title: Assessment of antibiotic susceptibility of Legionella pneumophila isolated from water systems in Poland.
abstract: OBJECTIVE
  Several studies have reported therapy failures in patients with legionnaires'disease; however, antimicrobial resistance of clinical and environmental isolates of Legionella spp. has not yet been documented. Routine susceptibility testing of Legionella spp. is not recommended because of difficulties in determining standard minimal inhibitory concentration values. The purpose of this study was to analyze the antimicrobial susceptibility of Legionella pneumophila. strains isolated from a water supply system.
  
  
  METHODS
  Twenty-eight isolates of L. pneumophila (16 - L. pneumophila SG 1, 12 - L. pneumophila SG 2-14) obtained from water systems in public buildings in Poland were tested. Susceptibility testing was performed using the E-test method. The tested antibiotic were azithromycin, ciprofloxacin, and rifampicin. The medium used for the susceptibility testing was BCYE-, a special medium for Legionella cultivation.
  
  
  RESULTS
  Among the tested strains, L. pneumophila was the only one resistant to azithromycin. It was a strain of L. pneumophila SG 2-14 isolated from the water system in a sanitorium. All isolates were found to be sensitive to ciprofloxacin and rifampicin. However, the azithromycin-resistant strain exhibited higher ciprofloxacin and rifampicin MIC (1.5 μg/ml, and 0.19 μg/ml, respectively). The MIC50 for azithromycin, ciprofloxacin, and rifampicin were 0,032, 0,125, and 0,003 μg/ml, respectively. The MIC90 for azithromycin, ciprofloxacin, and rifampicin were 0,032, 0,125, and 0,003 μg/ml, respectively.
  
  
  CONCLUSIONS
  Azithromycin resistance was found in one strain of L. pneumophila SG 2-14, but the resistance mechanism is unknown and needs further study. It is possible that therapeutic failures in Legionnaires' disease may be associated with bacterial resistance which should be taken into account. The antibiotic sensitivity testing described in this study could be helpful in detecting the resistance of clinical L. pneumophila isolates. Ciprofloxacin and rifampicin have good in vitro activity against environmental L. pneumophila SG 1 and SG 2-14 in Poland.
authors.affiliation: Department of Medical Microbiology, Medical University of Lublin, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sikora
authors.affiliation: Pope John Paul II State School of Higher Education of Biała Podlaska, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Gładysz
authors.affiliation: Pope John Paul II State School of Higher Education of Biała Podlaska, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kozioł-Montewka
authors.affiliation: Department of Medical Microbiology, Medical University of Lublin, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wójtowicz-Bobin
authors.affiliation: Department of Medical Microbiology, Medical University of Lublin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Stańczak
authors.affiliation: National Institute of Public Health - National Institute of Hygiene, Department of Environmental Hygiene, Warsaw, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Matuszewska
authors.affiliation: National Institute of Public Health - National Institute of Hygiene, Department of Environmental Hygiene, Warsaw, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Krogulska
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D006761:Hospitals; D016952:Legionella pneumophila / Q000187:drug effects*; D011044:Poland; D014871:Water Microbiology; D014881:Water Supply
chemical_list: D000900:Anti-Bacterial Agents