown@clinmicroinst.com... i7 JAC q The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.

2 S. D. Brown and M. J. Rybak Figure 1. States involved in the second year ( ) of PROTEKT US. 60 S. pneumoniae isolates, 20 S. pyogenes and 15 H. influenzae, collected from patients with community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute exacerbation of chronic obstructive pulmonary disease, acute/chronic sinusitis, acute/chronic otitis media or acute/chronic pharyngitis. Acceptable culture sources were blood, sputum, bronchoalveolar lavage, middle ear fluid, nasopharyngeal swab or aspirate cultures, sinus aspirate cultures or, for S. pyogenes only, throat cultures. Antimicrobial susceptibility testing Isolates were shipped to a central laboratory (CMI, Wilsonville, OR, USA) and, after re-identification, MICs were determined according to the NCCLS broth microdilution methodology. 2 Isolates of S. pneumoniae and S. pyogenes were tested against penicillin, co-amoxiclav, cefuroxime, clindamycin, erythromycin, clarithromycin, azithromycin, telithromycin, levofloxacin, gatifloxacin, tetracycline, linezolid and co-trimoxazole. H. influenzae isolates were tested against ampicillin, co-amoxiclav, cefprozil, cefuroxime, cefotaxime, clarithromycin, azithromycin, telithromycin, levofloxacin, gatifloxacin, moxifloxacin, tetracycline and linezolid (data not shown). b-lactamase production was determined for isolates of H. influenzae using the chromogenic cephalosporin (nitrocefin) test (Oxoid, Basingstoke, UK). Susceptibility was assessed according to NCCLS breakpoints. 3 For telithromycin the tentative NCCLS 2004 breakpoints 4 were applied to S. pneumoniae: susceptible <_ 1 mg/l, intermediate 2 mg/l and resistant >_4 mg/l; and H. influenzae: susceptible <_4 mg/l, intermediate 8 mg/l and resistant >_ 16 mg/l. No telithromycin breakpoints are currently proposed for S. pyogenes. Results Streptococcus pneumoniae Penicillin susceptibility. During , isolates of S. pneumoniae were collected from across the USA. Overall, 35.4% of isolates were non-susceptible to penicillin (MIC >_ 0.12 mg/l) with 21.2% fully resistant (MIC >_2 mg/l). The highest rate of penicillin non-susceptibility was detected in the south-central region (44.3%, Table 1), where 28.9% of isolates were fully resistant to penicillin. A total of 65 isolates were collected with a penicillin MIC of 8 mg/l and one isolate with a penicillin MIC of 16 mg/l. These were collected from 26 states, across all six regions. Variation was noted in the prevalence of penicillin non-susceptibility according to the culture source of the isolates (Table 1). Almost all penicillin-resistant isolates of S. pneumoniae were resistant to cefuroxime (0.1% susceptible) and one-third showed reduced susceptibility to co-amoxiclav (67.1% susceptible, Table 2). Susceptibility to the macrolides was reduced among penicillin-resistant isolates, with only 19.4% of isolates remaining susceptible to erythromycin. Clindamycin, tetracycline and co-trimoxazole also had reduced activity against penicillinresistant S. pneumoniae to varying extents (74.7%, 52.6% and 8.1% susceptibility, respectively). Susceptibility of penicillinintermediate S. pneumoniae was reduced to cefuroxime (67.0%), macrolides (erythromycin 50.1%), tetracycline (77.2%) and co-trimoxazole (48.0%). The most active antimicrobials against penicillin-resistant S. pneumoniae, according to MIC 90, were telithromycin and gatifloxacin (MIC mg/l, Table 2). Susceptibility among penicillin-resistant isolates was highest to gatifloxacin, telithromycin and linezolid (98.1%, 99.4% and 99.9%, respectively). Telithromycin was the most active antimicrobial against penicillin-intermediate isolates (MIC mg/l). Susceptibility among penicillin-intermediate isolates was highest to telithromycin, co-amoxiclav and linezolid (99.9%, 99.9% and 100%, respectively). The MIC distributions of penicillin, erythromycin, telithromycin and levofloxacin for penicillin-intermediate and -resistant S. pneumoniae are shown in Figure 2. Macrolide susceptibility. A total of 27.9% of isolates were resistant to erythromycin (representative macrolide). Distribution of i8

3 i9 Table 1. Distribution of penicillin, macrolide (erythromycin) and fluoroquinolone (levofloxacin) resistance among S. pneumoniae isolates from across the USA according to geographical region and culture source n susceptible (MIC <_1 mg/l) Percentage of S. pneumoniae isolates penicillin macrolide a fluoroquinolone b intermediate (MIC mg/l) resistant (MIC >_2 mg/l) susceptible (MIC <_0.25 mg/l resistant (MIC >_1 mg/l) susceptible (MIC <_2 mg/l) resistant (MIC >_8 mg/l) Region total USA north-central north-east north-west south-central south-east south-west Culture source total sputum blood BAL c ear NAP c sinus a A total of 18 isolates were macrolide intermediate (MIC 0.5 mg/l), data not shown, therefore percentages may not add up to 100. b A total of 11 isolates were levofloxacin intermediate (MIC 4 mg/l), data not shown, therefore percentages may not add up to 100. c BAL, bronchoalveolar lavage; NAP, nasopharynx. Susceptibility of RTI pathogens in in the USA

