Antibacterial resistance of community-acquired respiratory tract pathogens recovered from patients in Latin America: results from the PROTEKT surveillance study (1999-2000).
PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide 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 1806 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 erythromycin-resistant 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 beta-lactamase, ranging from 11% (Brazil) to 24.5% (Mexico). Among M. catarrhalis isolates, 138 (98.6%) produced beta-lactamase. Twenty-four (8.7%) of the S. pyogenes isolates were erythromycin-resistant; resistance being attributable to mefA (n=18), ermTR (n=5) and ermB (n=1). All H. influenzae, M. catarrhalis and S. pyogenes were fully susceptible to telithromycin. Methicillin resistance was found in 26.5% of the S. aureus isolates (Argentina 15%; Mexico 20%; Brazil 31.3%). Telithromycin was effective against 97.7% of methicillin-susceptible isolates. PROTEKT confirms that antibacterial resistance is an emerging problem in Latin America. The previously reported high levels of pneumococcal resistance to the beta-lactam and macrolides were exceeded. New agents that do not induce resistance or that exert low selective pressure, e.g. telithromycin, are essential to safeguard future antibacterial efficacy.
Mendes
C
C
Fleury Centre of Diagnostic Medicine, Laboratory of Microbiology, Universidade Federal de São Paulo, São Paulo, Brazil.
Marin
M E
ME
Quiñones
F
F
Sifuentes-Osornio
J
J
Siller
C Cuilty
CC
Castanheira
M
M
Zoccoli
C M
CM
López
H
H
Súcari
A
A
Rossi
F
F
Angulo
G Barriga
GB
Segura
A J A
AJ
Starling
C
C
Mimica
I
I
Felmingham
D
D
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001118:Argentina / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D018432:Drug Resistance, Multiple; D004917:Erythromycin / Q000494:pharmacology / Q000627:therapeutic use*; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008800:Mexico / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D001936:Moraxella catarrhalis / Q000187:drug effects / Q000302:isolation & purification; D010403:Penicillin Resistance; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D004917:Erythromycin