Nationwide surveillance of antimicrobial resistance among Haemophilus influenzae and Streptococcus pneumoniae in intensive care units in Taiwan

Abstract

A nationwide susceptibility surveillance of Streptococcus pneumoniae and Haemophilus influenzae isolates collected from patients treated at the intensive care units (ICUs) of ten Taiwanese major teaching hospitals was conducted from September 2005 through November 2005. High rates of resistance (intermediate/resistant) of S. pneumoniae to penicillin (85% resistance), ceftriaxone (46%/20%), and cefepime (43%/15%) by meningitis criteria, and in contrast, non-susceptibilities (intermediate/resistant) to penicillin (0%/0%), ceftriaxone (20%/0%) and cefepime (15%/0%) by non-meningitis criteria were noted (p values < 0.05) by the Clinical and Laboratory Standards Institute 2008. Resistant rate of S. pneumoniae to azithromycin was also high (63%). S. pneumoniae isolates were significantly more susceptible to ertapenem (87%) than to imipenem (39%) and meropenem (44%) (p values < 0.05). Rates of non-susceptibilities of H. influenzae isolates to ampicillin and cefaclor were high (55% and 45%, respectively). No beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae isolates were found. Imipenem has a notably higher MIC(90) value (8 microg/ml) for H. influenzae than that of the other two carbapenems. Tigecycline showed good in vitro activities against these two respiratory pathogens. High rates of resistance among isolates of S. pneumoniae and H. influenzae continue to exist in the ICUs of Taiwan.

High burden of antimicrobial resistance in Asia

“…In the USA and Europe, community-acquired meticillin-resistant Staphylococcus aureus (MRSA) [1], vancomycin-resistant enterococci (VRE) [2], Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae [3] and fluoroquinolone-and carbapenemresistant Pseudomonas aeruginosa [4] have spread throughout community and hospital settings. In striking contrast, high prevalence rates of penicillin-resistant Streptococcus pneumoniae [5,6], ␤-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae [7,8], carbapenem-non-susceptible Acinetobacter baumannii [9][10][11], extended-spectrum ␤-lactamase (ESBL)-producing K. pneumoniae [12,13], New Delhi metallo-␤-lactamase 1 (NDM-1)-producing Enterobacteriaceae [14], multidrug-resistant (MDR) Salmonella enterica serotypes Choleraesuis and Typhi [15][16][17], azole-resistant Candida spp. (particularly Candida glabrata) [18] and extensively drug-resistant Mycobacterium tuberculosis (XDR-TB) [19,20] are commonly reported in Asia.…”

“…In addition, the case fatality rate of invasive pneumococcal disease (IPD) reached 30.2% amongst patients aged >65 years [28]. In fact, increasing prevalence rates of ␤-lactam-and macrolide-resistant S. pneumoniae strains have been observed in many countries [6,29]. In the Asian Network for Surveillance of Resistant Pathogens (ANSORP) study, Song et al [5] demonstrated that Asians had the world's highest level of antimicrobial resistance in S. pneumoniae.…”

“…In addition, it has been found in Japan [8] and Korea [7] that production of altered penicillin-binding protein (PBP) (especially PBP3) in some BLNAR strains renders them non-susceptible to many second-and third-generation ␤-lactam cephalosporins [37]. As of 2005, the BLNAR strain had yet to be detected in Taiwan [6]. Another important pathogen that causes LRTIs in community settings is M. catarrhalis.…”

“…The percentage of H. influenzae strains that are non-susceptible to ampicillin is equally high in Taiwan [6] and Korea [7]. In addition, it has been found in Japan [8] and Korea [7] that production of altered penicillin-binding protein (PBP) (especially PBP3) in some BLNAR strains renders them non-susceptible to many second-and third-generation ␤-lactam cephalosporins [37].…”

Update on Antibacterial Resistance in Low-Income Countries: Factors Favoring the Emergence of Resistance

“…While a high rate of beta lactamase producers among H. influenzae were recovered from the nasopharynx of healthy children below 5 years of age, and among isolates from invasive cases (61,5% and 55%, respectively). In Taiwan, no BLNAR were isolated [158,159].…”