Antimicrobial susceptibility of 996 isolates of Streptococcus pneumoniae from clinical specimens was investigated in 11 Asian countries from September 1996 to June 1997. Korea had the greatest frequency of nonsusceptible strains to penicillin with 79.7%, followed by Japan (65.3%), Vietnam (60.8%), Thailand (57.9%), Sri Lanka (41.2%), Taiwan (38.7%), Singapore (23.1%), Indonesia (21.0%), China (9.8%), Malaysia (9.0%), and India (3.8%). Serotypes 23F and 19F were the most common. Pulsed-field gel electrophoresis (PFGE) of 154 isolates from Asian countries showed several major PFGE patterns. The serotype 23F Spanish clone shared the same PFGE pattern with strains from Korea, Japan, Singapore, Taiwan, Thailand, and Malaysia. Fingerprinting analysis of pbp1a, pbp2x, and pbp2b genes of 12 strains from six countries also showed identical fingerprints of penicillin-binding protein genes in most strains. These data suggest the possible introduction and spread of international epidemic clones into Asian countries and the increasing problems of pneumococcal drug resistance in Asian countries for the first time.

Pseudomonas pseudomallei causes the disease melioidosis, with protean manifestations, protracted clinical course and unpredictable response to antimicrobial treatment. Intracellular location of the organism is suspected to be the cause of these properties. This study was undertaken to examine the intracellular growth of this bacterium. Intracellular growth and survival was assessed at different time intervals, by Gram's stain and electronmicroscopic examination. During the first 5 h, the numbers of P. pseudomallei within phagocytes did not change significantly. By 18-21 h, gram-stained preparations revealed that P. pseudomallei cells completely filled the phagocytes and electronmicroscopy showed evidence of binary fission. During that time the number of cfu of P. pseudomallei growing simultaneously in vitro increased by log10 2-3. The phagocytes remained viable throughout the observation period and retained their capacity to produce an oxidative burst for the first hour of incubation. The ability of P. pseudomallei to survive and multiply in phagocytes shows that it is a facultative intracellular bacterium. This finding is relevant to the selection of antimicrobial regimens, and the management of the disease.

Data confirm that macrolide resistance in pneumococci is a serious problem in many Asian countries.

To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.