Factors Associated with Relative Rates of Antimicrobial Resistance amongStreptococcus pneumoniaein the United States: Results from the TRUST Surveillance Program (1998–2002)

Abstract

To identify factors associated with antimicrobial resistance, data were analyzed from 27,828 isolates of Streptococcus pneumoniae submitted to the Tracking Resistance in the United States Today (TRUST) surveillance program during 4 consecutive respiratory seasons. From the 1998-1999 season to the 2001-2002 season, the prevalence of azithromycin resistance increased by 4.8% to 27.5%, the prevalence of penicillin resistance increased by 3.7% to 18.4%, the prevalence of ceftriaxone resistance increased by 0.5% to 1.7%, and the prevalence of levofloxacin resistance increased by 0.3% to 0.9%. Isolates recovered from patients <18 years of age and lower respiratory tract specimens had elevated rates of penicillin, azithromycin, and trimethoprim-sulfamethoxazole resistance (P<.00001); penicillin resistance correlated with coresistance to trimethoprim-sulfamethoxazole (87.3%), azithromycin (76.3%), ceftriaxone (9.1%), and levofloxacin (1.3%) (P<.00001). Only 62 (0.2%) of 27,828 isolates were concurrently resistant to penicillin and levofloxacin. Minimum inhibitory concentrations (MICs) of penicillin correlated strongly with MICs of ceftriaxone (R2=0.90), trimethoprim-sulfamethoxazole (R2=0.53), and azithromycin (R2=0.41). Patient age, specimen source, and penicillin resistance were factors associated with antimicrobial resistance, particularly for nonfluoroquinolone antimicrobial agents.

Patient stratification in the management of acute bacterial exacerbation of chronic bronchitis: the role of levofloxacin 750 mg

“…However, 34.8% were resistant to azithromycin. This concurs with national surveillance studies, such as Tracking Resistance in the United States Today (TRUST), which continues to demonstrate 99% susceptibility to levofloxacin, but with resistance to macrolides of ,28% [22].…”

A pilot study of single-dose azithromycin versus three-day azithromycin or single-dose ceftriaxone for uncomplicated acute otitis media in children

“…These concentrations are well above the minimum inhibitory concentrations (MICs) of the majority isolates of the 3 most common otitis pathogens: Streptococcus pneumoniae (MIC 50 , 0.06 µg/mL; MIC 90 , 16 µg/mL; 72.3% susceptible), Haemophilus influenzae (MIC 90 , 2 µg/mL; 99.5% susceptible), and Moraxella catarrhalis (MIC 90 , Յ0.12 µg/mL; 99.9% susceptible). 29,30 Dagan et al 31 also determined middle-ear fluid levels of azithromycin in children with AOM who received the 3-day regimen. They reported a total mean azithromycin concentration of 3.51 µg/mL at 24-48 hours after the last dose.…”

Clinician Knowledge and Beliefs after Statewide Program to Promote Appropriate Antimicrobial Drug Use

“…Many of these illnesses are viral, and antimicrobial agents offer no benefit. However, widespread and inappropriate use of antimicrobial agents for viral illnesses has contributed to the emergence of infections caused by antimicrobial drug-resistant organisms such as Streptococcus pneumoniae (10)(11)(12). The proportion of invasive infections caused by penicillin-nonsusceptible S. pneumoniae increased nationally from 1% in 1992 to 27% in 2000 (10).…”