4 S. D. Brown and M. J. Rybak Table 2. Antimicrobial activity and susceptibility among S. pneumoniae isolates from across the USA, according to penicillin and macrolide susceptibility All isolates (n = ) PEN-I a (n = 1424) PEN-R a (n = 2124) MAC-R a (n = 2793) MIC90 MIC90 MIC90 MIC90 Antimicrobial Penicillin 2 <_ <_ Co-amoxiclav 2 <_ 0.12 > <_ > > >4 <_ 0.12 > Cefuroxime 8 <_ 0.12 > <_ 0.12 > >8 1 > <_ 0.12 > Clindamycin <_ 0.25 <_ 0.25 > >64 <_ 0.25 > >64 <_ 0.25 > >64 <_ 0.25 > Erythromycin 16 <_ 0.06 > >256 <_ 0.06 > >256 <_ 0.06 > >256 1 > Clarithromycin 16 <_ 0.03 > >256 <_ 0.03 > >256 <_ 0.03 > > > Azithromycin 32 <_ 0.03 > >256 <_ 0.03 > >256 <_ 0.03 > > > Telithromycin 0.25 <_ <_ <_ <_ Levofloxacin 1 <_ <_ Gatifloxacin 0.5 <_ 0.06 > <_ 0.06 > <_ 0.06 > <_ 0.06 > Tetracycline >4 <_ 0.06 > >4 <_ 0.06 > >4 <_ 0.06 > >4 <_ 0.06 > Linezolid 2 <_ Co-trimoxazole >4 <_ 0.25 > >4 <_ 0.25 > >4 <_ 0.25 >4 8.1 >4 <_ 0.25 > a PEN-I, penicillin intermediate, MIC mg/l; PEN-R, penicillin resistant, MIC >_2 mg/l; MAC-R, erythromycin resistant, MIC >_1 mg/l. resistance by region followed a similar pattern to penicillin, with the highest rates of macrolide resistance detected in the southcentral and south-east regions (34.7% and 34.6%, respectively, Table 1). As with penicillin, variation in the prevalence of macrolide resistance was noted among the culture sources (Table 1). There was almost complete cross-resistance between the three macrolides tested, with only 0.1% and 0.3% of erythromycinresistant isolates remaining susceptible to azithromycin and clarithromycin, respectively; 70.0% of macrolide-resistant isolates were susceptible to clindamycin. Macrolide-resistant isolates showed reduced susceptibility to penicillin (13.5% susceptible), cefuroxime (29.1%), tetracycline (51.9%) and co-trimoxazole (18.5%) (Table 2). The most active agents against macrolide-resistant S. pneumoniae were again telithromycin and gatifloxacin (MIC mg/l, Table 2), with the greatest percentage of isolates susceptible to telithromycin and linezolid (99.5% and 99.9%, respectively). The MIC distributions of penicillin, erythromycin, telithromycin and levofloxacin for macrolide (erythromycin)-resistant S. pneumoniae are shown in Figure 2. Fluoroquinolone susceptibility. A total of 105 (1.0%) S. pneumoniae isolates were resistant to levofloxacin (MIC >_ 8 mg/l), and 11 (0.1%) were intermediate (MIC 4 mg/l). In addition 215 (2.1%) isolates were at the levofloxacin susceptibility breakpoint of 2 mg/l. Resistance to gatifloxacin (MIC >_ 4 mg/l) was detected in 85 isolates (all of which were also resistant to levofloxacin). A further 22 isolates (0.2%) were gatifloxacin intermediate (MIC 2 mg/l) and 25 (0.2%) isolates were at the susceptibility breakpoint of 1 mg/l. Of the 20 levofloxacinresistant isolates that were not resistant to gatifloxacin, 19 were intermediate (MIC 2 mg/l) and one isolate was susceptible (MIC 0.5 mg/l). The highest rate of fluoroquinolone (levofloxacin) resistance was detected in the north-east and south-west regions (both 1.3%, Table 1). Susceptibility among isolates resistant to both penicillin and macrolides A total of 1709 (17.1%) isolates of S. pneumoniae were resistant to both penicillin and macrolides. Few of these isolates were susceptible to cefuroxime (0.2%) or co-trimoxazole (2.5%) (Table 3). Telithromycin (99.3% susceptible) and linezolid (99.8%) retained greatest activity against these isolates. Streptococcus pyogenes A total of 4508 isolates of S. pyogenes were collected during and, of the 4496 isolates with culture source information, 4159 (92.5%) were from throat cultures. All isolates were susceptible to penicillin (Table 4). Overall, 5.7% of isolates were resistant (MIC >_ 1 mg/l) and 0.3% were intermediate (MIC 0.5 mg/l) to erythromycin, with similar results for clarithromycin (5.5% resistant, 0.1% intermediate) and azithromycin (5.6% resistant, 0.3% intermediate). The MIC 90 of telithromycin was 0.03 mg/l, which was lower than those of azithromycin (0.25 mg/l) and erythromycin (0.12 mg/l). The MIC range for telithromycin against S. pyogenes was <_ with an MIC of >_4 mg/l for 12 isolates. These 12 isolates were also highly resistant to the macrolides (MICs >_ 256 mg/l). i10

5 Susceptibility of RTI pathogens in in the USA Figure 2. MIC distributions of penicillin, erythromycin, telithromycin and levofloxacin for S. pneumoniae isolates grouped according to penicillin (PEN-I, penicillin intermediate, MIC mg/l; PEN-R, penicillin resistant, MIC >_ 2 mg/l) and macrolide (MAC-R, erythromycin resistant, MIC >_ 1 mg/l) susceptibility. Key: black bars, all isolates (n = ); striped bars, penicillin-intermediate isolates (n = 1424); white bars, penicillin-resistant isolates (n = 2124); grey bars, macrolide-resistant isolates (n = 2793). Macrolide (erythromycin) resistance was similar in the six regions of the USA, with the highest rate of resistance observed in the south-central region (7.0%, Table 5). Haemophilus influenzae Among 3296 H. influenzae isolates collected in , 905 (27.5%) were b-lactamase producers. The highest prevalence of b-lactamase-producing isolates was among ear cultures (41.2%, Table 6). b-lactamase-producing isolates were most common in the south-central region (33.4%, Table 6). Overall, 27.8% of H. influenzae isolates were resistant to ampicillin. None of the 905 b-lactamase-producing isolates was susceptible to ampicillin (0.2% intermediate and 99.8% resistant). Thirteen isolates were ampicillin resistant (MIC >_ 4 mg/l), but b-lactamase-negative (BLNAR); six were from the north-central i11

6 S. D. Brown and M. J. Rybak Table 3. Antimicrobial susceptibility among 1709 S. pneumoniae isolates resistant to both penicillin and macrolides from across the USA Antimicrobial MIC 90 (mg/l) Range (mg/l) %S Penicillin Erythromycin >256 1 >256 0 Co-amoxiclav > > Cefuroxime >8 1 >8 0.2 Clindamycin >64 <_ 0.25 > Clarithromycin > > Azithromycin > > Telithromycin 1 <_ Levofloxacin Gatifloxacin 0.5 <_ 0.06 > Tetracycline >4 <_ 0.06 > Linezolid Co-trimoxazole >4 <_ 0.25 >4 2.5 Table 4. Antimicrobial activity and susceptibility among 4508 S. pyogenes isolates from across the USA Antimicrobial MIC 90 (mg/l) Range (mg/l) %S Penicillin <_ 0.06 <_ Co-amoxiclav <_ 0.12 <_ predicted from penicillin Cefuroxime <_ 0.12 <_ predicted from penicillin Clindamycin <_ 0.25 <_ 0.25 > Erythromycin 0.12 <_ 0.06 > Clarithromycin 0.06 <_ 0.03 > Azithromycin 0.25 <_ 0.03 > Telithromycin a 0.03 <_ Levofloxacin Gatifloxacin 0.25 <_ Tetracycline 0.25 <_ 0.06 > Linezolid 2 <_ Co-trimoxazole a 0.5 <_0.25 >4 a No NCCLS breakpoints available. region, three from the north-east, two from the south-east and two from the south-west. All BLNAR isolates were susceptible to cefotaxime, clarithromycin, azithromycin, telithromycin, levofloxacin, gatifloxacin and moxifloxacin; four were resistant to co-amoxiclav (nine susceptible); three were resistant to cefuroxime (two susceptible, eight intermediate); three were resistant to tetracycline (10 susceptible); one isolate was susceptible to cefprozil and 12 were intermediate or resistant (cefprozil test range mg/l). With the exception of ampicillin, the susceptibility of H. influenzae isolates ranged from 80.2% for clarithromycin to 100% for cefotaxime (Table 7). Among b-lactamase producers, cefprozil and clarithromycin had the lowest activity (59.9% and 75.8% of isolates susceptible, respectively). The MICs of all three fluoroquinolones tested were above the NCCLS susceptibility breakpoints for 10 H. influenzae isolates (levofloxacin MIC >2 mg/l, moxifloxacin and gatifloxacin MICs >1 mg/l). Seven of the isolates were collected from sputum, one from bronchoalveolar lavage, one from blood and one from nasopharyngeal swab or aspirate culture. The age range of the patients was years. All of these isolates were from New York State; nine were b-lactamase negative and remained susceptible to all the other antimicrobials tested. Discussion These data from report similar percentages of S. pneumoniae isolates non-susceptible to penicillin and resistant to macrolides to those reported by others in recent years, 5 8 with the south-central and south-east regions having the highest percentages. In all regions, penicillin-resistant isolates were more prevalent than penicillin-intermediate isolates. Penicillin susceptibility also varied with the culture source of the S. pneumoniae isolates, with the highest rates of non-susceptibility among isolates from nasopharyngeal, ear and sinus cultures. This is in accordance with the findings of Doern et al. 5 and Jacobs et al. 9 Irrespective of culture source, penicillin resistance was more prevalent than penicillin intermediate resistance. A total of 65 isolates with a penicillin MIC of 8 mg/l and one isolate with a penicillin MIC of 16 mg/l were collected from across the USA. Isolates with penicillin MICs of >_ 8 mg/l have been reported previously in Table 5. Distribution of macrolide (erythromycin) resistance among 4508 S. pyogenes isolates from across the USA according to geographical region Region n susceptible (MIC <_0.25 mg/l) Percentage of S. pyogenes isolates intermediate (MIC 0.5 mg/l) resistant (MIC >_1 mg/l) Total USA North-central North-east North-west a South-central South-east South-west a a Percentages add up to 99.9% due to rounding. i12

