title: Antimicrobial susceptibility of Streptococcus pneumoniae in adult patients with pneumococcal pneumonia in an urban hospital in Mozambique.
abstract: BACKGROUND
  Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in Africa. Antimicrobial resistance of S. pneumoniae to penicillin and other commonly used antibiotics has increased worldwide. However, prevalence data from the African region are sparse, especially with regard to adults.
  
  
  RESULTS
  In this study, adult patients presenting at an urban referral hospital in central Mozambique were screened for pneumococcal pneumonia during an 8-week period in 2010: Patients with a respiratory syndrome underwent chest radiography and a sputum sample was collected for pneumococcal culture and antimicrobial susceptibility testing. A urine sample was tested for the presence of pneumococcal antigen.177 patients with a respiratory syndrome were included. Overall, 41/177 (23%) patients fulfilled criteria for definite or probable pneumococcal pneumonia and in the group of patients with a positive chest x-ray this concerned 35/86 (41%) patients. 166 sputum cultures yielded 16 pneumococcal strains. One mg oxacillin disc testing identified potential penicillin resistance in 7/16 (44%) strains. Penicillin minimal inhibitory concentrations (MICs) were measured for 15 of these strains and ranged from <0.016-0.75 mg/L. No MICs >2 mg/L were found, but 3/15 (20%) pneumococcal strains had MICs >0.5 mg/L. All pneumococci were sensitive to erythromycin as measured by disc diffusion testing, whereas 44% was resistant to trimethoprim-sulfametoxazole.
  
  
  CONCLUSIONS
  The proportion of pneumonia cases attributable to pneumococcus appeared to be high. Whilst none of the S. pneumoniae strains tested were penicillin resistant, standard penicillin dosing for pneumonia may be insufficient given the observed range of pneumococcal penicillin MICs.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre (AMC), University of Amsterdam, Room F4-217, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands. j.c.bos@amc.nl.
authors.forename: Jeannet C
authors.initials: JC
authors.lastname: Bos
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Beishuizen
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Madeira
authors.forename: Elmano dos Santos
authors.initials: Edos S
authors.lastname: Gomonda
authors.forename: Esmeralda O
authors.initials: EO
authors.lastname: Cossa
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Macome
authors.forename: Reindert P
authors.initials: RP
authors.lastname: van Steenwijk
authors.forename: Constance
authors.initials: C
authors.lastname: Schultsz
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009073:Mozambique; D010068:Oxacillin / Q000494:pharmacology; D010406:Penicillins / Q000494:pharmacology; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000382:microbiology*; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004917:Erythromycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D010068:Oxacillin