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Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013)

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Abstract

Continuous nationwide surveillance of invasive pneumococcal disease (IPD) was conducted in Germany. From July 1, 1997, to June 30, 2013, data on penicillin susceptibility were available for 20,437 isolates. 2,790 of these isolates (13.7 %) originate from patients with meningitis and 17,647 isolates (86.3 %) are from non-meningitis cases. A slight decline in isolates susceptible at 0.06 and 0.12 μg/ml can be noticed over the years. Overall, 89.1 % of the isolates had minimum inhibitory concentrations (MICs) of ≤0.015 μg/ml. In 2012/2013, the first three isolates of Streptococcus pneumoniae with MICs of 8 μg/ml were found. The application of different guidelines with other MIC breakpoints for the interpretation of penicillin resistance leads to differences in susceptibility categorisation. According to the pre-2008 Clinical and Laboratory Standards Institute (CLSI) interpretive criteria, 5.3 % of isolates overall were intermediate and 1.4 % were resistant to penicillin. Application of the 2008–2014 CLSI interpretive criteria resulted in 7.6 % resistance among meningitis cases and 0.5 % intermediate resistance in non-meningitis cases. Referring to the 2009–2014 European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, 7.6 % of the isolates in the meningitis group were resistant to penicillin. In the non-meningitis group, 6.1 % of the isolates were intermediate and 0.5 % were resistant. These differences should be kept in mind when surveillance studies on pneumococcal penicillin resistance are compared.

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Acknowledgements

We thank the microbiological laboratories in Germany for their co-operation and for providing the isolates. This study was supported, in part, by Wyeth Pharma GmbH/Pfizer Deutschland GmbH, Germany. We thank Stephanie Perniciaro for the proofreading of the manuscript.

Conflict of interest

Ralf R. Reinert is an employee of Pfizer Vaccines. The university of Paul M. Tulkens has received research grants and speaker’s honoraria from Cempra Pharmaceuticals, Bayer AG, GSK and AstraZeneca. Mark van der Linden has received research grants and speaker’s honoraria from Pfizer, Sanofi Pasteur MSD, MSD and GSK.

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Authors and Affiliations

  1. Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH) Aachen, Pauwelsstr. 30, Aachen, Germany

    M. Imöhl, R. R. Reinert & M. van der Linden

  2. Specialty Care Business Unit Pfizer Inc., Pfizer Vaccines, 23–25, avenue du Dr. Lannelongue, 75668, Paris Cedex 14, France

    R. R. Reinert

  3. Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium

    P. M. Tulkens

Authors
  1. M. Imöhl
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  2. R. R. Reinert
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  3. P. M. Tulkens
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  4. M. van der Linden
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Corresponding author

Correspondence to M. Imöhl.

Appendix

Appendix

Table 1 CLSI and EUCAST breakpoints for Streptococcus pneumoniae
Full size table
Table 2 Resistance rates of S. pneumoniae isolates among meningitis and non-meningitis cases according to the CLSI 2008–2014 (parenterally administered antibiotics) and EUCAST 2009–2014 interpretive criteria per epidemiological year, in percent
Full size table

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Imöhl, M., Reinert, R.R., Tulkens, P.M. et al. Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013). Eur J Clin Microbiol Infect Dis 33, 2035–2040 (2014). https://doi.org/10.1007/s10096-014-2174-z

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  • DOI: https://doi.org/10.1007/s10096-014-2174-z

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