7 Susceptibility of RTI pathogens in in the USA Table 6. Distribution of H. influenzae isolates from across the USA according to geographical region and culture source n Percentage of H. influenzae isolates b-lactamase negative (n = 2391) b-lactamase positive (n = 905) Region total USA north-central north-east north-west south-central south-east south-west Culture source total sputum blood BAL ear NAP sinus BAL, bronchoalveolar lavage; NAP, nasopharynx. the USA, 6,7,10 and a recent study by Jones et al. 11 recorded two isolates with MICs of 16 and >32 mg/l, respectively. Among penicillin-intermediate and -resistant isolates, susceptibility to cefuroxime, clindamycin, the macrolides, tetracycline and co-trimoxazole was reduced. Susceptibility to co-amoxiclav was not reduced among penicillin-intermediate isolates. The only antimicrobials to maintain susceptibility and activity against penicillin-intermediate and -resistant isolates were telithromycin, the fluoroquinolones and linezolid. Susceptibility was reduced to penicillin, clindamycin, tetracycline and co-trimoxazole among macrolide-resistant S. pneumoniae. Only telithromycin, the fluoroquinolones and linezolid maintained susceptibility and activity. The mechanism of macrolide resistance is typically deduced using the clindamycin and Table 7. Antimicrobial activity and susceptibility among H. influenzae isolates from across the USA Antimicrobial macrolide MICs. Such deductions will not be discussed here as the genotypes of the macrolide-resistant isolates are presented elsewhere in this supplement. 12 There has been much discussion in the literature regarding the emergence of fluoroquinolone resistance in S. pneumoniae. In , the PROTEKT US programme collected 105 (1.0%) isolates that were resistant to levofloxacin. These isolates were distributed across the six regions of PROTEKT US. This is similar to the rate reported by Karlowsky et al. 6 for the same season, and Doern & Brown 13 for the first year of PROTEKT US. Brueggemann et al. 14 reported a rate of 0.5% in the USA between 1994 and Fluoroquinolone resistance is typically mediated by mutations in the quinolone-resistance-determining regions of both gyra (DNA gyrase subunit) and parc (topoisomerase IV subunit). 15 A single mutation may reduce the binding affinity of fluoroquinolones, thereby reducing activity and increasing the MIC, but is insufficient to confer phenotypic resistance. Lim et al. 16 recently showed that 59% of S. pneumoniae with a levofloxacin MIC of 2 mg/l had a first step parc mutation, which raises concerns as to the possible evolution of fluoroquinolone resistance. In this study, 215 isolates (2.1%) showed levofloxacin MICs of 2 mg/l. Also of concern is a recent report in which the authors postulate that previous exposure to a fluoroquinolone may result in the development of resistance upon treatment with an additional fluoroquinolone. 17 As it is a longitudinal study, PRO- TEKT US should be able to track the emergence of fluoroquinolone resistance in pneumococci. Of concern is the increasing number of isolates in the USA with resistance to multiple antimicrobials, 8,18 as this may limit empirical treatment options for CARTIs. A recent study postulated that 41% of S. pneumoniae isolates from the Active Bacterial Core surveillance sites in the USA will be resistant to both penicillin and erythromycin by July In the PROTEKT US study, b-lactam susceptibility was reduced among macrolide-resistant isolates, with only 13.5% of such isolates remaining susceptible to penicillin. Among penicillin-resistant isolates, only 19.4% were susceptible to erythromycin. Telithromycin and linezolid were the only antimicrobials in the panel that remained active against >99% of isolates. The S. pyogenes isolates collected from across the USA in remained susceptible to penicillin. Susceptibility All isolates (n = 3296) b-lactamase negative (n = 2391) b-lactamase positive (n = 905) MIC 90 MIC 90 MIC 90 Ampicillin >4 <_ 0.5 > <_ 0.5 > >4 2 >4 0.0 Co-amoxiclav 1 <_ 0.5 > <_ 0.5 > <_ 0.5 > Cefprozil >8 <_ 0.12 > >8 <_ 0.12 > >8 <_ 0.12 > Cefuroxime 4 <_ 0.12 > <_ 0.12 > <_ 0.12 > Cefotaxime <_ 0.12 <_ <_ 0.12 <_ <_ 0.12 <_ Clarithromycin 16 <_ 0.25 > <_ 0.25 > <_ Azithromycin 2 <_ 0.12 > <_ 0.12 > <_ Telithromycin 4 <_ 0.12 > <_ 0.12 > <_ 0.12 > Levofloxacin <_ 0.06 <_ <_ 0.06 <_ <_ 0.06 <_ Gatifloxacin <_ 0.03 <_ <_ 0.03 <_ <_ 0.03 <_ Moxifloxacin <_ 0.03 <_ 0.03 > <_ 0.03 <_ 0.03 > <_ Tetracycline 0.5 <_ 0.06 > <_ 0.06 > <_ 0.06 > i13

