Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999-2000)

OBJECTIVE: To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin. METHODS: Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR. RESULTS: Of 779 Streptococcus pneumoniae isolates worldwide, 43% were non-susceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (相似文献   

PROTEKT 1999-2000: a multicentre study of the antimicrobial susceptibility of respiratory tract pathogens in Japan.

DESIGN: A six-centre study in Japan during the winter of 1999-2000 assessed the in vitro activity of >20 antimicrobial agents against the common respiratory pathogens Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis. The minimum inhibitory concentrations (MIC) of each antimicrobial was determined against these isolates using National Committee for Clinical Laboratory Standards (NCCLS) methodology. RESULTS: Among S. pneumoniae isolates, 44.5% were penicillin resistant. The macrolide resistance rate was 77.9% with 90.5% of penicillin-resistant strains also being macrolide resistant. Resistance mechanisms in macrolide-resistant isolates were identified as mef(A) or erm(B) in 42.5% and 52.5%, respectively. Of the fluoroquinolone-resistant isolates (1.3%), most were also penicillin and macrolide resistant. All strains were inhibited by telithromycin at 相似文献   

Antimicrobial susceptibility of communityacquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014

<正>Objective To investigate the drug-resistance rate of community-acquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014.Methods A total of 860 strains(S.pneumoniae 299,K.pneumoniae 221,H.influenzae 185,S.aureus 116,and     

Demographic analysis of antimicrobial resistance among Streptococcus pneumoniae: worldwide results from PROTEKT 1999-2000.

DESIGN: The influence of demographic factors upon antimicrobial resistance among 3362 isolates of Streptococcus pneumoniae from 25 countries was investigated, using univariate comparison and multivariate logistic regression. RESULTS: Eleven countries had significantly higher rates (Odds ratios [OR]: 2.50-64.79) of penicillin and/or erythromycin resistance than the UK. After taking country effects into account, rates of penicillin resistance (OR 1.98) and erythromycin resistance (OR 1.89) were significantly higher among infants than adults. Fewer (OR 0.69) erythromycin-resistant isolates were collected from male than female patients. There was no difference in the incidence of penicillin or erythromycin resistance among inpatients or outpatients. Penicillin resistance was more prevalent among ear swabs than blood cultures (OR 2.07). Erm(B), the predominant macrolide resistance mechanism across all age groups, was particularly prevalent among bronchoalveolar lavage (69.1%) and sinus (68.8%) isolates. Isolates possessing both erm(B) and mef(A) were generally collected from South Korea and were most common among infants and children (10.3%) and ear samples (17.3%). Telithromycin susceptibility was >99.5%, irrespective of demography. CONCLUSIONS: Although demography had a significant impact on antimicrobial resistance of pneumococci, telithromycin remained highly active across all demographic groups.     

Antimicrobial susceptibility of Streptococcus pneumoniae isolated from patients with respiratory tract infections in Thailand

A total of 400 clinical Streptococcus pneumoniae strains from patients with respiratory diseases were collected from January 2002 to December 2005. In this study, an increased prevalence of penicillin-nonsusceptible S. pneumoniae (PNSP) from 63% in 2002-2003 to 69% in 2004-2005 was found. During 2004-2005, 56% were erythromycin-nonsusceptible S. pneumoniae (ENSP) and 54% were both PNSP and ENSP. The PNSP, ENSP and PNSP+ENSP groups showed similar trends, ie, sensitive to amoxicillin/clavulanate (range 97.2-98.5%), levofloxacin (range 90.7-92.4%), ceftriaxone (range 87.1-89.4%), and ofloxacin (range 64.8-66.1%). Lower levels of susceptibility were detected for azithromycin, clarithromycin, cefdinir, cefprozil, clindamycin, co-trimoxazole, chloramphenicol and tetracycline in penicillin and erythromycin-nonsusceptible strains. Of the macrolide-resistant S. pneumoniae, 55% of strains exhibited the M phenotype and 45% the constitutive MLS(B) phenotype. No pneumococci with the inducible MLS(B) phenotype were detected in Thailand.     

Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001)

Resistance to antimicrobial agents among clinically important pathogens in the community and hospital settings has compromised therapy and requires constant monitoring of emerging patterns. Although local information indexed by hospital service or ward remains preferred, the initiation of several comprehensive surveillance programs (SENTRY Antimicrobial Surveillance Program, MYSTIC Programme, ICARE, EARSS, etc.) offers quality susceptibility testing results to guide empirical treatment regimens. Enterococci and staphylococci with novel resistance mechanisms to glycopeptides (vancomycin, teicoplanin) require greater use of quinupristin/dalfopristin and linezolid. For streptococci, recent modifications of laboratory interpretive criteria for cefotaxime, ceftriaxone, and cefepime indicates that coverage remains at > or = 95%. Extended-spectrum beta-lactamases in Enterobacteriaceae and multidrug resistance in Acinetobacter spp. and Pseudomonas aeruginosa most challenge our choices of effective agents for nosocomial infections. Few new drugs have surfaced for therapy of these gram-negative bacilli, and two- or three-agent combination regimens may be required with greater frequency, especially to cover the more prevalent resistances among both gram-positive cocci and gram-negative nonfermentative rods.     

2012年中国成人社区获得性呼吸道感染主要致病菌耐药性的多中心研究

目的 调查2012年我国11家医院成人社区获得性呼吸道感染病原菌的耐药性.方法 收集2012年1-12月全国11家中心分离的599株成人社区获得性呼吸道感染病原菌,其中肺炎链球菌381株,流感嗜血杆菌137株,卡他莫拉菌81株.采用琼脂稀释法测定抗菌药物的MIC值.结果 50％(300/599)的菌株分离自60岁以上的患者,16.2％(97/599)的菌株分离自40岁以下的患者.按照肺炎链球菌口服青霉素的折点判定标准,56.7％(216/381)的肺炎链球菌为青霉素不敏感菌株(PNSSP),肺炎链球菌对大环内酯类的耐药率超过90％(345/381),对口服头孢菌素的耐药率为39.9％ ～50.7％(152 ～ 193株).肺炎链球菌对左氧氟沙星和莫西沙星的敏感度分别为97.8％(372/381)和99％(377/381).PNSSP对头孢曲松、阿莫西林/克拉维酸、头孢克洛、头孢呋辛的耐药率显著高于青霉素敏感菌株(PSSP).流感嗜血杆菌对除氨苄西林(71.5％,272/381)和头孢克洛(75.2％,286/381)外的抗菌药物的敏感度均超过90％.流感嗜血杆菌中β-内酰胺酶阳性率为21.9％(30/137),且β-内酰胺酶阳性菌株对氨苄西林、头孢克洛、氯霉素和四环素的耐药性显著高于β-内酰胺酶阴性菌株.氟喹诺酮类药物对流感嗜血杆菌的作用效果明显.除克林霉素、阿奇霉素和克拉霉素对卡他莫拉菌作用较差外,其他药物对卡他莫拉菌均具有较高的抗菌活性.结论 大环内酯类和口服头孢菌素类药物对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌的抗菌活性有限,左氧氟沙星和莫西沙星对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌仍具有较高的抗菌活性.     

Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis.

Current recommendations for empirical therapy for community-acquired urinary tract infection (UTI) in women hinge on knowledge of antimicrobial susceptibility patterns in the geographic region of the practitioner. We conducted a survey of antimicrobial susceptibilities of 103,223 isolates recovered from urine samples that were obtained in 1998 from female outpatients nationally and within 9 geographic regions in the United States. Resistance of Escherichia coli isolates to trimethoprim-sulfamethoxazole varied significantly according to geographic region, ranging from a high of 22% in the western United States to a low of 10% in the Northeast (P<.001). There were no clinically significant age-related differences in the susceptibility of E. coli to any of the study drugs, but the susceptibility to fluoroquinolones of non-E. coli isolates that were recovered from women who were aged >50 years was significantly lower than that of isolates recovered from younger women (P<.001). The in vitro susceptibility of uropathogens in female outpatients varies according to age and geographic region.     

