Antimicrobial susceptibility in community-acquired bacterial pneumonia in adults

Abstract

Objectives: To determine the antimicrobial susceptibility patterns of Streptococcus pneumoniae and Haemophilus influenzae, two bacterial pathogens commonly associated with communityacquired pneumonia. Design: Cross-sectional study. Setting: Bacterial isolates were obtained from adults suspected to have community-acquired pneumonia and who sought treatment at two city council clinics in Nairobi, Kenya. Susceptibility to antimicrobial agents was performed using a microdilution broth method, according to the criteria set by the National Committee for Clinical Laboratory Standards. Results: A total of 277 S. pneumoniae and 58 H. influenzae were obtained from 536 adults examined in the period January 1998 to December 1999. Of the 277 S. pneumoniae, only 56.7% were susceptible to penicillin and 7.6% of strains were resistant to two or more antimicrobial agents. Of the 58 H. influenzae strains, 91.4% were sensitive to ampicillin, with 6.8% resistant to two or more antimicrobial agents. 8.6% were ß-lactamase producers and accounted for the entire ampicillin-resistant population. Conclusion: The prevalence of resistance to penicillin and other commonly used antibiotics among pneumococci is high and the large number of multi-resistant strains among H. influenzae is a cause for concern. The prudent use of antibiotics in treatment of pneumonia and other infections should be advocated to minimise spread of resistance.

Novel Antibiotic-Resistant Pneumococcal Strains Recovered from the Upper Respiratory Tracts of HIV-Infected Adults and Their Children in Kisumu, Kenya

“…16,19 Penicillin and cotrimoxazole have been used for many years for treatment, however the emergence of penicillin and cotrimoxazole resistance is occurring at an alarming rate. 16,19,20 Within 277 pneumococci collected from adult pneumonia cases in Nairobi, Kenya, during 1998-1999, 43% were penicillin nonsusceptible. 19 Fifty percent of invasive isolates collected in Zimbabwe from HIV-positive adults and children between 1994 and 2000 were penicillin nonsusceptible, and resistance to cotrimoxazole was also common.…”

“…16,19,20 Within 277 pneumococci collected from adult pneumonia cases in Nairobi, Kenya, during 1998-1999, 43% were penicillin nonsusceptible. 19 Fifty percent of invasive isolates collected in Zimbabwe from HIV-positive adults and children between 1994 and 2000 were penicillin nonsusceptible, and resistance to cotrimoxazole was also common. 16 In a survey of carriage isolates recovered from children in Uganda during 1995, serogroups 6,9,14,19, and 23 accounted for 80% of the isolates, of which 83.5% were penicillin-nonsusceptible pneumococci (PNP) and 83.5% were cotrimoxazole resistant.…”

“…19 Fifty percent of invasive isolates collected in Zimbabwe from HIV-positive adults and children between 1994 and 2000 were penicillin nonsusceptible, and resistance to cotrimoxazole was also common. 16 In a survey of carriage isolates recovered from children in Uganda during 1995, serogroups 6,9,14,19, and 23 accounted for 80% of the isolates, of which 83.5% were penicillin-nonsusceptible pneumococci (PNP) and 83.5% were cotrimoxazole resistant. 18 In many other different countries increased numbers of PNP have been observed.…”

“…8 There are data indicating that the serotype spectrum found within invasive Streptococcus pneumoniae (SPN) recovered from the HIV-infected population more closely resembles that found within invasive isolates collected from the pediatric population. 7 Published accounts of PNP with serotypes/serogroups other than 6,9,14,19, and 23 are uncommon. For example, in recent population-based genotyping of 1,168 isolates recovered from invasive disease surveillance in the United States during 1999, instances of PNP outside of these serotypes/serogroups was only observed within a specific clone of serotype 35B and a single isolate of serotype 7B.…”

Progressive Increase in Antimicrobial Resistance among Invasive Isolates of Haemophilus influenzae Obtained from Children Admitted to a Hospital in Kilifi, Kenya, from 1994 to 2002

“…Meningitis and severe pneumonia are treated with chloramphenicol and benzylpenicillin, while mild pneumonia is treated with trimethoprim-sulfamethoxazole, ampicillin, or amoxicillin. Data on susceptibility to these antibiotics are scarce (7,9,13,15), and alternative drugs are considerably more costly. The Global Alliance on Vaccines and Immunization (GAVI) has offered financial support for conjugate Hib vaccine introduction, but response has been slow, as health ministries are cautious about a long-term commitment to an expensive vaccine.…”