Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe.
OBJECTIVE
To forecast trends in resistance to penicillin and erythromycin among Streptococcus pneumoniae in Europe.


METHODS
Since 1999, the European Antimicrobial Resistance Surveillance System (EARSS) has collected routine antimicrobial susceptibility test results of S. pneumoniae. To observe and predict changes of reduced susceptibility over time, we used a multinomial logistic regression model.


RESULTS
Large variations in penicillin and erythromycin non-susceptibility were observed between countries, and reduced susceptibility to erythromycin (17%) has become more frequent than reduced susceptibility to penicillin (10%) in Europe overall. An overall decrease in single penicillin non-susceptibility, but an increase in dual non-susceptibility was observed, indicating a shift of single penicillin to combined non-susceptibility with erythromycin. By 2006, the proportion of single erythromycin and dual non-susceptibility could increase to as much as 20.4% and 8.9%, respectively.


CONCLUSIONS
Our results indicate that appropriately dosed beta-lactams for empirical therapy are still the treatment of choice, and that macrolides should be used with prudence.
Bruinsma
Nienke
N
Centre for Infectious Disease Epidemiology, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands. nienke.bruinsma@rivm.nl
Kristinsson
Karl G
KG
Bronzwaer
Stef
S
Schrijnemakers
Paul
P
Degener
John
J
Tiemersma
Edine
E
Hryniewicz
Waleria
W
Monen
Jos
J
Grundmann
Hajo
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D010406:Penicillins; D004917:Erythromycin