Macrolide and Azithromycin Use Are Linked to Increased Macrolide Resistance in Streptococcus pneumoniae

Abstract

The connection between regional rates of antimicrobial resistance in Streptococcus pneumoniae and regional antimicrobial use in Finland was investigated. During the 6-year study period of 1997 to 2002, a total of 31,609 S. pneumoniae isolates were tested for penicillin resistance and a total of 23,769 isolates were tested for macrolide resistance in 18 central hospital districts in Finland. The regional macrolide resistance rates were compared with the local use of (i) all macrolides pooled and (ii) azithromycin. The penicillin resistance levels were compared with the consumption data for (i) penicillins, (ii) cephalosporins, (iii) all beta-lactams pooled, and (iv) all macrolides pooled. A statistically significant association between macrolide resistance and total use of macrolides and the use of azithromycin was found. Moreover, total use of beta-lactams and total use of cephalosporins were significantly connected to low-level penicillin resistance. A statistically significant association between penicillin-nonsusceptible isolates and penicillin or total macrolide consumption was not found.In conclusion, total macrolide use and azithromycin use are associated with increased macrolide resistance, and beta-lactam use and cephalosporin use are connected to increased low-level penicillin resistance in S. pneumoniae. Unnecessary prescribing of macrolides and cephalosporins should be avoided.Antimicrobial resistance in Streptococcus pneumoniae poses a major challenge for the management of pneumococcal infections including pneumonia, otitis media, sinusitis, meningitis, and sepsis. Penicillins and macrolides are often used in the treatment of respiratory tract infections. Therefore, it is not surprising that resistance to these drugs in S. pneumoniae has increased in many areas (8).A number of studies show that increased outpatient antimicrobial consumption is connected to increased antimicrobial resistance in S. pneumoniae (11,19,21). On the other hand, a decrease in the use of antimicrobials may, or may not, result in a decline in resistance levels in streptococci (1, 2, 24). However, many factors in this relationship need to be surveyed. It is not clear, for instance, how much and how quickly the consumption of a specific antimicrobial needs to increase to produce a given resistance level in a given community or area, where other factors such as housing, transport, and hygiene circumstances may also contribute to the spread of resistant clones.In this study, we investigated, in a nationwide study setting, whether antimicrobial resistance in S. pneumoniae is connected to previous antimicrobial use in Finland. We utilized data regarding a considerable number of pneumococcal isolates collected during 6 years by a comprehensive clinical microbiology laboratory network covering the entire country and data for annual regional drug consumption. With these data, we were able to conduct a regional survey on antimicrobial consumption and antibacterial resistance (2, 13). MATERIALS AND METHODSMacrolide and penicillin resista...

Long-term macrolide treatment for chronic respiratory disease

“…Reduced susceptibility of respiratory pathogens to macrolides has increased considerably over the last decade [115]. A similar increase has also been observed in the oro-pharyngeal carriage of macrolideresistant commensals, which, although usually harmless, can cause infection in immunocompromised hosts, or transfer the resistance acquired to other pathogens [116].…”

Epidemic of Mycoplasma pneumoniae infection in Denmark, 2010 and 2011

“…This is in contrast to other respiratory pathogens, such as Streptococcus pneumoniae, where resistance is closely linked to increased macrolide use [13]. This link was also observed following a previous Danish M. pneumoniae epidemic in 1998/99 [11].…”

Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice

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