Telithromycin- and Fluoroquinolone-Resistant Streptococcus pneumoniae in Taiwan with High Prevalence of Resistance to Macrolides and β-Lactams: SMART Program 2001 Data

Abstract

There is a high prevalence of ␤-lactam-and macrolide-resistant Streptococcus pneumoniae in Taiwan. To understand the in vitro susceptibilities of recent isolates of S. pneumoniae to fluoroquinolones and telithromycin (which is not available in Taiwan), the MICs of 23 antimicrobial agents for 936 clinical isolates of S. pneumoniae isolated from different parts of Taiwan from 2000 to 2001 were determined by the agar dilution method. Overall, 72% of isolates were not susceptible to penicillin (with 61% being intermediate and 11% being resistant) and 92% were resistant to erythromycin. Telithromycin MICs were >1 g/ml for 16% of the isolates, and for 99% of these isolates the MICs of all macrolides tested were >256 g/ml; all of these isolates had the constitutive macrolide-lincosamide-streptogramin B phenotype. Eighty-eight percent of the isolates were resistant to three or more classes of drugs. The ciprofloxacin MICs were >4 g/ml for six (0.6%) isolates from five patients collected in 2000 and 2001, and the levofloxacin MICs were >8 g/ml for five of these isolates. Seven isolates for which ciprofloxacin MICs were >4 g/ml, including one isolate recovered in 1999, belonged to three serotypes (serotype 19F, five isolates; serotype 23A, one isolate; and serotype 23B, one isolate). The isolates from the six patients for which ciprofloxacin MICs were >4 g/ml had different pulsed-field gel electrophoresis profiles and random amplified polymorphic DNA patterns, indicating that no clonal dissemination occurred over this time period. Despite the increased rate of fluoroquinolone use, the proportion of pneumococcal isolates for which ciprofloxacin MICs were elevated (>4 g/ml) remained low. However, the occurrence of telithromycin resistance is impressive and raises concerns for the future.

Clinical and economic burden of community-acquired pneumonia amongst adults in the Asia-Pacific region

“…Antibiotic resistance has important clinical and economic implications [13,15,42,43,[72][73][74][75][76][77][78][79][80][81][82]. The most important CAP organism with regard to antimicrobial resistance is S. pneumonia (Table 3).…”

Decreasing rates of resistance to penicillin, but not erythromycin, in Streptococcus pneumoniae after introduction of a policy to restrict antibiotic usage in Taiwan

“…A left shift of the penicillin MIC distribution with time was also noted, with MIC 50 s of 1 mg/L, 1 mg/L, 0.5 mg/L and 0.5 mg/L, and MIC 90 s of 4 mg/L, 2 mg/L, 2 mg/L and 1 mg/L, respectively, in isolates from 1998 to 1999, 2000, 2001 and 2003. Among the erythromycin‐resistant isolates collected in these periods, 60–67% exhibited high‐level resistance to erythromycin (MICs > 64 mg/L) [3,4]. Increasing rates of resistance to levofloxacin (MICs ≥ 8 mg/L) in these four periods were also observed, from 0.4% (one isolate), to 1.0% (two isolates), 0.4% (three isolates), and 2.6% (five isolates) [3,4].…”

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

“…Serotypes 23F and 19F, which have the highest rates of PNSSP, were found to be the predominant strains in nosocomial pneumococcal transmission in Japan [23]. These serotypes were also responsible for the spread of pneumococcal strains with high ␤-lactam resistance in Taiwan [14,24], including the international clones Taiwan 23F , Spain 23F and Taiwan 19F . Further work is needed to establish the in-hospital transmission routes responsible for these infections so that more effective control policies can be developed.…”

“…The relatively small number of HA-IPD patients in this study may explain why this difference did not reach statistical significance. In addition, because Taiwan is an area of high prevalence of pneumococcal antibiotic resistance [14], the high selective antibiotic pressure that contributed to alterations in pneumococcal antibiotic sensitivity [7][8][9][10] of HA-IPD would likely be attenuated. Another possible reason for this discrepancy is the heterogeneity in the pathogenesis of HA-IPD.…”