The Effect of Changes in the Consumption of Macrolide Antibiotics on Erythromycin Resistance in Group A Streptococci in Finland

Seppälä, Helena; Klaukka, Timo; Vuopio‐Varkila, Jaana; Muotiala, Anna; Helenius, Hans; Lager, K.; Huovinen, Pentti

doi:10.1056/nejm199708143370701

Cited by 1,060 publications

(590 citation statements)

References 19 publications

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“…Uma nova cepa de Staphylococcus aureus resistente à meticilina, adquirida na comunidade, tem sido descrita 78 , com propriedades diferentes das cepas adquiridas no hospital com esta caracterís-tica. A prevalência de microrganismos resistentes aos macrolídeos [79][80][81] e cefalosporinas 82 tem aumentado nas regiões com grande utilização de macrolídeos. Em geral, o planejamento da terapêutica antimicrobiana não deve ser baseado apenas no conhecimento do organismo mais provável numa determinada faixa etária e na gravidade da doença, mas também com informações acerca dos padrões locais de resistência aos antimicrobianos.…”

Section: Padrões De Resistência Aos Antimicrobianosunclassified

Diagnóstico etiológico das pneumonias: uma visão crítica

Rodrigues

Filho

Bush

2002

J. Pediatr. (Rio J.)

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Objetivo: revisar a literatura quanto ao diagnóstico etiológico das pneumonias agudas na faixa etária pediátrica. Fonte dos dados: revisão sistemática das citações do Medline e do Lilacs.Síntese dos dados: a utilização dos novos métodos diagnósticos, particularmente as técnicas imunológicas e a reação em cadeia da polimerase, de uso ainda incipiente no Brasil, tem se mostrado importante para a investigação epidemiológica e para a melhora no diagnóstico específico em termos de sensibilidade, especificidade e rapidez de resultados, com finalidade de orientação terapêutica adequada. A revisão dos estudos epidemiológicos das pneumonias agudas adquiridas na comunidade mostrou que o Streptococcus pneumoniae continua sendo o agente bacteriano mais importante, em todas as faixas etárias, tanto nos países desenvolvidos quanto nos em desenvolvimento. A resistência desse agente à penicilina e às cefalosporinas tem aumentado progressivamente em todos os continentes e tem-se constituído em um fator de preocupação. Os agentes de pneumonias atípicas, Mycoplasma pneumoniae e Chlamydia pneumoniae mostram-se, atualmente, como agentes importantes de pneumonias agudas adquiridas na comunidade, particularmente em crianças acima de 4 a 5 anos de idade, correspondendo, em países desenvolvidos, a cerca de até um terço dos casos. No entanto, ainda não está definida a sua importância epidemiológica nos países em desenvolvimento. O vírus respiratório sincicial é um agente freqüente de pneumonias agudas adquiridas na comunidade, pode determinar quadros mais graves, particularmente nos lactentes e crianças menores, sendo muito importante a sua investigação em crianças hospitalizadas por doença do trato respiratório inferior. A utilização das novas vacinas conjugadas contra Streptococcus pneumoniae e Haemophilus influenzae tipo b tiveram um impacto importante na morbidade e mortalidade das infecções causadas por esse agentes.Conclusões: a monitorização microbiológica e antimicrobiana deve ser um trabalho dinâmico e contínuo, e a procura e o desenvolvimento de novas vacinas, particularmente contra o VRS, poderá causar um grande impacto na prevenção das pneumonias agudas na infância.J Pediatr (Rio J) 2002; 78 (Supl.2): S129-S140: pneumonia, pneumopatias, diagnóstico. AbstractObjectives: to search literature related to the etiological diagnosis of acute pneumonia in children. Sources: systematic review of Medline and Lilacs databases.Summary of the findings: the use of new diagnostic methods such as immunological techniques and polymerase chain reaction has proven invaluable for specific diagnosis and epidemiological investigation, showing adequate sensitivity, specificity and promptness of results, with the aim of guiding therapy properly. Review of epidemiological studies of community acquired pneumonia showed that Streptococcus pneumoniae is still one of the most significant etiologic agents in all age groups, in developing and industrialized countries. Resistance of this agent to penicillin and cephalosporins is increasing in all continents...

