Letter to the Editor Antimicrobial resistance among patients hospitalized with lower in Europe Ad C Fluit,@) Jan Verhoef,(l) Int J Infect Dis 2002; and Franz-Josef Schmitz(‘) batter spp (7.9%), Escherichia coli (7.0%), Streptococcus pneumoniae (5.7%), Haemophilus infiuenzae (4.7%), Acinetobacter spp (4.4%), Klebsiella pneumoniae (4.3%), Serratia spp (3.8%), and Stenotrophomonas maltophilia (2.6%).The large contribution of Staphylococcus aureus is in agreement with a 1996 American national nosocomial infection surveillance report, which showed that Staphylococcus aureus was the commonest cause of pneumonia, accounting for (‘)Eijkman-Winkler Institute, University Hospital Utrecht, Utrecht, The Netherlands; (*IThe SENTRY Participant Group includes: Helmut Mittermayer (Austria), Marc Struelens (Belgium), Fred Goldstein (France), Vincent Jarlier (France), Jerome Etienne (France), Rene Courcol (France), Franz Daschner (Germany), Ulrich Hadding (Germany), Nikos Legakis (Greece), Gian-Carlo Schito (Italy), Gianmarco Rapponi (Italy), Piotr Heczko (Poland), Waleria Hyrniewicz (Poland), Dario Costa (Portugal), Evelio Perea (Spain), Fernando Baquero (Spain), Rogelio Martin Alvarez (Spain), Jacques Bille (Switzerland), Gary French (UK) This SENTRY antimicrobial surveillance program was funded by an educational grant from Bristol-Myers Squibb Pharmaceutical Company (Princeton, NJ, USA) The European Network for Antimicrobial Resistance and Epidemiology (ENARE) received a grant (ERBCHRCT940554) from the European Union Address correspondence to Eijkman-Winkler Hospital Utrecht, room G04.614, PO Box The Netherlands E-mail: A.C.Fluit@lab.azu.nl Editorial for the SENTRY Participants Groupc2) 6: 144-146 Lower respiratory tract infections represent a major concern, especially with increasing numbers of resistant Streptococcus pneumoniae, extended-spectrum plactamase-producing Enterobacteriaceae, and Staphylococcus aureus with reduced susceptibility to vancomycin Here, we report on the susceptibilities of isolates cultured from patients with lower respiratory tract infection to different antibiotics obtained from 20 western and central European hospitals in 1997 and 1998 as part of the SENTRY Antimicrobial surveillance Program.’ In total, 2083 isolates were obtained The most frequently isolated organisms from patients with lower respiratory tract infection were Staphylococcus aureus and Pseudomonas aeruginosa, comprising 21.0% and 20.3% of the isolates, respectively, followed by Entero- Corresponding isolates cultured from respiratory tract infection Office: New York Institute, University 85500,350s GA Utrecht, 19% of all isolates.2 Comparison of the frequency of isolation of bacterial species cultured from patients with lower respiratory tract infection in hospitalized patients between the European and Latin American arms of SENTRY shows that P aeruginosa and Staphylococcus aureus are the top two species, although their order is reversed.3 Acinetobacter spp ranked third in Latin America, with 11.9%, compared to seventh position in Europe On the other hand, only 1.4% of the isolates were Streptococcus pneumoniae in Latin America, compared to 5.7% in Europe Notably, H influenzae is absent among the top 10 species isolated in Latin America The MICSOS,MIC9oS and percentage susceptibilities of Staphylococcus aureus and Streptococcus pneumoniae for various antibiotics are presented