8 S. D. Brown and M. J. Rybak was reduced to the macrolides irrespective of the PROTEKT US region of origin. Overall, 5.7% of isolates were resistant to erythromycin (0.3% intermediate), which is similar to the findings of Critchley et al. 20 who reported 6.2% of S. pyogenes isolates in the USA in 1999 as azithromycin resistant. Other countries have reported a higher prevalence of macrolide resistance (e.g. 28.0% in Hong Kong 21 ), indicating that macrolide resistance in S. pyogenes could increase further in the USA. With the exception of linezolid, the MIC 90 of all antimicrobials tested was <_1 mg/l for S. pyogenes; that of telithromycin was 0.03 mg/l. The telithromycin MIC for 12 isolates was >_4 mg/l; these isolates were all macrolide and clindamycin resistant (MICs >256 mg/l and >_2 mg/l, respectively) suggestive of the MLS B resistance phenotype. Previous studies have shown that the activity of ketolides may be lower against S. pyogenes isolates that carry the MLS B resistance gene, erm(b). 22 Recent evidence suggests that the prevalence of b-lactamaseproducing H. influenzae isolates may be decreasing in the USA. 7,8 The PROTEKT US data from suggest a continuation of this trend. A small number of BLNAR isolates continues to be present in the USA; Thornsberry et al. 7 reported a prevalence of 0.3% (4/1152) in and 0.2% (4/1934) in , similar to the 0.4% identified in this study. Such resistance is probably mediated by alteration of the penicillinbinding proteins. With the exception of ampicillin, the MIC 90 of the antimicrobials tested was unaffected by the b-lactamase status of the isolates; values for co-amoxiclav, cefuroxime, cefotaxime, azithromycin, telithromycin, levofloxacin, gatifloxacin, moxifloxacin and tetracycline were all <_ 4 mg/l. Ten H. influenzae isolates were identified with levofloxacin, moxifloxacin and gatifloxacin MICs above the NCCLS susceptibility breakpoints; all were isolates from New York State. Twelve such isolates, also from New York State, were isolated in the first year of the PROTEKT US programme (Aventis, data on file), but they have not been reported by others. 7,8,23,24 These isolates give cause for concern, and warrant further investigation, especially as a treatment failure with levofloxacin for H. influenzae pneumonia has recently been reported in Spain. 25 In conclusion, results from the season of PRO- TEKT US indicate that antimicrobial resistance continues to be a problem among CARTI-causing pathogens in the USA and warrants continued monitoring in the future through longitudinal surveillance studies, such as PROTEKT US. The ketolide telithromycin continues to show high activity against common CARTI pathogens, including those that have developed resistance to the b-lactams and macrolides. Acknowledgements We gratefully acknowledge the centres that provided isolates for the second year of the PROTEKT US study. We also thank the researchers of CMI (Wilsonville, OR, USA) for their microbiological analysis of the isolates. Data analysis was carried out by Micron Research Ltd (Upwell, Cambridgeshire, UK). The PRO- TEKT US study is supported by Aventis. Transparency declarations S.D.B. has received funds for research from Aventis Pharmaceuticals and has served on an advisory board for telithromycin. M.J.R. has received a consulting fee for a meeting sponsored by Aventis Pharmaceuticals and an honorarium for speaking at a symposium that received educational support from Aventis. References 1. Adam, D. (2002). Global antibiotic resistance in Streptococcus pneumoniae. Journal of Antimicrobial Chemotherapy 50, Topic T1, National Committee for Clinical Laboratory Standards. (2000). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically Fifth Edition: Approved Standard M7-A5. NCCLS, Villanova, PA, USA. 3. National Committee for Clinical Laboratory Standards. (2002). Performance Standards for Antimicrobial Sensitivity Testing Twelfth Edition. Supplemental Tables M100-S12. NCCLS, Villanova, PA, USA. 4. National Committee for Clinical Laboratory Standards. (2004). Performance Standards for Antimicrobial Sensitivity Testing Fourteenth Edition. Supplemental Tables M100-S14. NCCLS, Villanova, PA, USA. 5. Doern, G. V., Heilmann, K. P., Huynh, H. K. et al. (2001). Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during , including a comparison of resistance rates since Antimicrobial Agents and Chemotherapy 45, Karlowsky, J. A., Thornsberry, C., Jones, M. E. et al. (2003). Factors associated with relative rates of antimicrobial resistance among Streptococcus pneumoniae in the United States: results from the TRUST Surveillance Program ( ). Clinical Infectious Diseases 36, Thornsberry, C., Sahm, D. F., Kelly, L. J. et al. (2002). Regional trends in antimicrobial resistance among clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States: results from the TRUST Surveillance Program, Clinical Infectious Diseases 34, Suppl.1, S4 S Karlowsky, J. A., Draghi, D. C., Thornsberry, C. et al. (2002). Antimicrobial susceptibilities of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in two successive respiratory seasons in the US. International Journal of Antimicrobial Agents 20, Jacobs, M. R., Bajaksouzian, S., Zilles, A. et al. (1999). Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 US surveillance study. Antimicrobial Agents and Chemotherapy 43, Doern, G. V., Brueggemann, A. B., Huynh, H. et al. (1999). Antimicrobial resistance with Streptococcus pneumoniae in the United States, Emerging Infectious Diseases 5, Jones, M. E., Karlowsky, J. A., Blosser-Middleton, R. et al. (2002). Longitudinal assessment of antipneumococcal susceptibility in the United States. Antimicrobial Agents and Chemotherapy 46, Farrell, D. J. & Jenkins, S. G. (2004). Distribution across the USA of macrolide resistance and macrolide resistance mechanisms among Streptococcus pneumoniae isolates collected from patients with respiratory tract infections: PROTEKT US Journal of Antimicrobial Chemotherapy 54, Suppl. S1, i Doern, G. V. & Brown, S. D. (2004). Antimicrobial susceptibility among community-acquired respiratory tract pathogens in the USA: data from PROTEKT US Journal of Infection 48, Brueggemann, A. B., Coffman, S. L., Rhomberg, P. et al. (2002). Fluoroquinolone resistance in Streptococcus pneumoniae in the United States since Antimicrobial Agents and Chemotherapy 46, Ruiz, J. (2003). Mechanisms of resistance to quinolones: target alterations, decreased accumulation and DNA gyrase protection. Journal of Antimicrobial Chemotherapy 51, i14

9 Susceptibility of RTI pathogens in in the USA 16. Lim, S., Bast, D., McGeer, A. et al. (2003). Antimicrobial susceptibility breakpoints and first-step parc mutations in Streptococcus pneumoniae: redefining fluoroquinolone resistance. Emerging Infectious Diseases 9, d Escrivan, T., Roussel-Delvallez, M., Alfandari, S. et al. (2003). High level of resistance to levofloxacin of Streptococcus pneumoniae following fluoroquinolone therapy. Infection 31, Whitney, C. G., Farley, M. M., Hadler, J. et al. (2000). Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. New England Journal of Medicine 343, McCormick, A. W., Whitney, C. G., Farley, M. M. et al. (2003). Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States. Nature Medicine 9, Critchley, I. A., Sahm, D. F., Thornsberry, C. et al. (2002). Antimicrobial susceptibilities of Streptococcus pyogenes isolated from respiratory and skin and soft tissue infections: United States LIBRA surveillance data from Diagnostic Microbiology and Infectious Disease 42, Cantón, R., Loza, E., Morosini, M. I. et al. (2002). Antimicrobial resistance amongst isolates of Streptococcus pyogenes and Staphylococcus aureus in the PROTEKT antimicrobial surveillance programme during Journal of Antimicrobial Chemotherapy 50, Suppl. S1, Giovanetti, E., Montanari, M. P., Marchetti, F. et al. (2000). In vitro activity of ketolides telithromycin and HMR 3004 against Italian isolates of Streptococcus pyogenes and Streptococcus pneumoniae with different erythromycin susceptibility. Journal of Antimicrobial Chemotherapy 46, Doern, G. V., Jones, R. N., Pfaller, M. A. et al. (1999). Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired respiratory tract infections: antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrobial Agents and Chemotherapy 43, Thornsberry, C., Ogilvie, P. T., Holley, H. P. et al. (1999). Survey of susceptibilities of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolates to 26 antimicrobial agents: a prospective US study. Antimicrobial Agents and Chemotherapy 43, Bastida, T., Pérez-Vázquez, M., Campos, J. et al. (2003). Levofloxacin treatment failure in Haemophilus influenzae pneumonia. Emerging Infectious Diseases 9, i15

ORIGINAL ARTICLE. Focus Technologies, Inc., 1 Hilversum, The Netherlands, 2 Herndon, Virginia and 3 Franklin, Tennessee, USA

ORIGINAL ARTICLE. Focus Technologies, Inc., 1 Hilversum, The Netherlands, 2 Herndon, Virginia and 3 Franklin, Tennessee, USA ORIGINAL ARTICLE In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis: a European multicenter study during 2000 2001 M. E. Jones 1, R. S. Blosser-Middleton

More information

Resistance Among Streptococcus pneumoniae: Patterns, Mechanisms, Interpreting the Breakpoints

Resistance Among Streptococcus pneumoniae: Patterns, Mechanisms, Interpreting the Breakpoints ...PRESENTATIONS... Resistance Among Streptococcus pneumoniae: Patterns, Mechanisms, Interpreting the Breakpoints Angela B. Brueggemann, MS; and Gary V. Doern, PhD Presentation Summary Streptococcus pneumoniae

More information

Annual Report: Table 1. Antimicrobial Susceptibility Results for 2,488 Isolates of S. pneumoniae Collected Nationally, 2005 MIC (µg/ml)

Annual Report: Table 1. Antimicrobial Susceptibility Results for 2,488 Isolates of S. pneumoniae Collected Nationally, 2005 MIC (µg/ml) Streptococcus pneumoniae Annual Report: 5 In 5, a total of, isolates of pneumococci were collected from 59 clinical microbiology laboratories across Canada. Of these, 733 (9.5%) were isolated from blood

More information

SUPPLEMENT ARTICLE. among clinical isolates of S. pneumoniae in the United

SUPPLEMENT ARTICLE. among clinical isolates of S. pneumoniae in the United SUPPLEMENT ARTICLE Regional Trends in Antimicrobial Resistance among Clinical Isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States: Results from

More information

ORIGINAL ARTICLE. influenzae and Moraxella catarrhalis to antimicrobial agents used to treat respiratory tract infections.