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Section: Padrões De Resistência Aos Antimicrobianosunclassified

Diagnóstico etiológico das pneumonias: uma visão crítica

Rodrigues

Filho

Bush

2002

J. Pediatr. (Rio J.)

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“…Thus, once resistant strains have become established in a population, the problem may not always be reversible, although some studies have indicated a decline in prevalence after intervention. 16,18,19 By contrast with most other countries in Europe, no increase of antibiotic resistance among invasive pneumococcal isolates in Sweden has been reported since 2000. 20 The frequency of PNSP in invasive isolates has varied between 2·5% and 5·0% and the number of invasive erythromycin-resistant pneumococci has not increased between 1999 and 2005.…”

Section: Pneumococcal Infectionmentioning

confidence: 99%

Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme

Mölstad

Erntell²,

Hanberger

et al. 2008

The Lancet Infectious Diseases

221

174

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Resistance) was therefore started in 1994 to provide surveillance of antibiotic use and resistance, and to implement the rational use of antibiotics and development of new knowledge. Between 1995 and 2004, antibiotic use for outpatients decreased from 15·7 to 12·6 defined daily doses per 1000 inhabitants per day and from 536 to 410 prescriptions per 1000 inhabitants per year. The reduction was most prominent in children aged 5-14 years (52%) and for macrolides (65%). During this period, the number of hospital admissions for acute mastoiditis, rhinosinusitis, and quinsy (peritonsillar abscess) was stable or declining. Although the epidemic spread in southern Sweden of penicillin-resistant Streptococcus pneumoniae was curbed, the national frequency increased from 4% to 6%. Resistance remained low in most other bacterial species during this period. This multidisciplinary, coordinated programme has contributed to the reduction of antibiotic use without measurable negative consequences. However, antibiotic resistance in several bacterial species is slowly increasing, which has led to calls for continued sustained efforts to preserve the effectiveness of available antibiotics.

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“…This is often the case in pathogenic populations (Foweraker et al, 2005;Fothergill et al, 2010;Workentine et al, 2013) because of spatial heterogeneity of drug concentrations (Baquero and Negri, 1997), historical exposure to antibiotics followed by immigration or mutation (Seppälä et al, 1997;Scanvic-Hameg et al, 2002) or the inherently high genetic diversity in chronic infections (Oliver et al, 2000(Oliver et al, , 2004. Natural populations are also genetically diverse in terms of drug resistance (D'Costa et al, 2006;Martinez, 2009).…”

Section: Introductionmentioning

confidence: 99%

Lytic phages obscure the cost of antibiotic resistance in Escherichia coli

Tazzyman

Hall

2014

The ISME Journal

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The long-term persistence of antibiotic-resistant bacteria depends on their fitness relative to other genotypes in the absence of drugs. Outside the laboratory, viruses that parasitize bacteria (phages) are ubiquitous, but costs of antibiotic resistance are typically studied in phage-free experimental conditions. We used a mathematical model and experiments with Escherichia coli to show that lytic phages strongly affect the incidence of antibiotic resistance in drug-free conditions. Under phage parasitism, the likelihood that antibiotic-resistant genetic backgrounds spread depends on their initial frequency, mutation rate and intrinsic growth rate relative to drug-susceptible genotypes, because these parameters determine relative rates of phage-resistance evolution on different genetic backgrounds. Moreover, the average cost of antibiotic resistance in terms of intrinsic growth in the antibiotic-free experimental environment was small relative to the benefits of an increased mutation rate in the presence of phages. This is consistent with our theoretical work indicating that, under phage selection, typical costs of antibiotic resistance can be outweighed by realistic increases in mutability if drug resistance and hypermutability are genetically linked, as is frequently observed in clinical isolates. This suggests the long-term distribution of antibiotic resistance depends on the relative rates at which different lineages adapt to other types of selection, which in the case of phage parasitism is probably extremely common, as well as costs of resistance inferred by classical in vitro methods.

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The Effect of Changes in the Consumption of Macrolide Antibiotics on Erythromycin Resistance in Group A Streptococci in Finland

Abstract: In Finland, after nationwide reductions in the use of macrolide antibiotics for outpatient therapy, there was a significant decline in the frequency of erythromycin resistance among group A streptococci isolated from throat swabs and pus samples.

Cited by 1,060 publications

References 19 publications

Diagnóstico etiológico das pneumonias: uma visão crítica

Diagnóstico etiológico das pneumonias: uma visão crítica

Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme

Lytic phages obscure the cost of antibiotic resistance in Escherichia coli

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