in Tables and 2, respectively Intermediate-resistant penicillin-resistant isolates were obtained from Germany, France, Spain, and Poland The highly resistant isolates were obtained from Germany, France, and Spain All isolates, with the exception of two penicillin-resistant Streptococcus pneumoniae isolates from France, were completely susceptible to quinupristin-dalfopristin The MI&s, MI&$ and percentage susceptibilities of Enterobacteriaceae and other Gram-negative bacteria for various antibiotics are presented in Tables and 4, respectively H injkenzae was susceptible to all p-lactam and fluoroquinolone antibiotics tested Based on resistance against ceftazidime, ceftriaxone, or aztreonam, four (2.7%) E coli isolates and 13 (14.4%) K pneumoniae isolates carried an extended-spectrum P-lactamase or were overproducers of AmpC Resistance to various antibiotics also tended to be higher for isolates from southern Europe, and isolates from hospitalized patients with lower respiratory infection showed markedly higher rates of resistance against most antibiotics compared to isolates from communityacquired pneumonia.4 In comparison to Gram-negative isolates from Latin America, the European isolates generally have clearly higher susceptibilities to almost all antibiotics tested.” With the exception of Acinetobacter spp., the susceptibilities of bacterial isolates cultured from patients with lower respiratory tract infection to various antibiotics still allow adequate treatment with traditional Antimicrobial resistance among isolates cultured from patients / Fluit et al Table agents Antimicrobial susceptibility (“/OS) and spectrum against aureus isolates obtained from patients 145 antimicrobial of activity (MIC so& of different with lower respiratory tract infection isolates Antimicrobial MRSA MICso/go wlml agents Cefazolin Ceftriaxone lmipenem Gentamicin Ciprofloxacin Erythromycin Clindamycin Quinupristin/dalfopristin Doxycycline Minocyclineb Rifampin Teicoplanin Vancomycin aureus; tested: 127 Table Antimicrobial susceptibility Streptococcus pneumoniae obtained 100.0 100.0 and activity spectrum patients with lower aureus; (n=289) %Susc 2 0.5h.a 0.1210.25 0.2510.5 ~0.5K0.5 SO.25lO.25 10.25KO.25 0.511 Ill 29.8 8.6 6.6 17.9 98.0 94.8 100 50.3 MSSA=methicillin-sensitive (%S) from %Susc 0.0 0.0 0.0 >16/>16 >321>32 >a/>8 >16/>16 >2/>2 >a/>8 >a/>8 0.510.5 4/>4 214 lb2 l/2 II2 aMRSA=methicillin-resistant number of MSSA isolates MSSA MGo/go w/ml (n=l51)” %umber 100.0 100.0 100.0 95.9 88.2 75.1 91.4 99.7 98.6 98.4 98.3 100.0 100.0 of MRSA isolates tested (MIC 50,~) of different antimicrobial respiratory tract infection 55: agents against lsola tes Antimicrobial PS-S pneumoniae MICso/go Mm1 agent 16 0.511 0.2510.5 PR=penicillin-resistant; (n=78) %Susc 2ba 214 II2 a/a 112 321>32 sat>8 >16/>16 0.512 0.510.5 %nvestigational drug, agents against and spectrum of activity of different antimicrobial patients with lower respiratory tract infections 0.0 0.0 20.0 0.0 100.0 100.0 100.0 0.0 13.3 13.3 80.0 100.0 no NCCLS breakpoint the most prevalent Isolates Antimicrobial agent Ampicillin Piperacillin Amoxicillin/clavulanate Piperacillin/tazobactam Ceftriaxone Ceftazidime Cefepime Aztreonam lmipenem Amikacin E coli (147) %Susc M&o/go w/ml >16/>16 4k-128 II16 SO.512 10.25K0.25 16/>16 I/64 32 0.25/>16 20.1214 16 0.512 218 0.512 l/16 2 34.7 65.3 5.4 75.5 74.9 74.9 97.1 78.4 98.8 95.8 92.2 