Etiology of community-acquired pneumonia in hospitalized patients in chile: the increasing prevalence of respiratory viruses among classic pathogens

BACKGROUND AND STUDY OBJECTIVES: The range and relative impact of microbial pathogens, particularly viral pathogens, as a cause of community-acquired pneumonia (CAP) in hospitalized adults has not received much attention. The aim of this study was to determine the microbial etiology of CAP in adults and to identify the risk factors for various specific pathogens. METHODS: We prospectively studied 176 patients (mean [+/- SD] age, 65.8 +/- 18.5 years) who had hospitalized for CAP to identify the microbial etiology. For each patient, sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for seven respiratory viruses. RESULTS: Microbial etiology was determined in 98 patients (55%). S pneumoniae (49 of 98 patients; 50%) and respiratory viruses (32%) were the most frequently isolated pathogen groups. Pneumococcal pneumonia was associated with tobacco smoking of > 10 pack-years (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2 to 5.4; p = 0.01). Respiratory viruses were isolated more often in fall or winter (28%; p = 0.011), and as an exclusive etiology tended to be isolated in patients >/= 65 years of age (20%; p = 0.07). Viral CAP was associated with antimicrobial therapy prior to hospital admission (OR, 4.5; 95% CI, 1.4 to 14.6). CONCLUSIONS: S pneumoniae remains the most frequent pathogen in adults with CAP and should be covered with empirical antimicrobial treatment. Viruses were the second most common etiologic agent and should be tested for, especially in fall or winter, both in young and elderly patients who are hospitalized with CAP.     

Changing trend of antimicrobial resistance among pathogens isolated from lower respiratory tract at a university-affiliated hospital of China, 2006-2010

Objective

To investigate the distribution and the antimicrobial resistance of pathogens in lower respiratory tract infection from 2006 to 2010.

Methods

The sputum specimens from inpatients with lower respiratory tract infection in the First Affiliated Hospital of Nanjing Medical University during the past five years were cultured and identified; the antimicrobial resistance was analyzed by the software WHONET 5.4.

Results

A total of 12,191 isolates were characterized in sputum samples: 73.5% were Gram-negative bacteria, 13.7% were Gram-positive bacteria, and 12.8% were fungi. The isolation rate of Acinetobacter was significantly increasing from 12.8% in 2006 to 26.4% in 2010. The Gram-negative bacterial resistance rate to the second and third generation cephalosporin increased year by year. Decreasing trend, 78.7% in 2006 decreased to 63.5% in 2010 (R²=0.93 and P<0.01), in resistance to clindamycin against Staphylococcus aureus was observed. Worth noting is the drug resistance of Acinetobacter and Klebsiella pneumoniae to carbapenem significantly increased (R²>0.3 and P≤0.05).

Conclusions

The antimicrobial resistance of pathogens in lower respiratory tract infection increased in recent years. The hospitals and government departments should strengthen management of the use of some antibiotics, such as the second/third generation cephalosporin and carbapenem, in order to enhance the effectiveness of medication.Key Words: Antimicrobial resistance, Acinetobacter, Staphylococcus aureus, lower respiratory tract, carbapenem     

Mycoplasma pneumoniae and other pathogens in the aetiology of lower respiratory tract infections among Japanese children

The causes of lower respiratory tract infections in 1544 children attending a Japanese hospital over a period of 7 years were investigated. Both cultivation and two serological techniques were used to detect Mycoplasma pneumoniae whereas viral involvement was investigated only by serology. Pathogens were identified in 52% of 1175 patients with pneumonia and 36% of 369 patients without pneumonia. Mycoplasma pneumoniae infection was specifically diagnosed in 414 (26.8%) of the 1544 patients. Respiratory syncytial virus (RSV) was dominant in children up to 2 years of age. By the age of 3 years, M. pneumoniae was equalling it in incidence and became the main pathogen in older groups. It is suggested that M. pneumoniae may be more important in the 3-6 years age group than hitherto suspected. These observations may influence the choice of antibiotics for treating lower respiratory tract infections in childhood.