title: Antimicrobial susceptibility of common pathogens from community-acquired lower respiratory tract infections in Estonia.
abstract: Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae (n = 49), Haemophilus influenzae (n = 66) and Moraxella catarrhalis (n = 25) from adults with community-acquired lower respiratory tract infections (CALRTI) was assessed in a national surveillance study in Southern Estonia during 2000-2003. In S. pneumoniae, no penicillin resistance and only 2.0% resistance to clarithromycin was present, although intermediate resistance to trimethoprim-sulphamethoxazole (TMP-SMX) reached 24.5%. Beta-lactamase production rate was 96.0% in M. catarrhalis, but only 3.0% in H. influenzae. Both Gram-negative strains lacked resistance to ciprofloxacin. Clarithromycin resistance was 12% in M. catarrhalis but lacking among H. influenzae (except for 18.2% intermediate resistance). Resistance to TMP-SMX was 12.0% and 24.2% in M. catarrhalis and H. influenzae, respectively. In summary, a favorable resistance pattern of the main CALRTI pathogens is preserved in Estonia to core antibacterials. Nevertheless, use of TMP-SMX in CALRTI is discouraged and clinical response should be carefully monitored, when clarithromycin is chosen against M. catarrhalis or H. influenzae.
authors.affiliation: Department of Pulmonary Medicine, University of Tartu, Estonia. alan@kliinikum.ee
authors.forename: A
authors.initials: A
authors.lastname: Altraja
authors.forename: P
authors.initials: P
authors.lastname: Naaber
authors.forename: E
authors.initials: E
authors.lastname: Tamm
authors.forename: S
authors.initials: S
authors.lastname: Meriste
authors.forename: A
authors.initials: A
authors.lastname: Kullamaa
authors.forename: H
authors.initials: H
authors.lastname: Leesik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D002444:Cefuroxime / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology; D017291:Clarithromycin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000494:pharmacology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin; D017291:Clarithromycin; D002444:Cefuroxime