Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands

Galan, Bastiaan E. de; Tilburg, Peter M.B. van; Sluijter, Marcel; Mol, Selena; Groot, Ronald de; Hermans, Peter W. M.; Jansz, A

doi:10.1053/jhin.1999.0580

Cited by 33 publications

(21 citation statements)

References 20 publications

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“…Other studies suggest that patient-to-patient spread is the most likely mechanism of the spread of FQ-resistant strains, mainly in the hospital (8). In this study, hospitalization is a significant risk factor in the univariate analysis, though multivariate analysis does not confirm it as an independent risk factor.…”

Section: Discussioncontrasting

confidence: 79%

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

2005

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We developed a case-control study in order to identify risk factors associated with pharyngeal colonization by Streptococcus pneumoniae with reduced susceptibility to fluoroquinolones (ciprofloxacin MIC, >4 g/ml). A total of 400 patients were studied for colonization by quinolone-nonsusceptible S. pneumoniae (QNSP) isolates and risk factors for this colonization. Isolate susceptibility was determined by the agar dilution method. Forty patients were colonized by QNSP (case patients), and 360 patients were not colonized by QNSP (control patients). The MIC range of ciprofloxacin for QNSP isolates was 4 to 8 g/ml. No isolates were resistant to levofloxacin and moxifloxacin. Risk factors significantly associated with QNSP colonization, according to univariate analysis, were recent hospitalizations (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.6 to 7.2; P < 0.01) and prior exposure to fluoroquinolones (OR, 6.04; 95% CI, 3.0 to 12.0; P < 0.01). Other factors such as chronic obstructive pulmonary disease (OR, 1.94; 95% CI; 0.7 to 5.0), prior exposure to penicillins (OR, 1,68; 95% CI, 0.8 to 3.3) and prior exposure to macrolides (OR 2; 95% CI, 0.6 to 6.2) were more frequent among patients colonized with QNSP, but there was no statistical significance. Multivariate analysis showed that exposure to fluoroquinolones was the only independent factor associated with colonization by QNSP (OR, 4.2; 95% CI, 1.8 to 9.4; P < 0.01). Throat colonization by QNSP is becoming frequent, though most of these isolates (all the isolates in this case) remain susceptible to newer fluoroquinolones. Previous treatment with fluoroquinolones seems to be the main risk factor associated with colonization by QNSP.The emergence and spread of drug-resistant Streptococcus pneumoniae are a major cause of concern in pneumococcal infection in recent years. More than 50% of isolates now found in several countries are resistant to penicillin (1,7,13,14,25), with Spain as one of the countries with the highest penicillin resistance rates (18). Among penicillin-resistant S. pneumoniae isolates, 60 to 80% are also resistant to cefuroxime, erythromycin, and clindamycin (13). Since the release in the late 1990s of newer fluoroquinolones (FQs) with enhanced activity against pneumococci, these drugs have been prescribed with increasing frequency for initial treatment of respiratory tract infections (10,22). FQ resistance rates remain low in S. pneumoniae in most countries (3,6,17), though higher resistance rates have been reported occasionally in some countries (9,12).Recent studies have shown that 30% of S. pneumoniae isolates for which the ciprofloxacin (CIP) MIC is 4 g/ml, and virtually all pneumococcal isolates for which the CIP MIC is Ͼ4 g/ml harbor one or more topoisomerases mutations (2), though not all these strains are levofloxacin (LEV) or moxifloxacin (MOX) resistant. Another recent study (16) showed that 59% of S. pneumoniae isolates intermediate for LEV (MIC of 2 g/ml) have a first-step mutation in parC. Thus, this group of strains with reduc...

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Section: Discussioncontrasting

confidence: 79%

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

2005

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“…Odds ratios (OR) and 95% confidence intervals (CI) were computed as an estimate of the relative risk. Clinical manifestations and disease severity were compared between each genotype by using the Student t test, 2 analysis, or the Fisher exact test. Multiple logistic regression analysis was done for variables associated with macrolide resistance genotypes by univariate analysis (P Ͻ 0.25).…”

Section: Designmentioning

confidence: 99%

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

Isozumi¹,

Ito²,

Ishida

et al. 2007

J Clin Microbiol

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Although macrolide-resistant Streptococcus pneumoniae strains possessing either the ermB or mefA gene are very common in Japan, clinical and microbial factors in community-acquired pneumonia (CAP) caused by different macrolide resistance genotypes have not been evaluated. A multicenter study of CAP caused by S. pneumoniae was performed in Japan from 2003 to 2005. A total of 156 isolates were tested for susceptibility to antibiotics correlated with ermB and mefA genotyping. Independent relationships between tested variables and possession of either the ermB or the mefA gene were identified. Of 156 isolates, 127 (81.4%) were resistant to erythromycin, with the following distribution of resistance genotypes: ermB alone (50.0%), mefA alone (23.7%), and both ermB and mefA (7.1%). All isolates were susceptible to telithromycin. By multivariate analysis, oxygen saturation of <90% on admission increased the risk for ermBpositive pneumococcal pneumonia (odds ratio [OR] ‫؍‬ 11.1; 95% confidence interval [CI] ‫؍‬ 1.30 to 95.0; P ‫؍‬ 0.03), but there were no associations with mefA or with ermB mefA positivity. Penicillin nonsusceptibility was associated with mefA-positive and with ermB-and mefA-positive isolates (OR ‫؍‬ 14.2; 95% CI ‫؍‬ 4.27 to 46.9; P < 0.0001 and P < 0.0001, respectively) but not with ermB-positive isolates. The overall patient mortality was 5.1%. Mortality, the duration of hospitalization, and the resolution of several clinical markers were not associated with the different erythromycin resistance genotypes. In Japan, S. pneumoniae with erythromycin resistance or possession of ermB, mefA, or both genes was highly prevalent in patients with CAP. The risk factors for ermB-positive, mefA-positive, and double ermB-mefA-positive pneumococcal pneumonia were different, but the clinical outcomes did not differ.

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“…The infecting strain of S. pneumoniae in HA-IPD may be carried by the patient at the time of hospitalisation [18] but may also be spread from an asymptomatic carrier or from another patient with pneumococcal disease in the hospital [19]. The former case may resemble the antibiotic susceptibility profiles originating from the community, whilst the latter case may be more frequently associated with multidrug-resistant S. pneumoniae [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical features, antimicrobial susceptibility, serotype distribution and outcomes of patients with hospital- and community-associated invasive pneumococcal disease

Lin

Liao

Lai

et al. 2010

International Journal of Antimicrobial Agents

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Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands

Cited by 33 publications

References 20 publications

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

Risk Factors Associated with Colonization by Pneumococci with Reduced Susceptibility to Fluoroquinolones in Adult Outpatients

Genotypes and Related Factors Reflecting Macrolide Resistance in Pneumococcal Pneumonia Infections in Japan

Comparison of clinical features, antimicrobial susceptibility, serotype distribution and outcomes of patients with hospital- and community-associated invasive pneumococcal disease

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