High rate of erythromycin and clarithromycin resistance among Streptococcus pneumoniae isolates from blood cultures from Providence, R.I

Lonks, John R.; Medeiros, Antone A.

doi:10.1128/aac.37.9.1742

Cited by 35 publications

(21 citation statements)

References 21 publications

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“…(22) There are conflicting data on whether this type of resistance correlates with clinical failure among patients with invasive pneumococcal disease treated with macrolide antibiotics. (7,9,10,13,17,23,24) The strongest predictor of macrolide resistance among patients with pneumococcal bacteremia was prior antibiotic use. Patients who have received > 24 hours of antibiotics therapy at the time the blood culture was drawn were four times more likely to harbor a macrolide resistant organism, compared to those not receiving prior antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some recent reports, however, are worrisome with reported development of pneumococcal bacteremia among patients receiving azithromycin or clarithromycin therapy, in association with low-level resistant strains. (12)(13)(14)(15) We performed this large multicenter U.S. study including over 1500 patients with pneumococcal bacteremia in order to increase our understanding regarding factors associated with antibiotic resistance and associated mortality. We will describe the susceptibility pattern of pneumococcal isolates in this cohort, and will determine the factors associated with antibiotic resistance and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Neuman

Kelley

Harper

et al. 2007

The Journal of Emergency Medicine

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We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. 1,574 patients at 34 sites were enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI], 75−80) to 49% (95%CI, 39−59); to cefotaxime/ ceftriaxone, from 92% (95%CI, 90−93) to 82% (95%CI, 72−89); and to macrolide, from 84% (95% CI, 82−87) to 55% (95%CI, 41−68). Factors associated with macrolide non-susceptibility include: >24 hours of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas Black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Neuman

Kelley

Harper

et al. 2007

The Journal of Emergency Medicine

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“…Recientemente se han descrito 2 nuevos mecanismos, relacionados con mutaciones en genes que codifican proteínas ribosómicas y la subunidad 23S del ARN ribosomal, que en algunos casos conllevan un incremento de 500 veces en la CIM de telitromicina 29 . Los macrólidos son el grupo de antimicrobianos de los que se han comunicado más casos de fracasos asociados a resistencia antibiótica [30][31][32][33][34][35][36][37] . En todos ellos se describe la persistencia de cultivos positivos de neumococo resistente a eritromicina en sangre o en otras muestras estériles tanto en niños como en adultos tratados con macrólidos de 14, 15 y 16 átomos.…”

Section: Macrólidosunclassified

Resistencias bacterianas y farmacodinámica como bases de la prescripción de antibióticos en infecciones respiratorias

Aguado-García

Martín-Herrero²,

Lumbreras³

2004

Enferm Infecc Microbiol Clin

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“…An increased telithromycin MIC in CO 2 was not correlated with loss of its activity in the murine sepsis/peritonitis model. Incubation in CO 2 has been reported to result in higher MICs of macrolides, clindamycin, and telithromycin for Streptococcus pneumoniae than those found in ambient air (6,9,10,11,15,16). Conversely, susceptibility testing of other antibiotics, namely ␤-lactams, evernimicin, and linezolid, does not appear to be affected by the presence or absence of CO 2 (3,5,7,8).…”

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confidence: 94%

Influence of Carbon Dioxide on the MIC of Telithromycin for Streptococcus pneumoniae : an In Vitro - In Vivo Study

Batard¹,

Juvin

Jacqueline³

et al. 2005

Antimicrob Agents Chemother

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Incubation in CO 2 resulted in higher (>3 doubling dilution) MICs of telithromycin than those found in ambient air for 31.2% of 346 Streptococcus pneumoniae ermB-positive strains. An increased telithromycin MIC in CO 2 was not correlated with loss of its activity in the murine sepsis/peritonitis model. Incubation in CO 2 has been reported to result in higher MICs of macrolides, clindamycin, and telithromycin for Streptococcus pneumoniae than those found in ambient air (6,9,10,11,15,16). Conversely, susceptibility testing of other antibiotics, namely ␤-lactams, evernimicin, and linezolid, does not appear to be affected by the presence or absence of CO 2 (3,5,7,8). This study reports the influence of CO 2 on the MIC of telithromycin against ermB-positive S. pneumoniae.MICs of erythromycin and telithromycin in ambient air and CO 2 . MICs of erythromycin and telithromycin were determined by using the agar dilution method for 675 clinical strains of S. pneumoniae (13). Plates were incubated for 16 h at 37°C, either in ambient air or in 5% CO 2 . Susceptibility to erythromycin was also assessed by agar diffusion (15 g of erythromycin per disk). MICs of telithromycin were also measured by microdilution according to the NCCLS recommendations (13). The MIC breakpoints of erythromycin were defined as the following: susceptible, Յ0.25 mg/liter; resistant, Ն1 mg/liter (13). The MIC breakpoints of telithromycin were defined according to the European Agency for the Evaluation of Medicinal Products (susceptible, Յ0.5 mg/liter; resistant, Ͼ2 mg/ liter) and according to the proposed NCCLS breakpoints (susceptible, Յ1 mg/liter; resistant, Ն4 mg/liter).Erythromycin MIC in ambient air was Ն0.25 mg/liter for 345 strains. Ten additional strains for which the erythromycin MICs were Յ0.25 mg/liter had an inhibition zone diameter of Ͻ22 mm. These 355 strains were tested for ermB and mefE genes by PCR as previously described (2). Erythromycin resistance genes were distributed as follows: ermB was present in 347 strains, mefE in 4 strains, mefE and ermB in 2 strains, and neither ermB nor mefE in 2 strains. Telithromycin MICs in ambient air (675 strains) were distributed as follows: Յ0.5 mg/liter for 667 strains (98.8%), 1 mg/liter for 4 strains (0.6%), and 2 mg/liter for 4 strains (0.6%). Telithromycin MICs were obtained in CO 2 for 659 strains and were Յ0.5 mg/liter for 591 strains (89.7%), 1 mg/liter for 36 strains (5.5%), and 2 mg/liter for 32 strains (4.8%). According to the European breakpoints, the frequency of strains with intermediate susceptibility to telithromycin was 1.2% in ambient air and 10.3% in CO 2 . These frequencies, according to the NCCLS breakpoints, were 0.6 and 4.9%, respectively.For 346 ermB-positive strains, the telithromycin MIC at which 50% of isolates tested are inhibited (MIC 50 ) in ambient air and in CO 2 was 0.015 and 0.06 mg/liter, and the MIC 90 was 0.25 and 2 mg/liter, respectively (Fig. 1). The proportion of strains for which the telithromycin MIC was Ͼ0.5 mg/liter was 2.3% in ambient air and 21.5% in C...

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High rate of erythromycin and clarithromycin resistance among Streptococcus pneumoniae isolates from blood cultures from Providence, R.I

Cited by 35 publications

References 21 publications

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Factors Associated With Antimicrobial Resistance and Mortality in Pneumococcal Bacteremia

Resistencias bacterianas y farmacodinámica como bases de la prescripción de antibióticos en infecciones respiratorias

Influence of Carbon Dioxide on the MIC of Telithromycin for Streptococcus pneumoniae : an In Vitro - In Vivo Study

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