Respiratory tract pathogens isolated from patients hospitalized with suspected pneumonia in Latin America: frequency of occurrence and antimicrobial susceptibility profile: results from the SENTRY Antimicrobial Surveillance Program (1997-2000 (original) (raw)
Related papers
Diagnostic Microbiology and Infectious Disease, 1998
Pneumonia is the most common fatal hospital-acquired infection, with attributable mortality rates ranging from 30 to 60%. Rapid initiation of optimal antimicrobial therapy is essential for obtaining treatment success. In this report the antimicrobial susceptibility of 556 strains from the lower respiratory tract were collected by the SENTRY Antimicrobial Surveillance Program (1997). These strains were iso-lated from hospitalized patients with pneumonia in 10 Latin American centers (6 countries) as part of this 68-center worldwide program. The isolates were susceptibility tested against more than 70 drugs (35 reported) by the reference broth microdilution method. Klebsiella pneumoniae and Escherichia coli phenotypically consistent with extended spectrum -lactamase (ESBL) production were characterized further by ribotyping and pulsed-field gel electrophoresis. The five most frequently isolated species were (n/%): Pseudomonas aeruginosa 149/26.8%), Staphylococcus aureus (127/22.8%), Acinetobacter spp. (66/11.9%), Klebsiella spp. (56/10.1%), and Enterobacter spp. (40/ 7.2%). P. aeruginosa demonstrated high rates of resistance to a majority of the antimicrobial drugs tested. Carbapenems, amikacin, and piperacillin/tazobactam demonstrated the highest susceptibility rates (73.8-77.2%) against P. aeruginosa, however the lowest resistance rate was observed for cefepime (6.7%). Acinetobacter spp. also showed very high rates of resistance and the most active compounds were imipenem and meropenem (89.0% susceptibility) followed by the tetracyclines. Cephalosporin susceptibilities among Klebsiella spp. were low: cefoxitin, 73.0%; ceftazidime, 69.4%; and ceftriaxone, 65.9%. Approximately 37% and 28% of K. pneumoniae and E. coli isolates, respectively, were considered ESBL producers based on NCCLS criteria. Ceftriaxone was active against only 52.5% of Enterobacter spp. isolates, whereas cefepime was active against 90.0% of isolates (MIC50, Յ0.12 g/mL). Oxacillin resistance was detected in nearly 50% of S. aureus isolates. The most active drugs against S. aureus were vancomycin,
Diagnostic Microbiology and Infectious Disease, 1998
Pneumonia is the most common fatal hospital-acquired infection, with attributable mortality rates ranging from 30 to 60%. Rapid initiation of optimal antimicrobial therapy is essential for obtaining treatment success. In this report the antimicrobial susceptibility of 556 strains from the lower respiratory tract were collected by the SENTRY Antimicrobial Surveillance Program (1997). These strains were iso-lated from hospitalized patients with pneumonia in 10 Latin American centers (6 countries) as part of this 68-center worldwide program. The isolates were susceptibility tested against more than 70 drugs (35 reported) by the reference broth microdilution method. Klebsiella pneumoniae and Escherichia coli phenotypically consistent with extended spectrum -lactamase (ESBL) production were characterized further by ribotyping and pulsed-field gel electrophoresis. The five most frequently isolated species were (n/%): Pseudomonas aeruginosa 149/26.8%), Staphylococcus aureus (127/22.8%), Acinetobacter spp. (66/11.9%), Klebsiella spp. (56/10.1%), and Enterobacter spp. (40/ 7.2%). P. aeruginosa demonstrated high rates of resistance to a majority of the antimicrobial drugs tested. Carbapenems, amikacin, and piperacillin/tazobactam demonstrated the highest susceptibility rates (73.8-77.2%) against P. aeruginosa, however the lowest resistance rate was observed for cefepime (6.7%). Acinetobacter spp. also showed very high rates of resistance and the most active compounds were imipenem and meropenem (89.0% susceptibility) followed by the tetracyclines. Cephalosporin susceptibilities among Klebsiella spp. were low: cefoxitin, 73.0%; ceftazidime, 69.4%; and ceftriaxone, 65.9%. Approximately 37% and 28% of K. pneumoniae and E. coli isolates, respectively, were considered ESBL producers based on NCCLS criteria. Ceftriaxone was active against only 52.5% of Enterobacter spp. isolates, whereas cefepime was active against 90.0% of isolates (MIC50, Յ0.12 g/mL). Oxacillin resistance was detected in nearly 50% of S. aureus isolates. The most active drugs against S. aureus were vancomycin,
Diagnostic Microbiology and Infectious Disease, 2000