ORIGINAL ARTICLE. influenzae and Moraxella catarrhalis to antimicrobial agents used to treat respiratory tract infections. ORIGINAL ARTICLE Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis collected from five centers in Brazil, 1997 98 I. A. Critchley 1, C. Thornsberry

More information

Antibiotics in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Antibiotics in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Antibiotics in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Sung Kyu Kim, M.D.Young Sam Kim, M.D. Department of Internal Medicine Yonsei University College of Medicine,

More information

Bacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota

Bacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated

More information

National Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults

National Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults National Clinical Guideline Centre Antibiotic classifications Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults Clinical guideline 191 Appendix N 3 December 2014

More information

CME/CE QUIZ CME/CE QUESTIONS. a) 20% b) 22% c) 34% d) 35% b) Susceptible and resistant strains of typical respiratory

CME/CE QUIZ CME/CE QUESTIONS. a) 20% b) 22% c) 34% d) 35% b) Susceptible and resistant strains of typical respiratory CME/CE QUIZ CME/CE QUESTIONS Continuing Medical Education Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for

More information

Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani

Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani 30-1-2018 1 Objectives of the lecture At the end of lecture, the students should be able to understand the following:

More information

Microbiology, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK

Microbiology, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK Journal of Antimicrobial Chemotherapy (2008) 62, Suppl. 2, ii97 ii103 doi:10.1093/jac/dkn356 Non-susceptibility trends among Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory

More information

PDF hosted at the Radboud Repository of the Radboud University Nijmegen

PDF hosted at the Radboud Repository of the Radboud University Nijmegen PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/26062

More information

Marc Decramer 3. Respiratory Division, University Hospitals Leuven, Leuven, Belgium

Marc Decramer 3. Respiratory Division, University Hospitals Leuven, Leuven, Belgium AAC Accepts, published online ahead of print on April 0 Antimicrob. Agents Chemother. doi:./aac.0001- Copyright 0, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

More information

EDUCATIONAL COMMENTARY - Methicillin-Resistant Staphylococcus aureus: An Update

EDUCATIONAL COMMENTARY - Methicillin-Resistant Staphylococcus aureus: An Update EDUCATIONAL COMMENTARY - Methicillin-Resistant Staphylococcus aureus: An Update Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain

More information

Over 40 Posters/Abstracts in Support of TREK Presented at the 2004 ECCMID

Over 40 Posters/Abstracts in Support of TREK Presented at the 2004 ECCMID Over 40 Posters/Abstracts in Support of TREK Presented at the ECCMID This was our best ECCMID ever for TREK presentations! The following posters and abstracts were in support of TREK products! Sensititre

More information

ACUTE EXACERBATIONS of COPD (AE-COPD) : The Belgian perspective

ACUTE EXACERBATIONS of COPD (AE-COPD) : The Belgian perspective ACUTE EXACERBATIONS of COPD (AE-COPD) : The Belgian perspective Antwerpen 8 november 2002 Yvan Valcke MD PhD AZ Maria Middelares Sint-Niklaas ACUTE EXACERBATIONS of COPD (AE-COPD) Treatment of AECB Role

More information

In vitro Activity of Gemifloxacin Against Recent Clinical Isolates of Bacteria in Korea

In vitro Activity of Gemifloxacin Against Recent Clinical Isolates of Bacteria in Korea J Korean Med Sci 2002; 17: 737-42 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences In vitro Activity of Gemifloxacin Against Recent Clinical Isolates of Bacteria in Korea Gemifloxacin is

More information

Appropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases

Appropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses

More information

Keywords: amoxicillin/clavulanate, respiratory tract infection, antimicrobial resistance, pharmacokinetics/pharmacodynamics, appropriate prescribing

Keywords: amoxicillin/clavulanate, respiratory tract infection, antimicrobial resistance, pharmacokinetics/pharmacodynamics, appropriate prescribing Journal of Antimicrobial Chemotherapy (2004) 53, Suppl. S1, i3 i20 DOI: 10.1093/jac/dkh050 Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review

More information

J. M. Blondeau*, M. Suter, S. Borsos and the Canadian Antimicrobial Study Group

J. M. Blondeau*, M. Suter, S. Borsos and the Canadian Antimicrobial Study Group Journal of Antimicrobial Chemotherapy (1999) 43, Suppl. A, 25 30 JAC Determination of the antimicrobial susceptibilities of Canadian isolates of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella

More information

Source: Portland State University Population Research Center (

Source: Portland State University Population Research Center ( Methicillin Resistant Staphylococcus aureus (MRSA) Surveillance Report 2010 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Health Authority Updated:

More information

Antimicrobial Pharmacodynamics

Antimicrobial Pharmacodynamics Antimicrobial Pharmacodynamics November 28, 2007 George P. Allen, Pharm.D. Assistant Professor, Pharmacy Practice OSU College of Pharmacy at OHSU Objectives Become familiar with PD parameters what they

More information

Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing

Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory

More information

Antimicrobial Stewardship Strategy: Antibiograms

Antimicrobial Stewardship Strategy: Antibiograms Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide

More information

EUCAST Expert Rules for Staphylococcus spp IF resistant to isoxazolylpenicillins

EUCAST Expert Rules for Staphylococcus spp IF resistant to isoxazolylpenicillins EUAST Expert Rules for 2018 Organisms Agents tested Agents affected Rule aureus Oxacillin efoxitin (disk diffusion), detection of meca or mec gene or of PBP2a All β-lactams except those specifically licensed

More information

Community Acquired Pneumonia: An Update on Guidelines

Community Acquired Pneumonia: An Update on Guidelines Community Acquired Pneumonia: An Update on Guidelines Claudia Summa, BScPhm Pharmacy Resident September 12, 2006 Objectives To give a brief description of the pathophysiology of community acquired pneumonia

More information

What s new in EUCAST methods?

What s new in EUCAST methods? What s new in EUCAST methods? Derek Brown EUCAST Scientific Secretary Interactive question 1 MIC determination MH-F broth for broth microdilution testing of fastidious microorganisms Gradient MIC tests

More information

WORKSHOP 6 Towards European consensus indications for major antibiotic classes: an exercise with the macrolides. Objectives

WORKSHOP 6 Towards European consensus indications for major antibiotic classes: an exercise with the macrolides. Objectives Objectives To establish the basic pharmacokinetic properties and safety profile of predefined macrolides. To make an inventory of the intrinsic susceptibilities of pathogenic organisms towards macrolides

More information

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Version 3.1 GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS Date ratified June 2008 Updated March 2009 Review date June 2010 Ratified by Authors Consultation Evidence base Changes

More information

Help with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST

Help with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST Help with moving disc diffusion methods from BSAC to EUCAST This document sets out the main differences between the BSAC and EUCAST disc diffusion methods with specific emphasis on preparation prior to

More information

Received 17 December 2003; accepted 22 December 2003

Received 17 December 2003; accepted 22 December 2003 Journal of Antimicrobial Chemotherapy (2004) 53, 609 615 DOI: 10.1093/jac/dkh130 Advance Access publication 3 March 2004 In vitro post-antibiotic effect of fluoroquinolones, macrolides, β-lactams, tetracyclines,

More information

...CONTINUING MEDICAL EDUCATION...

