Surveillance of antibiotic resistance in non invasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winters 2003 and 2004

Pasteurinstituut, Brussel, Eenheid Antibiotica-Onderzoek, Engelandstraat 642, B-1180 Brussel.
Acta clinica Belgica (Impact Factor: 0.59). 03/2006; 61(2):49-57. DOI: 10.1179/acb.2006.010
Source: PubMed


A total of 391 and 424 non-invasive isolates of Streptococcus pneumoniae collected by 15 laboratories during the 2003 and 2004 survey were tested for their susceptibility by a microdilution technique following NCCLS recommendations. Insusceptibility rates (IR) in the two surveys (2003/2004) were as follows: penicillin 15.0/14.7% [8.4/6.4% Resistance (R)], ampicillin 17.4/14.6% (R 9.0/7.1%), amoxicillin +/- clavulanic acid 2.6/1.2 % (R 0/0%), cefaclor 14.3/14.1% (R 11.5/13.4%), cefuroxime 13.6/12.7% (R 10.5/11.8%), cefuroxime-axetil 10.5/11.8% (R 10.0/9.2%) (breakpoints based on 250 mg), cefotaxime 4.9/6.2% (R 1.3/2.4%), ceftazidime NotTested (NT)/6.4 (R NT/2.6%), cefepime NT/6.4 (R NT/2.6%), imipenem 7.7/8.9 % (R 1.8/1.4%), ertapenem 0.8/NT% (R O/NT%), ciprofloxacin 13.8/9.0% (R 4.3/2.4%), levofloxacin 3.3/2.8% (R 1.5/0.2%), moxifloxacin 0.6/0.2% (R 0.3/0%), ofloxacin 13.5/9.0% (R 4.3/2.4%), erythromycin 26.1/24.7% (R 25.3/24.5%), azithromycin 25.4/24.7% (R 24.6/24.5%), telithromycin 0.8/0.2% (R 0.5/0%), clindamycin 21.2/18.4% (R 19.2/17.7%) and tetracycline 32.3/22.1% (R 29.2/19.3%). There were only minor differences in resistance rates according to age, sample site, admission type (i.e. ambulatory, hospitalized or long-term care facility patients), gender and geographic origin. Overall, telithromycin (MIC50, MIC90 in 2003/2004: 0.015 microg/ml, 0.12 microg/ml/ 0.008,0.06 respectively), ertapenem (0.03; 0.25/NT), moxifloxacin (0.06; 0.25/0.06, 0.12), and amoxicillin +/- clavulanic acid (0.03; 0.25/0.015, 0.5) were the most active compounds in both surveys. In 2003, the most common resistance phenotype was isolated insusceptibility to tetracycline (10.5%) followed by combined insusceptibility to erythromycin and tetracycline (9.3%). Erythromycin-tetracycline resistance (10.4%) was the most common in 2004. Isolates showing resistance to an antibiotic were significantly more present in 2003 than in 2004 (50.4% versus 40.8%). In penicillin-insusceptible isolates, MICs of all beta-lactams were increased but cross-resistance between penicillin and other beta-lactams in the penicillin-insusceptible isolates was not complete. In the 2003 survey, most of these isolates remained fully susceptible to ertapenem (94.9%) and amoxicillin +/- clavulanic acid (83.1%). In the 2004 survey, 91.9% of the penicillin insusceptible isolates remained susceptible to amoxicillin +/- clavulanic acid. In both surveys, the most common serotypes in penicillin insusceptible isolates were 14, 23,19 and 9 (20.0%, 20.0%, 16.4% and 10.9% respectively in 2003; 41.6%, 11.7%, 15.0% and 18.3% respectively in 2004).

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Available from: M.L. Lontie, Sep 28, 2015
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    ABSTRACT: This study aims to analyse antibiotic treatment of respiratory tract infections in ambulatory care in Belgium by: a) mapping antibiotic consumption over time and breaking down antibiotic consumption by infection type; b) discussing antibiotic treatment as recommended by Belgian guidelines; and c) reviewing the current evidence on the cost-effectiveness of antibiotic treatment. IMS Health data showed that the total volume of antibiotic consumption in ambulatory care in Belgium has increased over the years. Antibiotic consumption mainly originated from the use of broad-spectrum penicillins. The volume of fluoroquinolone use remains well controlled. Policy makers need to target the main drivers of inappropriate antibiotic consumption rather than a specific class of antibiotics when they aim to promote better use of antibiotics in ambulatory care. A ß-lactam-based therapy for CAP is recommended as first choice in Belgian guidelines and moxifloxacin is advocated for CAP outpatients with comorbid conditions or outpatients in whom infection with atypical pathogens needs to be considered. Because of its high eradicating power against the target organisms and because H. influenzae is the main pathogen to be covered, amoxicillin-clavulanic acid may be a first choice to treat COPD exacerbations, although this choice is subject to debate. Moxifloxacin is recommended in case of IgE-mediated ß-lactam allergy or severe intolerance to ß-lactam antibiotics for the treatment of COPD exacerbations or for the treatment of upper respiratory tract infections on the rare occasion that antibiotic treatment is warranted. One study supported the cost-effectiveness of first-line treatment of CAP with moxifloxacin in Belgium.

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