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TARGET Surveillance, a part of the LIBRA initiative: the effect of patient demography on the antibiotic susceptibility of Streptococcus pneumoniae from community-acquired respiratory-tract infections

Abstract number: 1134_04_126

Morrissey I., Colclough A., Dowling K., McKeon M., Viljoen L., Veltman T.

Objectives:  

To assess antibiotic (ABX) resistance (res) in S. pneumoniae (SP) collected in 2003 based on patient demographic data (PDD).

Methods:  

512 centres in 7 countries submitted 3233 SP. Penicillin G (PEN), amoxycillin–clavulanate (AMX/C), azithromycin (AZI), ceftriaxone (CTX), levofloxacin (LEV), gatifloxacin (GATI) and moxifloxacin (MXF) MICs were determined. Specimen source, infection type, age and gender PDD were collected and res compared based on 95% confidence intervals.

Results:  

Most PDD subset data was not statistically different (NS) to that of the total SP population (Tot pop). Results are shown below (bold > Tot pop; italic > Tot pop; parenthesis = NS). Age had the most significant effect on ABX res. PEN, AZI, AMX/C and CTX res was highest in children <6 years old. AMX/C res was also raised in children 6–17 years old but AZI res was NS. Res to PEN or AMX/C decreased with adult patients. PEN, AZI and AMX/C res was > the Tot pop in ear specimens and acute otitis media (both associated with age) and sinus aspirate (not associated with age). Res to PEN, AMX/C or CTX, but not AZI, increased in chronic otitis media infection (associated with age). In contrast, fluoroquinolone (FQ) res, esp. MXF, was very low in the Tot pop and even lower or zero in children <6 years old, sinus source/infection, chronic otitis media or tonsillitis. None of these PDD data was linked to country of origin.

  % res
 PDD subset (N)PENAZIAMX/CCTXLEVGATIMXF
-Tot pop (3233)22.134 05 01.81.31.10 3
Age0-1 years (424)38.449.812.54.50.20.20
 2-5 years (317)30.040.78.54.40.300
 6-17 years (224)(21.0)28.66.7(2.7)(0.9)(0.9)(0.5)
 18-64 years (1359)18.0(30.6)2.9(0.8)(1.8)(1.5)(0.3)
 >64 years (884)17.8(30.2)2.8(0.9)(1.4)(1.2)(0.5)
SourceEar (330)30.043.010.6(3.6)(1.2)(1.2)(0.3)
 Sinus aspirate (176)30.044.99.7(2.8)(0.6)(0.6)0
InfectionAcute otitis   media (306) 28.844.810.5NSNSNSNS
 Chronic ottis   media (63)36.5(36.5)12.74.8000
 Acute sinusitis (217) (21.2)(35.5)(5 1)(3.2)000
 Acute tonsillitis (119)(20.2)(31.1)(8.0)(4.0)(0.8)00

Conclusion:  

Some patient subsets such as children <6 years or all sinusitis patients (i.e. sinus aspirate source) have a greater chance of harbouring PEN, AZI or AMX/C res SP than the Tot pop. This was not the case with MXF or other FQ. This should be taken into account when empirical ABX therapy is being considered.

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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