Περίληψη:
Objectives: To determine antimicrobial susceptibility in isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from patients with community-acquired respiratory tract infections in Greece. Methods: MICs were determined by CLSI broth microdilution and susceptibility assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 99 S. pneumoniae and 52 H. influenzae isolates were collected. Overall, 36.4%of S. pneumoniae were penicillin susceptible by CLSI oral/EUCAST and 88.9% by CLSI intravenous (iv) breakpoints. All were fluoroquinolone susceptible with ≥ 94% of isolates also susceptible to amoxicillin, amoxicillin/clavulanic acid and ceftriaxone by CLSI and PK/PD breakpoints. Trimethoprim/sulfamethoxazole, cefuroxime, cefaclor and macrolides were less active, with rates of susceptibility of 83.8%, 69.7%, 50.5% and 49.5%, respectively, by CLSI. Generally susceptibility was the same or slightly lower by EUCAST, but the cefaclor difference was much greater. Among H. influenzae, 15.4% of isolates were β-lactamase positive. Susceptibility to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime and the fluoroquinolones was seen in > 95% of isolates by CLSI criteria. Susceptibility to azithromycin was seen in 94.2% of isolates using CLSI breakpoints, but clarithromycin susceptibility was lower (61.5%). However, susceptibility to both macrolides was seen in < 5% of isolates by PK/PD and EUCAST criteria. Susceptibility to trimethoprim/sulfamethoxazolewas seen in 71.2%of isolates. Conclusions: Owing to the high prevalence of macrolide resistance among S. pneumoniae and the reduced activity of clarithromycin against H. influenzae, it appears that these agents are not appropriate as monotherapy for community-acquired pneumonia in Greece. Amoxicillin/clavulanic acid, on the other hand, maintained excellent in vitro activity and, as opposed to the similarly effective fluoroquinolones, is safe to use in paediatric patients. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Συγγραφείς:
Torumkuney, D.
Papaparaskevas, J.
Morrissey, I.
Λέξεις-κλειδιά:
amoxicillin; amoxicillin plus clavulanic acid; azithromycin; cefaclor; ceftriaxone; cefuroxime; clarithromycin; cotrimoxazole; erythromycin; levofloxacin; macrolide; moxifloxacin; penicillin derivative; penicillinase; quinoline derived antiinfective agent; amoxicillin plus clavulanic acid; antiinfective agent; macrolide; quinolone derivative, antibiotic resistance; antibiotic sensitivity; Article; bacterium isolate; broth dilution; controlled study; Greece; Haemophilus influenzae; health survey; minimum inhibitory concentration; nonhuman; pharmacodynamics; pharmacokinetics; Streptococcus pneumoniae; adolescent; adult; aged; child; community acquired infection; drug effect; epidemiological monitoring; Haemophilus infection; human; microbial sensitivity test; middle aged; multidrug resistance; pneumococcal infection; questionnaire; respiratory tract infection; young adult, Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Fluoroquinolones; Greece; Haemophilus Infections; Haemophilus influenzae; Humans; Macrolides; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Streptococcus pneumoniae; Surveys and Questionnaires; Young Adult
