Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae in Sao Paulo, Brazil from 1996 to 2000

Koeth, Laura; Felmingham, D.; Jacobs, Michael; Rossi, Flávia

doi:10.1016/j.ijantimicag.2003.09.022

Cited by 16 publications

(11 citation statements)

References 20 publications

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“…A elevada taxa de resistência encontrada para o cotrimoxazol (79,5%) está de acordo com as relatadas em estudos nacionais de 54,5 27 , 61,2 [13][14][15] , 65 24 e 65,7% 28 e pode comprometer a indicação deste quimioterápico no tratamento das infecções pneumocócicas. Permanecem relativamente baixas as cifras para a eritromicina (11,3%) e clindamicina (11,3%), comparáveis com as relatadas em outros estudos nacionais: para eritromicina, valores de 3,8 27 , 5,5 13-15 , 5,7 28 e 6,2% 24 e para clindamicina, valores de 2,9 28 e 3,1% 27 . O fato de 16 cepas resistentes à eritromicina serem também resistentes à clindamicina sugere a manifestação do fenótipo MLS B , caracterizado pela resistência constitutiva aos macrolídeos, lincosaminas e estreptogramina B 29,30 .…”

Section: Discussionunclassified

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Mantese¹,

Paula²,

Almeida³

et al. 2009

J Pediatr (Rio J)

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Section: Discussionunclassified

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Mantese¹,

Paula²,

Almeida³

et al. 2009

J Pediatr (Rio J)

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“…Dosing of 250 mg or 500 mg q8h increased the latter breakpoints to 0.375 mg/liter or 0.75 mg/liter, respectively. Koeth et al (31) determined a PK-PD MIC breakpoint of Յ1 mg/liter for susceptibility for standard cefuroxime dosage regimens based on an fT ϾMIC of Ն40 to 50%. This higher breakpoint is expected, since Koeth et al (31) used average PK parameters for simulation and did not include BSV.…”

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New Semiphysiological Absorption Model To Assess the Pharmacodynamic Profile of Cefuroxime Axetil Using Nonparametric and Parametric Population Pharmacokinetics

Bulitta

Landersdorfer

Kinzig

et al. 2009

Antimicrob Agents Chemother

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Cefuroxime axetil is widely used to treat respiratory tract infections. We are not aware of a population pharmacokinetic (PK) model for cefuroxime axetil. Our objectives were to develop a semiphysiological population PK model and evaluate the pharmacodynamic profile for cefuroxime axetil. Twenty-four healthy volunteers received 250 mg oral cefuroxime as a suspension after a standardized breakfast. Liquid chromatographytandem mass spectrometry was used for drug analysis, NONMEM and S-ADAPT (results reported) were used for parametric population PK modeling, and NPAG was used for nonparametric population PK modeling. Monte Carlo simulations were used to predict the duration for which the non-protein-bound-plasma concentration was above the MIC (fT >MIC ). A model with one disposition compartment, a saturable and timedependent drug release from the stomach, and fast drug absorption from the intestine yielded precise (r > 0.992) and unbiased curve fits and an excellent predictive performance. The apparent clearance was 21.7 liters/h (19.8% coefficient of variation [CV]) and the volume of distribution 38.7 liters (18.3% CV). Robust (>90%) probabilities of target attainment (PTAs) were achieved by 250 mg cefuroxime given every 12 h (q12h) or q8h for MICs of <0.375 mg/liter or <0.5 mg/liter, respectively, for the bacteriostasis target fT >MIC of >40% and for MICs of <0.094 mg/liter or <0.375 mg/liter, respectively, for the near-maximal-killing target fT >MIC of >65%. For the >40% fT >MIC target, the PTAs for 250 mg cefuroxime q12h were >97.8% for Streptococcus pyogenes and penicillin-susceptible Streptococcus pneumoniae. Cefuroxime at 250 mg q12h or q8h achieved PTAs below 73% or 92%, respectively, for Haemophilus influenzae, Moraxella catarrhalis, and penicillin-intermediate S. pneumoniae for susceptibility data from various countries. Depending on the MIC distribution, 250 mg oral cefuroxime q8h instead of q12h should be considered, especially for more-severe infections that require near-maximal killing by cefuroxime.Cefuroxime axetil is the acetoxyethyl-ester prodrug of cefuroxime. Cefuroxime axetil is reliably absorbed and can be taken with or without a meal, although its extent of bioavailability is enhanced under the influence of food (20, 54). Cefuroxime has been successfully used in the treatment of upper and lower respiratory tract infections as well as genitourinary tract infections (45) and is active against Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, Klebsiella pneumoniae, Neisseria gonorrhoeae, penicillin-susceptible Streptococcus pneumoniae, and some isolates of penicillin-intermediate S. pneumoniae (6, 7, 25-27, 34, 35, 37, 38, 41, 55).A susceptibility breakpoint of Յ1 mg/liter has been determined for cefuroxime by national organizations in Britain (BSAC) (8) and Germany (DIN) (17). The susceptibility breakpoints from the Clinical and Laboratory Standards Institute (CLSI) (11) are Յ1 mg/liter for S. pneumoniae and Յ4 mg/liter for Haemophilus spp., Enterobacteriaceae, and Staphyl...

