title: Antimicrobial susceptibility of Streptococcus pneumoniae isolates from vaccinated and non-vaccinated patients with a clinically confirmed diagnosis of community-acquired pneumonia in Belgium.
abstract: We assessed the in vitro susceptibility of Streptococcus pneumoniae isolates from patients with confirmed community-acquired pneumonia (CAP) to β-lactams, macrolides and fluoroquinolones and the association of non-susceptibility and resistance with serotypes/serogroups (STs/SGs), patient's risk factors and vaccination status. Samples (blood or lower respiratory tract) were obtained in 2007-2009 from 249 patients (from seven hospitals in Belgium) with a clinical and radiological diagnosis of CAP [median age 61 years (11.6% aged <5 years); 85% without previous antibiotic therapy; 86% adults with level II Niederman's severity score]. MIC determination (EUCAST breakpoints) showed for: (i) amoxicillin, 6% non-susceptible; cefuroxime (oral), 6.8% resistant; (ii) macrolides: 24.9% erythromycin-resistant [93.5% erm(B)-positive] but 98.4% telithromycin-susceptible; and (iii) levofloxacin and moxifloxacin, all susceptible. Amongst SGs: ST14, all resistant to macrolides and most intermediate to β-lactams; SG19 (>94% ST19A), 73.5% resistant to macrolides and 18-21% intermediate to β-lactams; and SG6, 33% resistant to clarithromycin. Apparent vaccine failures: 3/17 for 7-valent vaccine (children; ST6B, 23F); 16/29 for 23-valent vaccine (adults ST3, 7F, 12F, 14, 19A, 22F, 23F, 33F). Isolates from nursing home residents, hospitalised patients and patients with non-respiratory co-morbidities showed increased MICs for amoxicillin, all β-lactams, and β-lactams and macrolides, respectively. Regarding antibiotic susceptibilities: (i) amoxicillin is still useful for empirical therapy but with a high daily dose; (ii) cefuroxime axetil and macrolides (but not telithromycin) are inappropriate for empirical therapy; and (iii) moxifloxacin and levofloxacin are the next 'best empirical choice' (no resistant isolates) but levofloxacin will require 500 mg twice-daily dosing for effective coverage.
authors.affiliation: Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Lismond
authors.forename: Sylviane
authors.initials: S
authors.lastname: Carbonnelle
authors.forename: Jan
authors.initials: J
authors.lastname: Verhaegen
authors.forename: Patricia
authors.initials: P
authors.lastname: Schatt
authors.forename: Annelies
authors.initials: A
authors.lastname: De Bel
authors.forename: Paul
authors.initials: P
authors.lastname: Jordens
authors.forename: Frédérique
authors.initials: F
authors.lastname: Jacobs
authors.forename: Anne
authors.initials: A
authors.lastname: Dediste
authors.forename: Frank
authors.initials: F
authors.lastname: Verschuren
authors.forename: Te-Din
authors.initials: TD
authors.lastname: Huang
authors.forename: Paul M
authors.initials: PM
authors.lastname: Tulkens
authors.forename: Youri
authors.initials: Y
authors.lastname: Glupczynski
authors.forename: Françoise
authors.initials: F
authors.lastname: Van Bambeke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001372:Aza Compounds / Q000494:pharmacology; D001530:Belgium / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D024841:Fluoroquinolones; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000592:standards; D008875:Middle Aged; D000077266:Moxifloxacin; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011804:Quinolines / Q000494:pharmacology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D014611:Vaccination; D055815:Young Adult; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D047090:beta-Lactams; D000658:Amoxicillin; D017291:Clarithromycin; D000077266:Moxifloxacin