The correct empiric choice of antimicrobial therapy in the treatment of pneumonia in hospitalized patients has established itself as a major therapeutic challenge to clinicians. Selection of an inappropriate antimicrobial agent could lead to increased rates of mortality and morbidity. Characteristics of pathogens responsible for this infection such as species prevalence, overall antimicrobial resistance rates, and mechanisms of detected resistance could serve as an invaluable resource to clinicians in making such therapeutic selections. This report addresses the aforementioned problems/needs by analysis of 712 strains isolated from the lower respiratory tract of patients hospitalized with a diagnosis of pneumonia in 10 Latin American medical centers in the SENTRY Antimicrobial Surveillance Program (1998). The four most frequently isolated pathogens (no/% of total) were: Pseudomonas aeruginosa (191/26.8%), Staphylococcus aureus (171/24.0%), Klebsiella spp. (86/12.1%), and Acinetobacter spp. (75/10.5%); representing nearly 75.0% of all isolates. More than 40 antimicrobial agents (23 reported) were tested against these isolates by reference broth microdilution methodology, and susceptibility profiles were established. The nonfermentative Gram-negative bacteria (P. aeruginosa and Acinetobacter spp.) exhibited high levels of resistance to the agents tested. Amikacin (77.5% susceptible) was the most active drug tested against P. aeruginosa, followed by piperacillin/tazobactam (73.3% susceptible) Ͼ meropenem (72.8%) Ͼ imipenem (71.7%) as the only antimicrobials possessing a susceptibility rate of Ͼ70.0%. Only the carbapenem class compounds, imipenem (81.3% susceptible) and meropenem (78.3% susceptible) possessed susceptibility rates Ͼ50.0% against the Acinetobacter spp. isolates. Based on published interpretive criteria, over 22.0% of the Klebsiella spp. and 12.5% of the Escherichia coli were classified as extended spectrum -lactamase (ESBL) producers.
Diagnostic Microbiology and Infectious Disease, 2001
Pneumonia is the second most frequent cause of nosocomial infection, and hospitalization frequently is needed for community-acquired pneumonia. Knowledge of causative pathogens through periodic surveillance, and their prevailing antimicrobial susceptibility patterns becomes paramount in choosing appropriate empiric therapy. The SENTRY Antimicrobial Surveillance Program, tracks pathogen distribution worldwide since 1997 and documents emerging resistance to a wide range of antimicrobial agents. During the respiratory disease season in 1998, each of 30 medical centers (25 in the United States [US], and five in Canada [CAN]) contributed 100 consecutive isolates obtained from hospitalized patients with suspected pneumonia. The 2773 organisms, processed by the monitor consisted of a total of 35 species, with Staphylococcus aureus comprising 25.6% of all isolates and five other species (Pseudomonas aeruginosa 18.7%, Haemophilus influenzae 9.4%, Streptococcus pneumoniae 7.8%, Klebsiella spp. 7.0%, and Enterobacter spp. 6.7%) making up almost 50% of the total. In the US, pneumococci (8.5%) were more prevalent than in CAN (4.1%; p ϭ 0.001). The US isolates of S. pneumoniae were variably susceptible to penicillin (76.8%), with non-susceptible strains demonstrating greater levels of cross resistance to macrolides (31.8%), cefepime (9.0%) and cefotaxime (6.8%), but remaining susceptible to gatifloxacin and quinupristin/dalfopristin. H. influenzae and Moraxella catarrhalis were generally ampicillin-resistant, 40.4 -44.4% and 93.7-95.7%, respectively. P. aeruginosa remained very susceptible to amikacin (91.3-93.8%) Ͼ tobramycin Ͼ meropenem Ͼ piperacillin/ tazobactam Ͼ gentamicin Ͼ piperacillin Ͼ cefepime (80.0 -81.8%). Extended spectrum -lactamase phenotypes among the Klebsiella spp. were isolated from five medical centers in the US and were 4.8 -6.0% overall; a rate similar to the previous year. Among the US isolates of Enterobacter spp., only 77.6% and 79.6% were susceptible to ceftazidime and cefotaxime, respectively, but Ͼ90% were inhibited by cefepime, imipenem, meropenem, aminoglycosides, and fluoroquinolones. Isolates from CAN were generally more susceptible, except for Pseudomonas isolates, where resistance to aminoglycosides, fluoroquinolones and imipenem was greater. The SENTRY Program results outline important national differences in the frequencies of pathogen occurrence, but more importantly, identify unstable patterns of resistance to available antimicrobial drugs, and serves as a reference for results of other local, national or international investigations.
