Antimicrobial susceptibility of Streptococcus pneumoniae isolates from vaccinated and non-vaccinated patients with a clinically confirmed diagnosis of community-acquired pneumonia in Belgium

被引:7
|
作者
Lismond, Ann
Carbonnelle, Sylviane
Verhaegen, Jan [2 ]
Schatt, Patricia [3 ]
De Bel, Annelies [4 ]
Jordens, Paul [5 ]
Jacobs, Frederique [6 ]
Dediste, Anne [7 ]
Verschuren, Frank [8 ]
Huang, Te-Din [9 ]
Tulkens, Paul M. [1 ]
Glupczynski, Youri [10 ]
Van Bambeke, Francoise
机构
[1] Catholic Univ Louvain, Unite Pharmacol Cellulaire & Mol, Louvain Drug Res Inst, B-1200 Brussels, Belgium
[2] Univ Ziekenhuis Gasthuisberg, Microbiol Lab, Louvain, Belgium
[3] Clin Notre Dame Grace, Microbiol Lab, Gosselies, Belgium
[4] Univ Ziekenhuis Brussel, Brussels, Belgium
[5] Onze Lieve Vrouw Hosp, Afdeling Pneumol, Aalst, Belgium
[6] Free Univ Brussels, Hop Erasme, Clin Malad Infect, B-1070 Brussels, Belgium
[7] CHU St Pierre, Microbiol Lab, Brussels, Belgium
[8] Clin Univ St Luc, Serv Urgences, B-1200 Brussels, Belgium
[9] Clin Univ St Luc, Microbiol Lab, B-1200 Brussels, Belgium
[10] CHU Mt Godinne, Microbiol Lab, Yvoir, Belgium
关键词
Streptococcus pneumoniae; beta-Lactams; Macrolides; Fluoroquinolones; Community-acquired pneumonia; Serotyping; Vaccine; EUCAST; CLSI; Breakpoints; CONJUGATE VACCINE; SEROTYPE; 19A; RESISTANCE; FLUOROQUINOLONE; GUIDELINES; MANAGEMENT; MACROLIDE; GERMANY; ADULTS;
D O I
10.1016/j.ijantimicag.2011.11.011
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
We assessed the in vitro susceptibility of Streptococcus pneumoniae isolates from patients with confirmed community-acquired pneumonia (CAP) to beta-lactams, macrolides and fluoroquinolones and the association of non-susceptibility and resistance with serotypes/serogroups (STs/SGs), patient's risk factors and vaccination status. Samples (blood or lower respiratory tract) were obtained in 2007-2009 from 249 patients (from seven hospitals in Belgium) with a clinical and radiological diagnosis of CAP [median age 61 years (11.6% aged <5 years); 85% without previous antibiotic therapy; 86% adults with level II Niederman's severity score]. MIC determination (EUCAST breakpoints) showed for: (i) amoxicillin, 6% non-susceptible; cefuroxime (oral), 6.8% resistant; (ii) macrolides: 24.9% erythromycin-resistant [93.5% erm(B)-positive] but 98.4% telithromycin-susceptible; and (iii) levofloxacin and moxifloxacin, all susceptible. Amongst SGs: ST14, all resistant to macrolides and most intermediate to beta-lactams; SG19 (>94% ST19A), 73.5% resistant to macrolides and 18-21% intermediate to beta-lactams; and SG6, 33% resistant to clarithromycin. Apparent vaccine failures: 3/17 for 7-valent vaccine (children; ST6B, 23F); 16/29 for 23-valent vaccine (adults ST3, 7F, 12F, 14, 19A, 22F, 23F, 33F). Isolates from nursing home residents, hospitalised patients and patients with non-respiratory co-morbidities showed increased MICs for amoxicillin, all beta-lactams, and beta-lactams and macrolides, respectively. Regarding antibiotic susceptibilities: (i) amoxicillin is still useful for empirical therapy but with a high daily dose; (ii) cefuroxime axetil and macrolides (but not telithromycin) are inappropriate for empirical therapy; and (iii) moxifloxacin and levofloxacin are the next ` best empirical choice' (no resistant isolates) but levofloxacin will require 500 mg twice-daily dosing for effective coverage. (C) 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
引用
收藏
页码:208 / 216
页数:9
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