...CONTINUING MEDICAL EDUCATION... ...CONTINUING MEDICAL EDUCATION...... Drug Resistance and the Treatment of Upper Respiratory Infections GOAL To provide comprehensive and up-to-date information concerning drug resistance and the implications

More information

Concise Antibiogram Toolkit Background

Concise Antibiogram Toolkit Background Background This toolkit is designed to guide nursing homes in creating their own antibiograms, an important tool for guiding empiric antimicrobial therapy. Information about antibiograms and instructions

More information

European Committee on Antimicrobial Susceptibility Testing

European Committee on Antimicrobial Susceptibility Testing European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control as recommended by EUCAST Version 5.0, valid from 015-01-09 This document should be cited as "The

More information

ANTIMICROBIAL SUSCEPTIBILITY IN COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN ADULTS. S. KARIUKI, J. MUYODI, B. MIRZA, W. MWATU and J.J.D.

ANTIMICROBIAL SUSCEPTIBILITY IN COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN ADULTS. S. KARIUKI, J. MUYODI, B. MIRZA, W. MWATU and J.J.D. April 2003 EAST AFRICAN MEDICAL JOURNAL 213 East African Medical Journal Vol. 80 No 4 April 2003 ANTIMICROBIAL SUSCEPTIBILITY IN COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN ADULTS S. Kariuki, PhD, J. Muyodi,

More information

Antimicrobial resistance: a class effect?

Antimicrobial resistance: a class effect? Journal of Antimicrobial Chemotherapy (2002) 50, Suppl. S2, 7 12 DOI: 10.1093/jac/dkf508 Antimicrobial resistance: a class effect? J. Prieto*, A. Calvo and M. L. Gómez-Lus Microbiology I Department, School

More information

a. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.

a. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2. AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony

More information

Jan A. Jacobs* and Ellen E. Stobberingh

Jan A. Jacobs* and Ellen E. Stobberingh Journal of Antimicrobial Chemotherapy (996) 37, 37-375 In-vitro antimicrobial susceptibility of the 'Streptococcus millerv group {Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius)

More information

January 2014 Vol. 34 No. 1

January 2014 Vol. 34 No. 1 January 2014 Vol. 34 No. 1. and Minimum Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) Broth dilution: cation-adjusted Mueller-Hinton

More information

Brief reports. Decreased susceptibility to imipenem among penicillin-resistant Streptococcus pneumoniae

Brief reports. Decreased susceptibility to imipenem among penicillin-resistant Streptococcus pneumoniae Journal of Antimicrobial Chemotherapy (1997) 40, 105 108 Brief reports JAC Decreased susceptibility to imipenem among penicillin-resistant Streptococcus pneumoniae Andreas Pikis a *, Jacob A. Donkersloot

More information

Antibiotics & treatment of Acute Bcterial Sinusitis. Walid Reda Product Manager. Do your antimicrobial options meet your needs?

Antibiotics & treatment of Acute Bcterial Sinusitis. Walid Reda Product Manager. Do your antimicrobial options meet your needs? Antibiotics & treatment of Acute Bcterial Sinusitis Walid Reda Product Manager Do your antimicrobial options meet your needs? Antimicrobial Effects: What s involved? Effect in Humans: Serum concentration

More information

INTRODUCTION. Keywords Antimicrobial resistance, respiratory tract pathogens, surveillance principles and practice, global situation

INTRODUCTION. Keywords Antimicrobial resistance, respiratory tract pathogens, surveillance principles and practice, global situation Surveillance of resistance in bacteria causing community-acquired respiratory tract infections D. Felmingham 1, C. Feldman 2, W. Hryniewicz 3, K. Klugman 4,S.Kohno 5, D. E. Low 6, C. Mendes 7 and A. C.

More information

Tel: Fax:

Tel: Fax: CONCISE COMMUNICATION Bactericidal activity and synergy studies of BAL,a novel pyrrolidinone--ylidenemethyl cephem,tested against streptococci, enterococci and methicillin-resistant staphylococci L. M.

More information

Advanced Practice Education Associates. Antibiotics

Advanced Practice Education Associates. Antibiotics Advanced Practice Education Associates Antibiotics Overview Difference between Gram Positive(+), Gram Negative(-) organisms Beta lactam ring, allergies Antimicrobial Spectra of Antibiotic Classes 78 Copyright

More information

number Done by Corrected by Doctor Dr Hamed Al-Zoubi

number Done by Corrected by Doctor Dr Hamed Al-Zoubi number 8 Done by Corrected by Doctor Dr Hamed Al-Zoubi 25 10/10/2017 Antibacterial therapy 2 د. حامد الزعبي Dr Hamed Al-Zoubi Antibacterial therapy Figure 2/ Antibiotics target Inhibition of microbial

More information

EUCAST recommended strains for internal quality control

EUCAST recommended strains for internal quality control EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC

More information

Should we test Clostridium difficile for antimicrobial resistance? by author

Should we test Clostridium difficile for antimicrobial resistance? by author Should we test Clostridium difficile for antimicrobial resistance? Paola Mastrantonio Department of Infectious Diseases Istituto Superiore di Sanità, Rome,Italy Clostridium difficile infection (CDI) (first

More information

ANTIMICROBIAL SUSCEPTIBILITY DETECTION OF ELEVATED MICs TO PENICILLINS IN β- HAEMOLYTIC STREPTOCOCCI

ANTIMICROBIAL SUSCEPTIBILITY DETECTION OF ELEVATED MICs TO PENICILLINS IN β- HAEMOLYTIC STREPTOCOCCI HAEMOLYTIC STREPTOCOCCI This specimen was designated as a sample from a skin wound that was to be cultured, identified to species level and susceptibility tested [1-3]. The culture contained a Streptococcus

More information

Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems

Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Micro 301 Antimicrobial Drugs 11/7/12 Significance of antimicrobial drugs Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Definitions Antibiotic Selective

More information

Typhoid fever - priorities for research and development of new treatments

Typhoid fever - priorities for research and development of new treatments Typhoid fever - priorities for research and development of new treatments Isabela Ribeiro, Manica Balasegaram, Christopher Parry October 2017 Enteric infections Enteric infections vary in symptoms and

More information

European Committee on Antimicrobial Susceptibility Testing

European Committee on Antimicrobial Susceptibility Testing European Committee on Antimicrobial Susceptibility Testing Routine and extended internal quality control for MIC determination and disk diffusion as recommended by EUCAST Version 8.0, valid from 018-01-01

More information

Christiane Gaudreau* and Huguette Gilbert

Christiane Gaudreau* and Huguette Gilbert Journal of Antimicrobial Chemotherapy (1997) 39, 707 712 JAC Comparison of disc diffusion and agar dilution methods for antibiotic susceptibility testing of Campylobacter jejuni subsp. jejuni and Campylobacter

More information

Childrens Hospital Antibiogram for 2012 (Based on data from 2011)

Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Prepared by: Department of Clinical Microbiology, Health Sciences Centre For further information contact: Andrew Walkty, MD, FRCPC Medical

More information

Routine internal quality control as recommended by EUCAST Version 3.1, valid from

Routine internal quality control as recommended by EUCAST Version 3.1, valid from Routine internal quality control as recommended by EUCAST Version.1, valid from 01-01-01 Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus

More information

Treatment costs associated with community-acquired pneumonia by community level of antimicrobial resistance

Treatment costs associated with community-acquired pneumonia by community level of antimicrobial resistance Journal of Antimicrobial Chemotherapy (2008) 61, 1162 1168 doi:10.1093/jac/dkn073 Advance Access publication 29 February 2008 Treatment costs associated with community-acquired pneumonia by community level

More information

56 Clinical and Laboratory Standards Institute. All rights reserved.

56 Clinical and Laboratory Standards Institute. All rights reserved. Table 2C 56 Clinical and Laboratory Standards Institute. All rights reserved. Table 2C. Zone Diameter and Minimal Inhibitory Concentration Breakpoints for Testing Conditions Medium: Inoculum: diffusion:

More information

Chemotherapy of bacterial infections. Part II. Mechanisms of Resistance. evolution of antimicrobial resistance

Chemotherapy of bacterial infections. Part II. Mechanisms of Resistance. evolution of antimicrobial resistance Chemotherapy of bacterial infections. Part II. Mechanisms of Resistance evolution of antimicrobial resistance Mechanism of bacterial genetic variability Point mutations may occur in a nucleotide base pair,

More information

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Version 1.0 23 December 2011 General enquiries and contact details This is the first version (1.0) of the Protocol

More information

Understanding the Hospital Antibiogram

Understanding the Hospital Antibiogram Understanding the Hospital Antibiogram Sharon Erdman, PharmD Clinical Professor Purdue University College of Pharmacy Infectious Diseases Clinical Pharmacist Eskenazi Health 5 Understanding the Hospital

More information

Antimicrobial Stewardship in Ambulatory Care

Antimicrobial Stewardship in Ambulatory Care Antimicrobial Stewardship in Ambulatory Care Nila Suntharam, M.D. May 5, 2017 Dr. Suntharam indicated no potential conflict of interest to this presentation. She does not intend to discuss any unapproved/investigative

More information

Antibiotic Reference Laboratory, Institute of Environmental Science and Research Limited (ESR); August 2017

Antibiotic Reference Laboratory, Institute of Environmental Science and Research Limited (ESR); August 2017 Antimicrobial susceptibility of Shigella, 2015 and 2016 Helen Heffernan and Rosemary Woodhouse Antibiotic Reference Laboratory, Institute of Environmental Science and Research Limited (ESR); August 2017

More information

Review Article Factors Affecting the Cost Effectiveness of Antibiotics

Review Article Factors Affecting the Cost Effectiveness of Antibiotics Chemotherapy Research and Practice Volume 2011, Article ID 249867, 6 pages doi:10.1155/2011/249867 Review Article Factors Affecting the Cost Effectiveness of Antibiotics Steven Simoens Research Centre

More information

Antimicrobial susceptibility

Antimicrobial susceptibility Antimicrobial susceptibility PATTERNS Microbiology Department Canterbury ealth Laboratories and Clinical Pharmacology Department Canterbury District ealth Board March 2011 Contents Preface... Page 1 ANTIMICROBIAL

More information

The World Health Organization has referred to. Antibiotic Resistance: The Iowa Experience DRUG UTILIZATION. Nancy Bell, RPh

The World Health Organization has referred to. Antibiotic Resistance: The Iowa Experience DRUG UTILIZATION. Nancy Bell, RPh DRUG UTILIZATION Antibiotic Resistance: The Iowa Experience Nancy Bell, RPh Background: In the past 10 years, the number of strains of Streptococcus pneumoniae and other common respiratory pathogens that

More information

Neisseria gonorrhoeae telithromycin in vitro

Neisseria gonorrhoeae telithromycin in vitro THE JAPANESE JOURNAL OF ANTIBIOTICS 58 3 37( 97 ) Neisseria gonorrhoeae telithromycin in vitro 4 4 2002 4 2 Neisseria gonorrhoeae 22 telithromycin (TEL) erythromycin (EM), clarithromycin (CAM), penicillin

More information

Antimicrobial susceptibility of Neisseria gonorrhoeae in Greece: data for the years

Antimicrobial susceptibility of Neisseria gonorrhoeae in Greece: data for the years Journal of Antimicrobial Chemotherapy (2006) 57, 775 779 doi:10.1093/jac/dkl040 Advance Access publication 21 February 2006 Antimicrobial susceptibility of Neisseria gonorrhoeae in Greece: data for the

More information

Received 10 February 2009/Returned for modification 14 April 2009/Accepted 14 May 2009

Received 10 February 2009/Returned for modification 14 April 2009/Accepted 14 May 2009 JOURNAL OF CLINICAL MICROBIOLOGY, July 2009, p. 2187 2193 Vol. 47, No. 7 0095-1137/09/$08.00 0 doi:10.1128/jcm.00304-09 Copyright 2009, American Society for Microbiology. All Rights Reserved. Development

More information

جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی

جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه

More information

In vitro activity of telavancin against recent Gram-positive clinical isolates: results of the Prospective European Surveillance Initiative

In vitro activity of telavancin against recent Gram-positive clinical isolates: results of the Prospective European Surveillance Initiative Journal of Antimicrobial Chemotherapy (2008) 62, 116 121 doi:10.1093/jac/dkn124 Advance Access publication 19 April 2008 In vitro activity of telavancin against recent Gram-positive clinical isolates:

More information

INVESTIGATOR. R. Vanhoof 1, Engelandstraat 642, B-1180 Brussel.

INVESTIGATOR. R. Vanhoof 1, Engelandstraat 642, B-1180 Brussel. REPORT. In vitro study to investigate the antimicrobial activity of various antibiotics against noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2-3 (SP3). INVESTIGATOR.

More information

Choosing the Ideal Antibiotic Therapy and the Role of the Newer Fluoroquinolones in Respiratory Tract Infections

Choosing the Ideal Antibiotic Therapy and the Role of the Newer Fluoroquinolones in Respiratory Tract Infections ...CLINICIAN INTERVIEW... Choosing the Ideal Antibiotic Therapy and the Role of the Newer Fluoroquinolones in Respiratory Tract Infections An interview with Robert C. Owens, Jr., PharmD, Clinical Pharmacy

More information

Clinical efficacy of cefpodoxime in respiratory tract infection

Clinical efficacy of cefpodoxime in respiratory tract infection Journal of Antimicrobial Chemotherapy (2002) 50, Topic T1, 23 27 DOI: 10.1093/jac/dkf805 Clinical efficacy of cefpodoxime in respiratory tract infection Robert Cohen* Department of Microbiology, Intercommunal

More information

Towards Rational International Antibiotic Breakpoints: Actions from the European Committee on Antimicrobial Susceptibility Testing (EUCAST)

Towards Rational International Antibiotic Breakpoints: Actions from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) Towards Rational International Antibiotic Breakpoints: Actions from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) A report to ISC presented by Paul M. Tulkens representative of

More information

Levofloxacin and moxifloxacin resistant Haemophilus influenzae in a patient with common variable immunodeficiency (CVID): a case report

Levofloxacin and moxifloxacin resistant Haemophilus influenzae in a patient with common variable immunodeficiency (CVID): a case report 46 Case Report Levofloxacin and moxifloxacin resistant Haemophilus influenzae in a patient with common variable immunodeficiency (CVID): a case report CT Hapuarachchi 1, GK Karunaratne 2, NR de Silva 3,

More information

Please distribute a copy of this information to each provider in your organization.

