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Susceptibility of recent paediatric respiratory isolates of Streptococcus pneumoniae and Haemophilus influenzae in Spain

Abstract number: 902_p524

Latorre C.

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Objectives:

Resistance to penicillin and/or erythromycin in Streptococcus pneumoniae, and b-lactamase (BLA) production in Haemophilus influenzae are well-known predictor factors for treatment failure of acute otitis media in children. It is therefore critical to monitor rates of resistance in the community in order to tailor empiric therapeutic recommendations.

Methods:

A prospective, multicentre (25 hospitals in 13 Autonomous Communities, CCAA) antimicrobial survey was carried out between November 2001 and October 2002. A total of 373 consecutive S. pneumoniae and 438 H. influenzae isolates from children with community-acquired respiratory tract infections were collected and sent to a central laboratory for further processing. Susceptibility testing was performed by a semiautomated microdilution method following NCCLS M100-S12 recommendations. Breakpoints for penicillin and erythromycin were >=2 and >=1 mg/L, respectively. Nitrocefin test was used to detect BLA production.

Results:

Excluding those CCAA with less than 18 isolates (11 pneumococcal isolates: 36% penicillin resistant and 82% erythromycin resistant; and 38 H. influenzae: 21% BLA producers) for the sake of accuracy, mean penicillin resistance was 20% (95% CI 14–26), whereas erythromycin resistance was 48% (95% CI 36–60) for S. pneumoniae, and the MLSb phenotype was dominant (90%). As for H. influenzae, BLA production was 14% (95% CI 9–19). Rates by CCAA are given in the table.

CCAAS. pneumoniaeH. influenzae
NPenicillin resistance (%)Erthromycin Resistance (%) CCAA NBLA production (%) 
Andalucia4020%55%Andalucia3412%
Cantabria3617%17%Cantabria3716%
Cataluña4120%42%Cataluña9217%
Galicia2025%55%Galicia1921%
Madrid7225%46%Madrid5718%
PaisVasco957%47%PaisVasco684%
Valencia3017%53%Valencia4719%
Murcia2829%68%Aragon297%

Conclusions:

BLA production in paediatric respiratory H. influenzae was below 20% and around 15%. Currently, resistance to penicillin does not seem to keep increasing among paediatric respiratory isolates and remains around 20%. However, resistance to erythromycin among paediatric pneumococcal isolates is alarmingly high, with regions showing more than 60%. Only Cantabria had <20%. Macrolides do not provide adequate coverage against the two key bacterial pathogens involved in infantile respiratory infections in Spain and therefore, in the absence of sounding reasons, empirical prescription of macrolides should be avoided.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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