International Journal of Antimicrobial Agents, 2009
The objective of this study was to determine: (i) the prevalence of resistance in current clinical isolates of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis and Klebsiella pneumoniae; (ii) the prevalence of production of extended-spectrum -lactamases (ESBLs) and methicillin resistance in S. aureus; and (iii) regional differences in the prevalence of ESBL production and clonality of K. pneumoniae isolates. Pathogens causing respiratory tract infections in hospitalised patients were prospectively collected from all over Germany. Drugs tested by Etest included moxifloxacin, levofloxacin, amoxicillin/clavulanic acid, cefuroxime, clarithromycin and penicillin G. ESBL production by K. pneumoniae was determined using cefotaxime/ceftazidime ± clavulanic acid. Deutsches Institut für Normung (German Institute for Standardisation)/European Committee on Antimicrobial Susceptibility Testing (DIN/EUCAST) breakpoints were used where applicable. Overall, 1859 pathogens were analysed. For all species tested the fluoroquinolones achieved the highest overall susceptibility rate (92.8%) compared with clarithromycin (60.5%), amoxicillin/clavulanic acid (85.7%) and cefuroxime (89.6%). From 438 K. pneumoniae isolates, 13.0% produced an ESBL. The ESBL prevalence was 38.8% in Eastern Germany with a trend towards clonality in some centres, but ranged from 4.7% to 7.1% in Southern, Northern and Western Germany. Among the methicillin-susceptible S. aureus isolates, 10.1% were moxifloxacin-and levofloxacinresistant. Of the S. pneumoniae isolates, 99.3% were moxifloxacin-and levofloxacin-susceptible, 93.9% were penicillin G-susceptible and 85.7% were clarithromycin-susceptible. With a MIC 90 value (minimal inhibitory concentration for 90% of the isolates) of 0.19 mg/L, moxifloxacin was more potent than levofloxacin (MIC 90 = 1 mg/L) against S. pneumoniae. Haemophilus influenzae and M. catarrhalis were almost 100% susceptible to the quinolones; 100% of the M. catarrhalis but only 4.5% of the H. influenzae strains were clarithromycin-susceptible. Moxifloxacin was the most active agent amongst the drugs tested, in particular against Gram-positive pathogens.
A Cross-Canada Surveillance of Antimicrobial Resistance in Respiratory Tract Pathogens
Canadian Journal of Infectious Diseases, 1999
OBJECTIVE: To determine the prevalence of antimicrobial resistance in clinical isolates ofStreptococcus pneumoniae, Haemophilus influenzaeandMoraxella catarrhalisfrom medical centres across Canada.METHODS: Fifty laboratories from across Canada were asked to collect up to 25 consecutive clinical isolates ofS pneumoniae,H influenzaeandM catarrhalisat some time between September 1994 and May 1995, and then again between September and December of 1996. A total of 2364S pneumoniae, 575H influenzaeand 200M catarrhalissamples were collected.H influenzaeandM catarrhalisisolates were tested for the production of beta-lactamase.S pneumoniaeisolates were characterized as penicillin susceptible, intermediately resistant or high level penicillin-resistant. Minimal inhibitory concentrations (MICs) were determined using a microbroth dilution technique described by the National Committee of Clinical Laboratory Standards.RESULTS: Between the two collection periods, there was a significant increase i...
