#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Antibiotická rezistence Streptococcus pneumoniae a Streptococcus pyogenes v letech 1996–2009


Authors: P. Urbášková;  H. Žemličková;  Pracovní Skupina Pro Monitorování Rezistence (psmr) *
Authors place of work: Národní referenční laboratoř pro antibiotika, Centrum laboratorních činností, Státní zdravotní ústav Praha
Published in the journal: Epidemiol. Mikrobiol. Imunol. 60, 2011, č. 1, s. 10-20

Summary

Study objectives:
To analyze trends in the resistance of Streptococcus pneumoniae to penicillin and acrolides and of S. pyogenes to macrolides over a 14-year period and to determine serotypes and molecular characteristics in a selected group of S. pneumoniae strains resistant to these antibiotics.

Material and ethods:
Susceptibility to antibiotics was tested by the participating laboratories by the disk diffusion method in isolates of both bacterial species from the lower and upper respiratory tract from 1996–2009. The National Reference Laboratory for Antibiotics NRL/ATB) determined the minimal inhibitory concentrations of penicillin and erythromycin for invasive pneumococcal isolates from 2000–2009 and performed multilocus sequence analysis of selected resistant strains.

Results:
Over the 14-year period monitored, penicillin resistance of S. pneumoniae isolates from the upper and lower respiratory tract showed a slightly downward trend similarly to blood isolates monitored since 2000. Resistance to macrolides in S. pneumoniae isolates was lower than penicillin resistance, regardless of the sample origin until 2005, but became higher than penicillin resistance in 2006 to follow a continuously upward trend since then. In 2009, the penicillin resistance rates of S. pneumoniae isolates from the upper respiratory tract, lower respiratory tract and blood were 3.5%, 5.1% and 4.7%, respectively, while the respective erythromycin resistance rates reached 8.4%, 12.2% and 5.5%. When using the new clinical breakpoints for pneumococci from pneumonia cases depending on penicillin dose and administration interval, only two (0.1%) of 1528 strains from the blood were confirmed as penicillin resistant (MIC 4 mg/l). Resistance of S. pyogenes to macrolides, reported in 16.5% of strains in 2001, sharply decreased to 9% in 2003 as a result of an intervention to promote the use of penicillin for the treatment of tonsillopharyngitis, and reached 11.1% in 2009. Among penicillin resistant strains of S. pneumoniae, the spread of clone Spain9V-3 (ST156) was confirmed, and among S. pneumoniae strains resistant to erythromycin alone, the spread of clones Poland6B-20 (ST315) and England9V-14 (ST9) was found.

Conclusions:
The favourable low prevalence of penicillin resistance among S. pneumoniae strains, which in addition is negligible in the light of the new clinical breakpoints for penicillin resistance in strains from patients with pneumonia, contrasts with the ever increasing resistance of this species to macrolides. The highest rates of resistance to macrolides found in the strains isolated mainly from the sputum of adult patients confirm the preference for macrolides over the drugs of choice amoxicillin or penicillin G in the treatment of adults with pneumococcal pneumonia. Further spread of successful multiresistant clones of S. pneumoniae, the presence of which has been revealed in the Czech Republic, can only be prevented by a radical reduction in overuse or misuse of antibiotics.

Keywords:
Streptococcus pneumoniae – Streptococcus pyogenes – antibiotic resistance – typing.


Zdroje

1. Dowell, S. F., Marcy, S. M., Phillips, W. R. et al. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics, 1998, 101,1 (Suppl), p. 16315–184.

2. Gonzales, R., Bartlett, J. G., Besser, R. E. et al. Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: Background, specific aims and methods. Ann. Intern. Med., 2001, 134, 6, p. 478–529.

3. Jindrák, V., Marek, J., Vaniš, V. et al. Improvements in antibiotic prescribing by community paediatricians in the Czech Republic. Eurosurveillance, 2008, Euro Surveill., 2008, 13, 46, p. 19040. Dostupné na www: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19040

4. Musher, D. Streptococcus pneumoniae. In Man­dell, G. L., Bennet, J. E., Dolin, R. (eds), Principles and Practice in Infectious Diseases (7th ed), Churchill Livingstone, 2010, p. 2623–2642.

5. Hoza, J., Jindrák, V., Marešová, V. et al. Konsenzus používání antibiotik I. Penicilinová antibiotika. Prakt. Lék., 2002, 82, p. 247–306.

6. Lim, W. S., Baudouin, S. V., George, R. C. et al. Guidelines for management of community acquired pneumonia in adults: update 2009. Thorax, 2009, 64, Suppl. III, p. 55.

7. Mandell, L. A., Wunderink, R. G., Anzueto, A. et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community – acquired pneumonia in adults. Clin. Infect. Dis., 2007, 44, Suppl 2, p. S27–72.

8. European Committee on Antimicrobial Suscep­tibility Testing Breakpoint tables for interpretation of MICs and zone diameters. Version 1, April 2010 (online). Dostupné na www: http://www.eucast.org/ clinical_breakpoints/

9. Bébrová, E., Jindrák, V., Kolář, M., Marešová, V., Urbášková, P. Doporučený postup pro antibiotickou léčbu respiračních infekcí v primární péči. Prakt. Lék., 2003, 83, p. 502–515.

10. Baquero, F. Evolving resistance patterns of Streptococcus pneumoniae: A link with long-acting macrolide consumption? J. Chemother., 1999, 11, Suppl 1, p. 35–43.

11. Baquero, F. Trends in antibiotic resistance of respiratory pathogens: an analysis and commentary on a collaborative surveillance study. J. Antimicrob. Chemother., 1996, Suppl. A, p. 117–132.

