Susceptibilities to Telithromycin and Six Other Agents and Prevalence of Macrolide Resistance Due to L4 Ribosomal Protein Mutation among 992 Pneumococci from 10 Central and Eastern European Countries

Abstract

The macrolide and levofloxacin susceptibilities of 992 isolates of Streptococcus pneumoniae from clinical specimens collected in 1999 and 2000 were determined in 10 centers in Central and Eastern European countries. The prevalences of penicillin G-intermediate (MICs, 0.125 to 1 g/ml) and penicillin-resistant (MICs, <2 g/ml) Streptococcus pneumoniae isolates were 14.3 and 16.6%, respectively. The MICs at which 50% of isolates are inhibited (MIC 50 s) and the MIC 90 s of telithromycin were 0.016 and 0.06 g/ml, respectively; those of erythromycin were 0.06 and >64 g/ml, respectively; those of azithromycin were 0.125 and >64 g/ml, respectively; those of clarithromycin were 0.03 and >64 g/ml, respectively; and those of clindamycin were 0.06 and >64 g/ml, respectively. Erythromycin resistance was found in 180 S. pneumoniae isolates (18.1%); the highest prevalence of erythromycin-resistant S. pneumoniae was observed in Hungary (35.5%). Among erythromycin-resistant S. pneumoniae isolates, strains harboring erm ( (2 strains [1.1%]). Similar pulsed-field gel electrophoresis patterns suggested that some strains containing L4 mutations from the Slovak Republic, Bulgaria, and Latvia were clonally related. Of nine strains highly resistant to levofloxacin (MICs, >8 g/ml) six were isolated from Zagreb, Croatia. Telithromycin at <0.5 g/ml was active against 99.8% of S. pneumoniae isolates tested and may be useful for the treatment of respiratory tract infections caused by macrolide-resistant S. pneumoniae isolates.

Phenotypes and Genotypes of Erythromycin-Resistant Pneumococci in Italy

“…As regards M-type isolates, recent Italian rates ranging between one-third (in the present study) and one-fifth (6,13,20,23) of erythromycin-resistant isolates contrast with the complete absence of M-type pneumococci in recent surveys carried out in a country as close as France (1,10). Rates of M-type isolates similar to those found in Italy have been reported in Greece (35), in a multinational European study (30), in Georgia (United States) (11), and in Taiwan (17); lower rates have been reported in Spain (32), Belgium (8), Central and Eastern European countries (24), and South Africa (22); higher rates have been reported in Germany (27), Japan (26), Canada (16), and in a nationwide study in the United States (9). mef(A) and mef(E) genes in M-type pneumococci.…”

Changes in Serotypes and Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Strains in Cleveland: a Quarter Century of Experience

“…The trays were incubated under ambient conditions at 35°C for 20 to 24 h, and the lowest concentration showing no growth read as the MIC. Macrolide-resistant, clindamycin-susceptible isolates were also tested for inducible clindamycin resistance by the erythromycin disk induction method, using erythromycin (15 g) and clindamycin (2 g) disks placed 10 mm apart (edge to edge) on plates (25,41). Inducible clindamycin resistance is indicated by blunting of the clindamycin zone on the side where the erythromycin disk was placed, and inducibly clindamycin-resistant isolates are interpreted as clindamycin resistant.…”

“…Multidrug-resistant (MDR) strains were defined as being nonsusceptible to all three drug classes tested. Selected macrolideresistant strains were tested for the presence of erm(B) and mef(E) genes by PCR with primers and conditions previously described, with expected PCR products of 639 and 345 bp, respectively (25,(40)(41)(42).…”

Molecular Epidemiology And Antibacterial Susceptibility Of Streptococci Isolated From Healthy Children Attending Day Care Units

“…The first penicillin resistant pneumococci was reported in 1977, (6) especially in Kayseri, a central city of Turkey, but no high level penicillin-resistant clinical isolate of S. pneumoniae has been isolated (7). Erythromycin-resistant S. pneumoniae and erythromycin-resistant S. pyogenes strains have been reported in many countries (8)(9)(10). This resistance is mediated mainly by two resistance genes erm(B)and mef(A), and in rare strains by ribosomal mutation (9,11).…”

“…Erythromycin-resistant S. pneumoniae and erythromycin-resistant S. pyogenes strains have been reported in many countries (8)(9)(10). This resistance is mediated mainly by two resistance genes erm(B)and mef(A), and in rare strains by ribosomal mutation (9,11).…”