82.0 85.6 0.06/>4 4 83.8 86.8 K pneumoniae MICso/go wfml >16/>16 16/>128 2116 l/64 SO.25132 16 10.1214 16 l/16 0.0310.25 0.06/l 0.5K0.5 (90) %Susc Serratia MKso/go wlml 6.7 61.1 82.2 86.7 85.6 85.6 93.3 87.8 >16/>16 m>i28 >16/>16 l/32 10.25116 10.12/l 16 0.0612 0.2512 so.5/1 100.0 96.7 82.2 80.0 95.6 95.6 96.7 spp (79) %Susc 17.7 81.0 11.4 88.6 89.9 93.7 97.5 93.7 100.0 93.7 83.5 82.3 89.9 93.7 97.5 146 International Journal of Infectious Table Antimicrobial susceptibility gram-negative organisms cultured Diseases I Volume 6, Number 2,2002 (%S) and activity from patients with spectrum (MIC~WVJ) of different lower respiratory tract infection antimicrobial agents against lsola tes Antimicrobial agent Piperacillin Ticarcillin Ticarcillin-clavulanate Piperacillin-tazobactam Ceftriaxone Ceftazidime Cefepime Aztreonam Meropenem lmipenem Amikacin Gentamicin Ciprofloxacin Ofloxacin Levofloxacin “no NCCLS breakpoint defined; b investigational P aeruginosa MIGOISQ Mm1 (n=428) 4/>128 16/>128 161128 4l>64 16/>32 2/>16 2/l 4/>16 0.2518 II>8 4116 21>16 0.25/>2 II>4 4 83.2 80.6 83.4 88.6 41.8 82.9 86.9 77.3 86.5 79.4 91.1 77.3 78.3 70.1 77.3 128/z-128 321128 32/>128 32/>64 >321>32 16/>16 al>16 >16/>16 1/>8 0.5/>8 16/>32 >16/>16 >2>2 >4/>4 4/>4 drug, no NCCLS breakpoints defined %SUSC first-line antibiotics, although the situation with p aeruginosa and Staphylococcus aureus gives reason for concern Close monitoring of bacterial isolates for resistance will be required ACKNOWLEDGMENTS The authors wish to thank Miriam Klootwijk, Karlijn Kusters, Stefan de Vaal and Alice Florijn for their expert technical assistance REFERENCES Pfaller MA, Jones RN, Doern GV, Kugler K, the SENTRY Participants Group Bacterial pathogens isolated from patients with bloodstream infection: frequencies of Acinetobacter MlCso/so wJml spp (n=92) 0%susc 35.9 46.7 49.9 48.9 33.7 46.7 60.9 23.9 77.2 79.4 50.0 34.8 38.0 38.0 39.1 maltophilia MlCso/s0 vuglml 64/>128 32h.128 2l64 16/>64 >32/>32 4/>16 >16/>16 16l>16 S8l>8 >8/>8 16/>32 4/>16 0.51~2 0.512 SO.511 (n=SS) % SUSC 30.9 43.6 81.8 52.7 13.0 70.9 58.2 43.6 9.1 0.0 61.8 50.9 81.8 96.4 95.7 occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada 1997) Antimicrob Agents Chemother 1998; 42:1762-1770 CDC NNIS System National nosocomial infections surveillance report, data summary October 1986-April 1996, issued May 1996 Am J Infect Dis 1996; 24:380-388 Sader HS, Jones RN, Gales AC, et al Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY antimicrobial surveillance program (1997) Diagn Microbial Infect Dis 1998; 32:289-301 Fluit AC, Schmitz F-J, Jones ME, et al Antimicrobial resistance among community-acquired pneumonia isolates in Europe: first results from the SENTRY Antimicrobial Surveillance Program 1997 Int J Infect Dis 1999; 3:153-156 ... different with lower respiratory tract infection isolates Antimicrobial MRSA MICso/go wlml agents Cefazolin Ceftriaxone lmipenem Gentamicin Ciprofloxacin Erythromycin Clindamycin Quinupristin/dalfopristin... Penicillin Cefotaxime Cefuroxime Levofloxacin Grepafloxacin Trovafloxacin Gatifloxacinb Erythromycin Clindamycin Azithromycin Quinupristin/dalfopristin Vancomycin aPS=peniciIIin-susceptibie; defined.. .Antimicrobial resistance among isolates cultured from patients / Fluit et al Table agents Antimicrobial susceptibility (“/OS) and spectrum against aureus isolates obtained from patients 145 antimicrobial