title: A cross-Canada surveillance of antimicrobial resistance in respiratory tract pathogens.
abstract: OBJECTIVE
  To determine the prevalence of antimicrobial resistance in clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis from medical centres across Canada.
  
  
  METHODS
  Fifty laboratories from across Canada were asked to collect up to 25 consecutive clinical isolates of S pneumoniae, H influenzae and M catarrhalis at some time between September 1994 and May 1995, and then again between September and December of 1996. A total of 2364 S pneumoniae, 575 H influenzae and 200 M catarrhalis samples were collected. H influenzae and M catarrhalis isolates were tested for the production of beta-lactamase. S pneumoniae isolates were characterized as penicillin susceptible, intermediately resistant or high level penicillin-resistant. Minimal inhibitory concentrations (MICs) were determined using a microbroth dilution technique described by the National Committee of Clinical Laboratory Standards.
  
  
  RESULTS
  Between the two collection periods, there was a significant increase in highly penicillin-resistant S pneumoniae from 2.1% to 4.4% (P<0.05) and an increase in intermediately penicillin-resistant strains from 6.4% to 8.9% (P<0.05). A significant increase in high level penicillin-resistant S pneumoniae was noted among paediatric isolates. No significant difference in the susceptibilities of comparator agents was detected. A significant increase in the number of beta-lactamase producing H influenzae, 34% to 43% (P<0.05) was observed. Ninety-five per cent of M catarrhalis isolates were beta-lactamase producers in both time periods.
  
  
  CONCLUSIONS
  During the course of this study, the incidence of penicillin resistance in S pneumoniae doubled. As a result of this increase, infections due to this organism in sites where poor penetration of beta-lactam antibiotics occur may become increasingly difficult to manage.
authors.affiliation: Departments of Microbiology, Mount Sinai and Princess Margaret Hospitals, and University of Toronto, Toronto, Ontario.
authors.forename: R J
authors.initials: RJ
authors.lastname: Davidson
authors.forename: D E
authors.initials: DE
authors.lastname: Low