European Journal of Pediatrics

, Volume 165, Issue 1, pp 3–8 | Cite as

Trends in antibiotic resistance of respiratory tract pathogens in children in Geneva, Switzerland

  • Thomas Jaecklin
  • Peter Rohner
  • Véronique Jacomo
  • Kurt Schmidheiny
  • Alain Gervaix
Original Paper


Bacteria increasingly resistant to antibiotics are a major treatment concern of respiratory tract pathogens in children. The aim of this study was to assess the trends of resistance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis to several classes of antibiotics in children <16 years of age and to compare its prevalence with surrounding countries. We studied retrospectively the susceptibility of respiratory tract pathogens isolated from specimens collected from patients at the Geneva Children’s Hospital between 1989 and 2004. The susceptibility of S. pneumoniae to penicillin decreased from 98% to 58% ( P <0.001) within 16 years, mainly due to strains intermediately resistant (MICs 0.12–1.0 µg/ml). Also erythromycin-susceptible pneumococci decreased from 97% to 63% ( P <0.001). The susceptibility of H. influenzae to amoxicillin also significantly declined (87% vs. 82%, P <0.001), and the susceptibility of M. catarrhalis to this drug almost disappeared (29% vs. 5%, P <0.001). However, in 2004 these two bacteria remained 100% susceptible to amoxicillin-clavulanic acid, second and third generation cephalosporins. Invasive H. influenzae strains were significantly more resistant to ampicillin than non-invasive strains, but no susceptibility difference between invasive and non-invasive S. pneumoniae was determined. Conclusion:During the 16 years studied, the antibiotic resistance of respiratory tract pathogens steadily and significantly increased in children, especially S. pneumoniae. This situation in Geneva is similar to neighbouring France rather than to the rest of Switzerland. A permanent surveillance of microbial susceptibility to antibiotics is essential and a limitation of antibiotic prescription together with information of the judicious use may impede the actual resistance trend.


Antibiotic resistance  Haemophilus influenzae  Moraxella catarrhalis  Streptococcus pneumoniae 



