title: In vitro antibacterial activity of beta-lactams and non-beta-lactams against Streptococcus pneumoniae isolates from Sydney, Australia.
abstract: OBJECTIVE
  This study was undertaken to determine the antimicrobial resistance patterns of strains of Streptococcus pneumoniae from Sydney, Australia, comparing penicillin-susceptible, -intermediate and -resistant isolates.
  
  
  METHODS
  Non-duplicate cultures of S. pneumoniae were collected from 1 January to 31 December 2002 in the three penicillin-susceptibility categories. Minimum inhibitory concentrations (MICs) of 19 antibacterial agents were determined by agar dilution based on the National Committee for Clinical Laboratory Standards (NCCLS) methodology. Overall for 2002, 687 non-duplicate isolates were obtained, of which 190 (28%) were intermediate or resistant to penicillin. From this set, 183 isolates were selected for study: 88 (48%) in the penicillin-susceptible group (MIC <or= 0.06 mg/L), 25 (14%) in the penicillin-intermediate group (MIC 0.125-1.0 mg/L) and 70 (38%) in the penicillin-resistant group (MIC >or= 2.0 mg/L).
  
  
  RESULTS
  Resistance to non-beta-lactams was more common in penicillin-intermediate or -resistant strains. Multidrug resistance (resistance to >or= 2 non-beta-lactams) was found in 3% of penicillin-susceptible, 52% of penicillin-intermediate and 87% of penicillin-resistant isolates. Erythromycin resistance was seen in 22% of the penicillin-susceptible strains but increased significantly to 60% and 89% in the penicillin-intermediate and resistant strains, respectively. Clindamycin, tetracycline and trimethoprim/sulfamethoxazole showed similar diminished activity in penicillin-intermediate and -resistant strains; 64, 84 and 91% of the penicillin-resistant isolates were resistant to clindamycin, tetracycline and to trimethoprim/sulfamethoxazole, respectively. Chloramphenicol resistance was comparatively low level except 19% of the penicillin-resistant strains were resistant. Ciprofloxacin MICs for 14 strains were raised (MICs 4-16 mg/L); three of these were penicillin-susceptible, one penicillin-intermediate and 10 penicillin-resistant. Only one isolate was resistant to moxifloxacin and to gatifloxacin. Resistance to rifampicin, vancomycin, oritavancin, or linezolid was not detected. Twenty-three isolates were intermediate and one resistant to quinupristin/dalfopristin - 22 of these were penicillin resistant.
  
  
  CONCLUSIONS
  Streptococcus pneumoniae isolates from Sydney are commonly resistant to beta-lactams and available non-beta-lactam agents, especially if they are penicillin non-susceptible. Resistance to moxifloxacin and gatifloxacin is still rare, but some isolates were non-susceptible to quinupristin/dalfopristin. It is important to continue to survey resistance patterns to recognise emerging resistances which affect the selection of empirical antimicrobials to treat infections with S. pneumoniae.
authors.affiliation: Department of Microbiology, South Western Area Pathology Service, Liverpool, Australia. i.gosbell@unsw.edu.au
authors.forename: Iain B
authors.initials: IB
authors.lastname: Gosbell
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Fernandes
authors.forename: Clarence J
authors.initials: CJ
authors.lastname: Fernandes
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001315:Australia; D002701:Chloramphenicol / Q000494:pharmacology; D002981:Clindamycin / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D006801:Humans; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology; D015363:Quinolones / Q000494:pharmacology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D013752:Tetracycline / Q000494:pharmacology; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D015363:Quinolones; D047090:beta-Lactams; D002981:Clindamycin; D004917:Erythromycin; D002701:Chloramphenicol; D013752:Tetracycline