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“…Por exemplo, foram encontrados no estado de Minas Gerais valores de 12,8% para RI e de 2,1% para RP dentre 94 cepas obtidas de 1993 a 1998 17 . A ampliação desse estudo, incluindo amostras coletadas até 1999, mas restritas a crianças de até 6 anos de idade, evidenciou uma taxa global de resistência de 20,7% 13 , valor próximo ao de 20%, encontrado em estudos locais em território nacional 25,26 . Em Minas Gerais, estudos locais têm apontado cifras de 11,8% de cepas oxacilina-resistentes 27 e 15,5% de cepas invasivas de pneumococo com resistência à penicilina, de acordo com os critérios tradicionais 28 .…”

Section: Discussionunclassified

“…Novos pontos de corte de sensibilidade in vitro para a penicilina 15 26 , e para clindamicina, de 2,9 25 e 3,1% 26 .…”

Section: Discussionunclassified

New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

Wolkers

Mantese

Paula³

et al. 2009

J Pediatr (Rio J)

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Objective: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia.Methods: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clínicas de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility.Results: From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients ≤ 12 years old were analyzed. The patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. The strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) ≤ 0.06 µg/mL for susceptibility (S), 0.12 to 1 µg/mL for intermediate resistance (IR), and ≥ 2 µg/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (≤ 2 µg/mL for S, 4 µg/mL for IR and ≥ 8 µg/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin). Conclusions:When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%. ≤ 0,06 µg/mL para sensibilidade (S), 0,12 a 1 µg/mL para resistência intermediária (RI) e ≥ 2 µg/mL para resistência plena (RP)], 22 cepas apresentaram RI e 11, RP para penicilina. De acordo com os critérios atuais do CLSI de 2008 (≤ 2 µg/mL para S, 4 µg/mL para RI e ≥ 8 µg/mL para RP) apenas uma cepa confirmou RI à penicilina. Detectouse resistência a cotrimoxazol (80%), tetraciclina (21%), eritromicina (13%), clindamicina (13%) e ceftriaxona (uma cepa, simultaneamente resistente a penicilina). J Pediatr (Rio J) Conclusões:Com a aplicação dos novos pontos de corte para sensibilidade in vitro, as taxas de resistência a penicilina caíram 97%, de 33 para 1%. J Pediatr (Rio J)

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Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae in Sao Paulo, Brazil from 1996 to 2000

Cited by 16 publications

References 20 publications

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

New Semiphysiological Absorption Model To Assess the Pharmacodynamic Profile of Cefuroxime Axetil Using Nonparametric and Parametric Population Pharmacokinetics

New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains

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