Please distribute a copy of this information to each provider in your organization. HEALTH ADVISORY TO: Physicians and other Healthcare Providers Please distribute a copy of this information to each provider in your organization. Questions regarding this information may be directed to

More information

2015 Antibiotic Susceptibility Report

2015 Antibiotic Susceptibility Report Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens

More information

GENERAL NOTES: 2016 site of infection type of organism location of the patient

GENERAL NOTES: 2016 site of infection type of organism location of the patient GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered

More information

Streptococcus pneumoniae. Oxacillin 1 µg as screen for beta-lactam resistance

Streptococcus pneumoniae. Oxacillin 1 µg as screen for beta-lactam resistance Streptococcus pneumoniae Oxacillin µg as screen for beta-lactam resistance Version 6. June Streptococcus pneumoniae and zone diameter correlates The following histograms present inhibition zone diameter

More information

Antibiotic Kinetic and Dynamic Attributes for Community-Acquired Respiratory Tract Infections

Antibiotic Kinetic and Dynamic Attributes for Community-Acquired Respiratory Tract Infections ...PRESENTATIONS... Antibiotic Kinetic and Dynamic Attributes for Community-Acquired Respiratory Tract Infections David P. Nicolau, PharmD Presentation Summary Factors, including the age of the treatment

More information

ORIGINAL ARTICLE /j x. Western Reserve University, Cleveland, OH, USA and 3 Wockhardt Research Centre, Aurangabad, India

ORIGINAL ARTICLE /j x. Western Reserve University, Cleveland, OH, USA and 3 Wockhardt Research Centre, Aurangabad, India ORIGINAL ARTICLE 10.1111/j.1469-0691.2004.01017.x Activity of the new quinolone WCK 771 against pneumococci P. C. Appelbaum 1, G. A. Pankuch 1, B. Bozdogan 1, G. Lin 1, M. R. Jacobs 2, M. V. Patel 3, S.

More information

The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards

The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards The Basics: Using CLSI Antimicrobial Susceptibility Testing Standards Janet A. Hindler, MCLS, MT(ASCP) UCLA Health System Los Angeles, California, USA jhindler@ucla.edu 1 Learning Objectives Describe information

More information

Int.J.Curr.Microbiol.App.Sci (2017) 6(3):

Int.J.Curr.Microbiol.App.Sci (2017) 6(3): International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 891-895 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.603.104

More information

Burton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents

Burton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Burton's Microbiology for the Health Sciences Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Chapter 9 Outline Introduction Characteristics of an Ideal Antimicrobial Agent How

More information

Is erythromycin bactericidal

Is erythromycin bactericidal Is erythromycin bactericidal Search Comparison of erythromycin, clarithromycin, azithromycin, telithromycin, roxithromycin: mechanism of action, spectrum of activity, side effects, drug interactions. Erythromycin

More information

Approach to pediatric Antibiotics

Approach to pediatric Antibiotics Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus

More information

INCIDENCE OF BACTERIAL COLONISATION IN HOSPITALISED PATIENTS WITH DRUG-RESISTANT TUBERCULOSIS

INCIDENCE OF BACTERIAL COLONISATION IN HOSPITALISED PATIENTS WITH DRUG-RESISTANT TUBERCULOSIS INCIDENCE OF BACTERIAL COLONISATION IN HOSPITALISED PATIENTS WITH DRUG-RESISTANT TUBERCULOSIS 1 Research Associate, Drug Utilisation Research Unit, Nelson Mandela University 2 Human Sciences Research Council,

More information

2016 Antibiotic Susceptibility Report

2016 Antibiotic Susceptibility Report Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates

More information

Doxycycline for strep pneumonia

Doxycycline for strep pneumonia Doxycycline for strep pneumonia Antibiotic Levofloxacin (Levaquin) 750 mg, 500 mg for the treatment of respiratory, skin, and urinary tract infections, user reviews and ratings. 14-12-1995 John G. Bartlett,

More information

Pneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center

Pneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center Pneumonia considerations 2017 Galia Rahav Infectious diseases unit Sheba medical center Sir William Osler (1849 1919) "Father of modern medicine Pneumonia: The old man's friend The captain of the men of

More information

Compliance of manufacturers of AST materials and devices with EUCAST guidelines

Compliance of manufacturers of AST materials and devices with EUCAST guidelines Compliance of manufacturers of AST materials and devices with EUCAST guidelines Data are based on questionnaires to manufacturers of materials and devices for antimicrobial susceptibility testing. The

More information

Emergence of Antibiotic Resistance in Upper and

Emergence of Antibiotic Resistance in Upper and ...PRESENTATIONS... Emergence of Antibiotic Resistance in Upper and Lower Respiratory Tract Infections Michael R. Jacobs, MB, BCh, PhD Presentation Summary The increase in antibiotic resistance is of great

More information

microbiologists. In this article, we will discuss some of the challenges the laboratory faces with antimicrobial susceptibility

microbiologists. In this article, we will discuss some of the challenges the laboratory faces with antimicrobial susceptibility CE Update [microbiology and virology] Challenges in Antimicrobial Susceptibility Testing and Reporting Melinda D. Poulter, PhD, MT(ASCP), Janet F. Hindler, MT(ASCP) UCLA Medical Center, Department of Pathology

More information

Background and Plan of Analysis

Background and Plan of Analysis ENTEROCOCCI Background and Plan of Analysis UR-11 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony count, to perform the identification

More information

Antimicrobial Resistance Trends in the Province of British Columbia

Antimicrobial Resistance Trends in the Province of British Columbia 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel 604.707.2443 Fax 604.707.2441 www.bccdc.ca Antimicrobial Resistance Trends in the Province of British Columbia 2013 Prepared by the Do Bugs Need Drugs? Program

More information

Summa Health System, Akron, Ohio and North-eastern Ohio Universities College of Medicine, Rootstown, Ohio, USA

Summa Health System, Akron, Ohio and North-eastern Ohio Universities College of Medicine, Rootstown, Ohio, USA REVIEW Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia T. M. File Jr Summa Health System, Akron, Ohio and North-eastern Ohio Universities College of Medicine, Rootstown,

More information

Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice?

Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice? Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice? With the support of Wallonie-Bruxelles-International 1-1 In vitro evaluation of antibiotics : the antibiogram

More information

Aminoglycosides. Spectrum includes many aerobic Gram-negative and some Gram-positive bacteria.

Aminoglycosides. Spectrum includes many aerobic Gram-negative and some Gram-positive bacteria. Aminoglycosides The only bactericidal protein synthesis inhibitors. They bind to the ribosomal 30S subunit. Inhibit initiation of peptide synthesis and cause misreading of the genetic code. Streptomycin

More information

Outpatient Antimicrobial Therapy. Role of Antibacterials in Outpatient Treatment of Respiratory Tract Infection. Acute Bacterial Rhinosinusitis

Outpatient Antimicrobial Therapy. Role of Antibacterials in Outpatient Treatment of Respiratory Tract Infection. Acute Bacterial Rhinosinusitis Outpatient Antimicrobial Therapy B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy University of California San Francisco Role of Antibacterials in Outpatient Treatment

More information

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1 Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director

More information

Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how?

Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Andrea Duppenthaler andrea.duppenthaler@insel.ch Limping patient local pain swelling tenderness warmth fever acute Osteomyelitis

More information