minimal inhibitory concentration


  1. 1.
    Aldrich JH, Nelson FD (1984) Linear probability, logit, and probit models, Sage Publications, Beverly HillsGoogle Scholar
  2. 2.
    Appelbaum PC (1992) Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis 15: 77–83PubMedGoogle Scholar
  3. 3.
    Baquero F, Loza E (1994) Antibiotic resistance of microorganisms involved in ear, nose and throat infections. Pediatr Infect Dis J 13: S9–S14; discussion S20–S21PubMedGoogle Scholar
  4. 4.
    Beekmann SE, Heilmann KP, Richter SS, Garcia-de-Lomas J, Doern GV (2005) Antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and group A beta-haemolytic streptococci in 2002–2003. Results of the multinational GRASP Surveillance Program. Int J Antimicrob Agents 25: 148–156CrossRefPubMedGoogle Scholar
  5. 5.
    Bronzwaer SL, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen IK, Kool JL, Sprenger MJ, Degener JE (2002) A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 8: 278–282PubMedGoogle Scholar
  6. 6.
    Cappelletty D (1998) Microbiology of bacterial respiratory infections. Pediatr Infect Dis J 17: S55–S61CrossRefPubMedGoogle Scholar
  7. 7.
    Doern GV (1995) Resistance among problem respiratory pathogens in pediatrics. Pediatr Infect Dis J 14: 420–423PubMedGoogle Scholar
  8. 8.
    Doern GV, Brueggemann A, Holley HP, Jr., Rauch AM (1996) Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study. Antimicrob Agents Chemother 40: 1208–1213PubMedGoogle Scholar
  9. 9.
    Felmingham D (2004) Comparative antimicrobial susceptibility of respiratory tract pathogens. Chemotherapy 50: 3–10CrossRefPubMedGoogle Scholar
  10. 10.
    Filippini M, Masiero G, Moschetti K (2004) Regional differences in outpatient antibiotic consumption in Switzerland. Facoltà di Scienze economiche, Università della Svizzera italiana, Lugano, Quaderno N. 04–09Google Scholar
  11. 11.
    Guillemot D, Courvalin P (2001) Better control of antibiotic resistance. Clin Infect Dis 33: 542–547CrossRefPubMedGoogle Scholar
  12. 12.
    Guillemot D, Henriet L, Laurent C, Lecoeur H, Weber P, Carbon C (2001) Optimization of antibiotic use rapidly decreases penicillin resistant Streptococcus pneumoniae (PRSp) carriage: the AUBEPPIN Study (abstract). 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, G-1527Google Scholar
  13. 13.
    Jacobs MR, Felmingham D, Appelbaum PC, Gruneberg RN (2003) The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 52: 229–246CrossRefPubMedGoogle Scholar
  14. 14.
    Jorgensen JH, Doern GV, Maher LA, Howell AW, Redding JS (1990) Antimicrobial resistance among respiratory isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the United States. Antimicrob Agents Chemother 34: 2075–2080PubMedGoogle Scholar
  15. 15.
    Karchmer AW (2004) Increased antibiotic resistance in respiratory tract pathogens: PROTEKT US--an update. Clin Infect Dis 39: S142–S150CrossRefPubMedGoogle Scholar
  16. 16.
    Lehmann D, Gratten M, Montgomery J (1997) Susceptibility of pneumococcal carriage isolates to penicillin provides a conservative estimate of susceptibility of invasive pneumococci. Pediatr Infect Dis J 16: 297–305CrossRefPubMedGoogle Scholar
  17. 17.
    Liassine N, Gervaix A, Hegi R, Strautman G, Suter S, Auckenthaler R (1999) Antimicrobial susceptibility of bacterial pathogens in the oropharynx of healthy children. Eur J Clin Microbiol Infect Dis 18: 217–220CrossRefPubMedGoogle Scholar
  18. 18.
    Loeffler JM, Garbino J, Lew D, Harbarth S, Rohner P (2003) Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 35: 843–850CrossRefPubMedGoogle Scholar
  19. 19.
    Molstad S, Cars O (1999) Major change in the use of antibiotics following a national programme: Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA). Scand J Infect Dis 31: 191–195CrossRefPubMedGoogle Scholar
  20. 20.
    Muhlemann K, Matter HC, Tauber MG, Bodmer T (2003) Nationwide surveillance of nasopharyngeal Streptococcus pneumoniae isolates from children with respiratory infection, Switzerland, 1998–1999. J Infect Dis 187: 589–596CrossRefPubMedGoogle Scholar
  21. 21.
    Murray P, Baron E, Jorgensen J, Pfaller M, Yolken R (2003) Manual of Clinical Microbiology, 8. American Society for Microbiology, WashingtonGoogle Scholar
  22. 22.
    Nissinen A, Gronroos P, Huovinen P, Herva E, Katila ML, Klaukka T, Kontiainen S, Liimatainen O, Oinonen S, Makela PH (1995) Development of beta-lactamase-mediated resistance to penicillin in middle-ear isolates of Moraxella catarrhalis in Finnish children, 1978–1993. Clin Infect Dis 21: 1193–1196PubMedGoogle Scholar
  23. 23.
    Ostroff SM, Harrison LH, Khallaf N, Assaad MT, Guirguis NI, Harrington S, el-Alamy M (1996) Resistance patterns of Streptococcus pneumoniae and Haemophilus influenzae isolates recovered in Egypt from children with pneumonia. The Antimicrobial Resistance Surveillance Study Group. Clin Infect Dis 23: 1069–1074PubMedGoogle Scholar
  24. 24.
    Pradier C, Dunais B, Carsenti-Etesse H, Dellamonica P (1997) Pneumococcal resistance patterns in Europe. Eur J Clin Microbiol Infect Dis 16: 644–647CrossRefPubMedGoogle Scholar
  25. 25.
    Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, Huovinen P (1997) The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med 337: 441–446CrossRefPubMedGoogle Scholar
  26. 26.
    Standards NCfCL (2004) Performance standards for antimicrobial susceptibility testing. Wayne, National Committee for Clinical Laboratory Standards, 14th informational supplement M100-S114Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Thomas Jaecklin
    • 1
  • Peter Rohner
    • 2
  • Véronique Jacomo
    • 2
  • Kurt Schmidheiny
    • 3
  • Alain Gervaix
    • 1
  1. 1.Department of PaediatricsHôpital des EnfantsGeneva 14 Switzerland
  2. 2.Central Bacteriology LaboratoryGeneva University HospitalGeneva Switzerland
  3. 3.Department of EconomicsTufts UniversityMedford USA

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