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

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• 作者：Ann Lismond^a ; Sylviane Carbonnelle^a ; ¹ ; Jan Verhaegen^b ; Patricia Schatt^c ; Annelies De Bel^d ; Paul Jordens^e ; Fré ; dé ; rique Jacobs^f ; Anne Dediste^g ; Frank Verschuren^h ; Te-Din Huangⁱ ; ² ; Paul M. Tulkens^a ; ^{tulkens@facm.ucl.ac.be} ; Youri Glupczynski^j ; Franç ; oise Van Bambeke^a
• 关键词：Streptococcus pneumoniae ; ¦Â-Lactams ; Macrolides ; Fluoroquinolones ; Community-acquired pneumonia ; Serotyping ; Vaccine ; EUCAST ; CLSI ; Breakpoints
• 刊名：International Journal of Antimicrobial Agents
• 出版年：2012
• 出版时间：March 2012
• 年：2012
• 卷：39
• 期：3
• 页码：208-216
• 全文大小：921 K

文摘

We assessed the in vitro susceptibility of Streptococcus pneumoniae isolates from patients with confirmed community-acquired pneumonia (CAP) to ¦Â-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 ¦Â-lactams; SG19 (>94 % ST19A), 73.5 % resistant to macrolides and 18-21 % intermediate to ¦Â-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 ¦Â-lactams, and ¦Â-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.