International Journal of Antimicrobial Agents, 2001
We measured the susceptibility of Canadian isolates of three respiratory tract pathogens (Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae) to several currently approved antimicrobial agents by two different methods. We also measured the susceptibility of isolates to seven fluoroquinolones. Beta-lactamase was produced by 123/566 (21.7%) of H. influenzae isolates compared with 178/200 (89%) of M. catarrhalis isolates. For S. pneumoniae 83/374 (22.2%) isolates were penicillin resistant and of these 2.1% (8/374) showed high level resistance (MIC ] 2 mg/l). Regardless of methodology, all fluoroquinolones were highly active against H. influenzae (MIC 90 5 0.031 mg/l) and M. catarrhalis (MIC 90 5 0.064 mg/l) isolates. Susceptibility of H. influenzae to cefuroxime and amoxycillin/clavulanic acid was 99 -100% whereas 84 -85.5% were susceptible to cefaclor and cefprozil. Azithromycin susceptibility ranged from 82.6 to 99.2% depending on the method. M. catarrhalis isolates were uniformly susceptible to all agents tested except amoxycillin. Cross-resistance in S. pneumoniae to all non-quinolone agents was concurrent with increasing penicillin resistance as shown by increasing MIC 90 values. For the fluoroquinolones tested, the rank order of potency based on MIC 90 values was as follows: gemifloxacin (0.031-0.063 mg/l), trovafloxacin (0.125 mg/l), moxifloxacin (0.125-0.25 mg/l), grepafloxacin (0.125-0.25 mg/l), gatifloxacin (0.5 mg/l), levofloxacin (1 mg/l) and ciprofloxacin (2 mg/l). Our study confirms either a high or increasing prevalence of antimicrobial resistant respiratory pathogens in Canada and also compares the new and old fluoroquinolones and their potential role as therapy for community-acquired infections. The prevalence of b-lactamase positive H. influenzae may have decreased from levels reported in previous studies.
Brazilian Journal of Infectious Diseases, 2003
Telithromycin) is a global surveillance study established in 1999 to monitor antibacterial resistance of respiratory tract organisms. Thirteen centers from Argentina, Brazil and Mexico participated during 1999-2000; they collected 1,806 isolates (Streptococcus pneumoniae 518, Haemophilus influenzae 520, Moraxella catarrhalis 140, Staphylococcus aureus 351, S. pyogenes 277). Overall, 218 (42.1%) of the S. pneumoniae isolates had reduced susceptibility to penicillin, 79 (15.3%) were penicillin-resistant and 79 (15.3%) were erythromycin-resistant. Mexico had the highest prevalence of penicillin (76.5%) and erythromycin (31.2%) resistance. Of 77 erythromycinresistant S. pneumoniae tested for resistance genotype, 43 possessed mef(A), 33 possessed erm(B) and 1 possessed both erm(B) and mef(A) mechanism. All S. pneumoniae isolates were fully susceptible to telithromycin, linezolid, teicoplanin and vancomycin. Among H. influenzae isolates, 88 (16.9%) produced β
Journal of Infection and Chemotherapy, 2015
The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents. Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was as high as 50.5%, and those of penicillin-intermediate and-resistant S. pneumoniae were 1.1% and 0.0%, respectively. Among H. influenzae, 17.6% of them were found to be b-lactamase-non-producing ampicillin (ABPC)intermediately resistant, 33.5% to be b-lactamase-non-producing ABPC-resistant and 11.0% to be b-lactamase-producing ABPC-resistant strains. Extended spectrum b-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo b-lactamase were 2.9% and 0.6%, respectively. Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.
Journal of Infection and Chemotherapy, 2012
The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents. Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was as high as 50.5%, and those of penicillin-intermediate and-resistant S. pneumoniae were 1.1% and 0.0%, respectively. Among H. influenzae, 17.6% of them were found to be b-lactamase-non-producing ampicillin (ABPC)intermediately resistant, 33.5% to be b-lactamase-non-producing ABPC-resistant and 11.0% to be b-lactamase-producing ABPC-resistant strains. Extended spectrum b-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo b-lactamase were 2.9% and 0.6%, respectively. Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.