1. Int J Antimicrob Agents. 2012 Mar;39(3):208-16. Epub 2012 Jan 14.

Antimicrobial susceptibility of Streptococcus pneumoniae isolates from vaccinated
and non-vaccinated patients with a clinically confirmed diagnosis of
community-acquired pneumonia in Belgium.

Lismond A, Carbonnelle S, Verhaegen J, Schatt P, De Bel A, Jordens P, Jacobs F,
Dediste A, Verschuren F, Huang TD, Tulkens PM, Glupczynski Y, Van Bambeke F.

Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute,
Université catholique de Louvain, Brussels, Belgium.

We assessed the in vitro susceptibility of Streptococcus pneumoniae isolates from
patients with confirmed community-acquired pneumonia (CAP) to β-lactams,
macrolides and fluoroquinolones and the association of non-susceptibility and
resistance with serotypes/serogroups (STs/SGs), patient's risk factors and
vaccination status. Samples (blood or lower respiratory tract) were obtained in
2007-2009 from 249 patients (from seven hospitals in Belgium) with a clinical and
radiological diagnosis of CAP [median age 61 years (11.6% aged <5 years); 85%
without previous antibiotic therapy; 86% adults with level II Niederman's
severity score]. MIC determination (EUCAST breakpoints) showed for: (i)
amoxicillin, 6% non-susceptible; cefuroxime (oral), 6.8% resistant; (ii)
macrolides: 24.9% erythromycin-resistant [93.5% erm(B)-positive] but 98.4%
telithromycin-susceptible; and (iii) levofloxacin and moxifloxacin, all
susceptible. Amongst SGs: ST14, all resistant to macrolides and most intermediate
to β-lactams; SG19 (>94% ST19A), 73.5% resistant to macrolides and 18-21%
intermediate to β-lactams; and SG6, 33% resistant to clarithromycin. Apparent
vaccine failures: 3/17 for 7-valent vaccine (children; ST6B, 23F); 16/29 for
23-valent vaccine (adults ST3, 7F, 12F, 14, 19A, 22F, 23F, 33F). Isolates from
nursing home residents, hospitalised patients and patients with non-respiratory
co-morbidities showed increased MICs for amoxicillin, all β-lactams, and
β-lactams and macrolides, respectively. Regarding antibiotic susceptibilities:
(i) amoxicillin is still useful for empirical therapy but with a high daily dose;
(ii) cefuroxime axetil and macrolides (but not telithromycin) are inappropriate
for empirical therapy; and (iii) moxifloxacin and levofloxacin are the next 'best
empirical choice' (no resistant isolates) but levofloxacin will require 500mg
twice-daily dosing for effective coverage.

Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy.
All rights reserved.

PMID: 22245497  [PubMed - in process]