title: Antibacterial resistance of community-acquired respiratory tract pathogens recovered from patients in Latin America: results from the PROTEKT surveillance study (1999-2000).
abstract: 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.
authors.affiliation: Fleury Centre of Diagnostic Medicine, Laboratory of Microbiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Mendes
authors.forename: M E
authors.initials: ME
authors.lastname: Marin
authors.forename: F
authors.initials: F
authors.lastname: Quiñones
authors.forename: J
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: C Cuilty
authors.initials: CC
authors.lastname: Siller
authors.forename: M
authors.initials: M
authors.lastname: Castanheira
authors.forename: C M
authors.initials: CM
authors.lastname: Zoccoli
authors.forename: H
authors.initials: H
authors.lastname: López
authors.forename: A
authors.initials: A
authors.lastname: Súcari
authors.forename: F
authors.initials: F
authors.lastname: Rossi
authors.forename: G Barriga
authors.initials: GB
authors.lastname: Angulo
authors.forename: A J A
authors.initials: AJ
authors.lastname: Segura
authors.forename: C
authors.initials: C
authors.lastname: Starling
authors.forename: I
authors.initials: I
authors.lastname: Mimica
authors.forename: D
authors.initials: D
authors.lastname: Felmingham
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin