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Macrolide susceptibility and serotype specific macrolide resistance of invasive isolates of Streptococcus pneumoniae in Germany from 1992 to 2008

DOI: 10.1186/1471-2180-10-299

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From 1992 to 2008, data on macrolide susceptibility were available for 11,807 invasive isolates. 8,834 isolates (74.8%) were from adults (≥ 16 years), and 2,973 isolates (25.2%) from children (< 16 years). The overall nonsusceptibility rate of all isolates was 16.2% (intermediate, 0.2%; resistant, 16.0%). Higher resistance rates were observed among children (intermediate, 0.2%; resistant, 23.8%) than among adults (intermediate, 0.3%; resistant 13.4%). Maximum nonsusceptibility rates during the period under study were observed in 2005 (children: intermediate, 0.3%; resistant, 32.3%; adults: intermediate, 0.0%; resistant, 18.6%), while nonsusceptibility rates in 2008 were considerably lower, especially for children (children: intermediate, 0.0%; resistant, 15.2%; adults: intermediate, 0.1%; resistant, 12.9%). The rate of resistance was higher among the vaccine serotypes (7-valent, 36.6%; 10-valent, 28.2%; 13-valent, 24.3%) than among the non vaccine serotypes (non 7-valent, 6.5%; non 10-valent, 7.4%; non 13-valent, 6.3%). Serotype 14 (69.6% nonsusceptibility) proved to be the most resistant serotype.There has been a considerable and statistically significant decrease in macrolide nonsusceptibility in Germany since 2005, especially among children.Streptococcus pneumoniae is a leading pathogen in bacterial pneumonia, sepsis and meningitis in humans worldwide [1,2]. In many European countries the rate of resistance of S. pneumoniae to macrolides has exceeded that of penicillin [3]. Concerning penicillin, it has been described that treatment of patients with nonmeningeal invasive pneumococcal infections with nonsusceptible isolates was not associated with higher mortality rates [4-6]. In 2008 new penicillin breakpoints for S. pneumoniae were published by the CLSI [7], differentiating meningitis and non-meningitis cases of invasive pneumococcal disease (IPD). Their impact on susceptibility categorisation in Germany was described previously by our group [8]. However, for ma


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