12. Baquero, F., Baquero-Artigao, G., Cantón, R., García-Rey, C. Antibiotic consumption and resistance selection in Streptococcus pneumoniae. J. Antimicrob. Chemother., 2002, 50, Suppl S2, p. 27–37.

13. Jelínková, J., Urbášková, P., Motlová, J., Jelínek J. Sensitivity of Streptococcus pyogenes to penicillin over a period of fourthy years. J. Chemother., 1993, Suppl I, 5, p. 297–298.

14. Dvořák, P., Urbášková, P., Štika, L., Macková, B., Bíba, V. Používání antibiotik v ambulantní péči v České republice. Prakt. Lék., 2004, 84, p. 369–374.

15. Urbášková, P., Pracovní skupina pro monitoro­vání rezistence Vzestup rezistence Streptococcus pyo­genes k makrolidovým antibiotikům v České republice. Prakt. Lék., 1999, 79, p. 636–640.

16. Urbášková, P., Jakubů, V., Pracovní skupina pro monitorování antibiotické rezistence Rezistence k makrolidům u druhu Streptococcus pyogenes v České republice v období let 1996–2003. Epidemiol. Mikrobiol. Imunol., 2004, 53, p. 196–202.

17. Barlow, G. D., BSAC Council Swine flu and antibiotics. J. Antimicrob. Chemother., 2009, 64, p. 889–894.

18. Akkerman, A. E., Kuyvenhoven, M. M., Wouden, J. C., Verheij, TJ. M. Determinants of antibiotic overprescribing in respiratory tract infections in general practice. J. Antimicrob. Chemother., 2005, 56, p. 930–936.

19. Goossens, H., Ferech, M., Vander Stichele, R., Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: a cross national database study. Lancet, 2005, 365, p. 579–587.

20. Furuya, E. Y., Lowy, F. D. Antimicrobial-resistant bacteria in the community setting. Nat. Rev. Microbiol., 2006, 4, p. 36–45.

21. Sande-Bruinsma, N., Grundmann, H., Verloo, D. et al. Antimicrobial drug use and resistance in Europe. Emerg. Infect. Dis., 2008, 14, p. 1722–1730.

22. Urbášková, P. Pracovní skupina pro monitorování rezistence. Zprávy CEM, 1997, 6, p. 22.

23. European Antimicrobial Surveillance Resistance System. EARSS Annual Report 2008, (Czech Republic s.116–117). Dostupné na www: http://www.ecdc.europa. eu/ens/activities/surveillance/EARS-Net/Documents/ 2008_EARSS_Annual_Report.pdf

24. EARSS Manual 2005. National Institute for Public Health and the Environment (RIVM), 2005.

25. Sorensen, U. B. Typing of pneumococci by using 12 pooled antisera. J. Clin. Microbiol., 1993, 31, p. 2097–2100.

26. Enright, M. C., Spratt, B. G. A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology, 1998, 144, p. 3049–3060.

27. Urbášková, P. Rezistence bakterií k antibiotikům. Vybrané metody. Praha: Trios 1998. ISBN 80-238-3106-2.

28. Clinical and Laboratory Standards Institute. Perfor­mance standards for antimicrobial susceptibility testing, twentieth informational supplement. CLSI Document M100-S20. Clinical and Laboratory Standards Institute, USA, Pa, 2010.

29. Ball, P., Baquero, F., Cars, O. et al. Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence. J. Antimicrob. Chemother., 2002, 49, p. 31–40.

30. Urbášková, P. Rezistence k antibiotikům u Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae a Moxarella catarrhalis v České republice v roce 1996 a 1997. Klin. Mikrobiol. Inf. Lék., 1998, 4, p. 292–298.

31. Urbášková, P., Pracovní skupina pro monitorování rezistence Trendy rezistence izolátů Streptococcus pneumoniae, Haemophilus influenzae a Streptococcus pyogenes z dýchacích cest v České republice v průběhu tří let (1996–1998). Klin. Mikrobiol. Inf. Lék., 1999, 5, p. 311–319.

32. Urbášková, P., Wunschová, M., Lebedová, V., Křížová, P. Rezistence k 10 antibiotikům u invazivních izolátů Haemophilus influenzae, izolovaných v období 1999– 2002 v České republice. Prakt. Lék., 2004, 84, 12, p. 705–709.

33. Urbášková, P. Rezistence k antibiotikům u kmenů Streptococcus pneumoniae ze závažných infekcí v České republice, 1996–1998. Klin. Mikrobiol. Inf. Lék., 1999, 5, p. 49–54.

34. Urbášková, P., Motlová, J., Žemličková, H., CZ‑EARSS Antibiotická rezistence invazivních pneumokoků a jejich sérotypy v České republice. Čas. Lék. čes., 2004, 143, p. 178–183.

35. Urbášková, P., Marešová, V., Jindrák, J. et al. Konsenzus používání antibiotik II. Makrolidová antibiotika. Prakt. Lék., 2003, 83, p. 563–571.

36. Coffey, T. J., Daniels, M., Enright, M. C., Spratt, B. G. Serotype 14 variants of the Spanish penicillin-resistant serotype 9V clone of Streptococcus pneumoniae arose by large recombinational replacements of the cpsA-pbp1a region. Microbiology, 1999, 45, p. 2023–2031.

Štítky
Hygiene and epidemiology Medical virology Clinical microbiology

Článok vyšiel v časopise

Epidemiology, Microbiology, Immunology

Číslo 1

2011 Číslo 1

Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#