Antimicrobial resistance in invasive and colonising <i>Streptococcus pneumoniae</i> in North India

Abstract

The present study was done to detect the antibiotic resistance in S. pneumoniae. One hundred twenty S. pneumoniae isolates from clinical specimens and 50 from nasopharyngeal sites were subjected to antimicrobial susceptibility testing by Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC) determination for penicillin and cefotaxime non-susceptible isolates. A total of 22 isolates (18.3%) from clinical sites and eight (16%) from nasopharyngeal sites showed decreased susceptibility to penicillin by oxacillin disk diffusion test. MICs of 26 of these resistant strains ranged from 0.12-1 µg/mL (intermediate resistance) by broth dilution and E test. Only four isolates, two from sputum and two from nasopharyngeal swabs, showed MIC of 2 µg/mL (complete resistance). However, MIC of two cefotaxime resistant isolates (by disk diffusion) was in the susceptible range (0.5 µg/mL). Highest antimicrobial resistance was seen to cotrimoxazole (55.2%) and tetracycline (61.2%). Antimicrobial resistance to cotrimoxazole and tetracycline was much more in clinical isolates than colonizing isolates. Multi-drug resistant phenotype was detected in 76.9% (20 of 26) of isolates that were intermediately sensitive to penicillin and 50% (2 of 4) of penicillin resistant isolates (co-resistant to tetracycline and cotrimoxazole). Routine screening for antibiotic susceptibility is recommended for clinical isolates of pneumococci. Strains with reduced susceptibility to penicillin should be subjected to MIC determination to detect relative resistance or true resistance as such strains are associated with increased virulence.The choice of antibiotics should be guided by the prevalence of local resistance patterns of pneumococci.

Increasing invasive disease due to penicillin resistant <i> S. pneumoniae </i> in India

“…[11] This latest recommendation for the Þ rst time is based on the clinical syndrome and route of penicillin administration. Further, this MIC break point tends to change the earlier Þ ndings of PIRSP, published in the literature up to early 2008, to a much lower percentage for non meningitis isolates [1][2][3]5,[8][9][10] and higher percentage of complete penicillin resistance to meningitis isolates. [6,7] However, this particular study isolate antimicrobial MIC break point interpretation remains valid as it conforms to CLSI 2008 recommendation also.…”

“…This includes 7.3% (n = 11) isolates; [7] 15.4% (n = 2) [8] and 25% (n = 3); [9] 20% (n = 30) with 0.12 -1 µg/mL and 2 µg/mL of 26 and four respiratory isolates respectively. [10] However, in 2008, the Clinical Laboratory Standards Institute (CLSI) after re-evaluating with the more recent clinical data published new MIC penicillin break points for S. pneumoniae. [11] This latest recommendation for the Þ rst time is based on the clinical syndrome and route of penicillin administration.…”

Study of Penicillin Resistance and Multidrug Resistance of Streptococcus pneumoniae in a Tertiary Care Hospital

“…Other Indian studies reported were Goyal et al, (2007) 18%, Ravi Kumar et al, (2014) 17% and Upala Devi et al, (2012 17%. In contrast, a very low resistance rate of 1.5% was reported by the invasive bacterial infection surveillance group (IBIS) from India and other authors Reba et al, (2001) 7.3%.…”

“…There is also an increase in multidrug-resistant strains. This is of major concern as it can lead to treatment failure, prolonged hospital stay, thus increasing morbidity and mortality (Goyal et al, 2007;Chawla et al, 2010 …”

Hospital-based surveillance of invasive pneumococcal disease and pneumonia in South Bangalore, India

“…In a retrospective examination of serotypes and susceptibility in patients with invasive and clinically significant S. pneumoniae infections in Puducherry [8], one serotype 3 isolate was identified in a child aged <5 years and serotyping was not performed for serogroup 6 and 19 isolates. Several recent publications suggest that the incidence of antibiotic-resistant strains of S. pneumoniae is increasing in India [9][10][11]. Southeast Asian estimates of S. pneumoniae burden of disease in children aged <5 years are 2991 per 100,000 children (95% CI 2329, 3717) for invasive pneumococcal disease and 2911 per 100,000 children (95% CI 2265, 3622) for pneumonia [12].…”