Antimicrobial use in Europe and antimicrobial resistance in Streptococcus pneumoniae

  • S. Riedel
  • S. E. Beekmann
  • K. P. Heilmann
  • S. S. Richter
  • J. Garcia-de-Lomas
  • M. Ferech
  • H. Goosens
  • G. V. Doern
Concise Article

Abstract

The study presented here determined the relationship between antimicrobial resistance in Streptococcus pneumoniae and the use of antimicrobial agents in 15 different European countries. Pneumococcal isolates (n = 1974) recovered from patients with community-acquired respiratory tract infections during the winter of 2004–2005 in 15 European countries were characterized. The overall percentages of isolates demonstrating intermediate or complete resistance to penicillin, erythromycin, tetracycline, trimethoprim-sulfamethoxazole (TMP-SMX) and ciprofloxacin were 24, 24.6, 19.8, 26.7 and 2%, respectively, as determined using the broth microdilution MIC method recommended by the Clinical and Laboratory Standards Institute. The overall and mean antimicrobial consumption levels (ACL)—i.e., the defined daily doses per 1,000 inhabitants per day—were obtained from the European Surveillance of Antimicrobial Consumption project for each of the 15 countries for the years 1998–2004. Using linear regression analysis, the mean annual ACL for β-lactams, macrolides, tetracyclines, TMP-SMX and fluoroquinolones in each country was compared to the country-specific resistance rates determined in 2004–2005. The rate of overall antimicrobial use in all 15 European countries was significantly associated with antimicrobial resistance in S. pneumoniae. There was variation among the different antimicrobial classes as drivers of resistance, with β-lactams having the strongest association.

References

  1. 1.
    Felmingham D, Grüneberg RN, the Alexander Project Group (2000) The Alexander project 1996–1997: latest susceptibility data from this international study of bacterial pathogens from community-acquired lower respiratory tract infections. JAC 45:191–203PubMedGoogle Scholar
  2. 2.
    Jacobs MR, Felmingham D, Appelbaum PC, Grüneberg RN et al (2003) The Alexander project 1998–2002: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. JAC 52:229–246PubMedGoogle Scholar
  3. 3.
    Klugman KP (1990) Pneumococcal resistance to antibiotics. Clin Microbiol Rev 3:171–196PubMedGoogle 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 β-hemolytic streptococci in 2002–2003: results of the multinational GRASP Surveillance Program. Int J Antimicrob Agents 25:148–156PubMedCrossRefGoogle Scholar
  5. 5.
    Jones ME, Blosser-Middleton RS, Critchley IA, Karlowsky JA, Thornsberry C, Sahm DF (2003) In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis: a European multicenter study during 2000–2001. CMI 9:590–599PubMedGoogle Scholar
  6. 6.
    Doern GV, Heilmann KP, Huynh HK, Rhomberg PR, Coffman SL, Brueggemann AB (2001) Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in the United States during 1999–2000, including a comparison of resistance rates since 1994–1995. Antimicrob Agents Chemother 45:1721–1729PubMedCrossRefGoogle Scholar
  7. 7.
    Goossens H, Ferech M, Vander Stichele R, Elseviers M (2005) Outpatient antibiotic use in Europe and association with resistance: a cross national database study. Lancet 365:579–587PubMedGoogle Scholar
  8. 8.
    Garcia-Rey C, Aguilar L, Baquero F, Casal J, Dal-Re R (2002) Importance of local variations in antibiotic consumption and geographical differences of erythromycin and penicillin resistance in Streptococcus pneumoniae. JCM 40:159–164Google Scholar
  9. 9.
    Bronzwaer SL, Cars O, Bücholz U (2002) European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 8:278–282PubMedCrossRefGoogle Scholar
  10. 10.
    Melander E, Ekdahl K, Jönsson G, Mölstad S (2000) Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics. Pediatr Infect Dis J 19:1172–1177PubMedCrossRefGoogle Scholar
  11. 11.
    Clinical and Laboratory Standards Institute (2006) Performance standards for antimicrobial susceptibility testing: approved standard and informational supplement M100-S16. CLSI, Wayne, PAGoogle Scholar
  12. 12.
    Chen DK, McGeer A, de Azavedo JC, Low DE (1999) Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada, Canadian Bacterial Surveillance Network. N Engl J Med 341:233–239PubMedCrossRefGoogle Scholar
  13. 13.
    World Health Organization (2004) Collaborating Centre for Drug Statistics Methodology. ATC index with DDDs. WHO, Oslo, NorwayGoogle Scholar
  14. 14.
    Ferech M, Coenen S, Malhotra-Kumar S, Dvorakova K, Hendrickx E, Suetens C, Goossens H (2006) European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe. J Antimicrob Chemother 58:401–407PubMedCrossRefGoogle Scholar
  15. 15.
    Vander Stichele R, Elseviers M, Ferech M et al (2004) European surveillance of antimicrobial consumption (ESAC): data collection performance and methodological approach. Br J Clin Pharmacol 58:419–428CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • S. Riedel
    • 1
  • S. E. Beekmann
    • 1
  • K. P. Heilmann
    • 1
  • S. S. Richter
    • 1
  • J. Garcia-de-Lomas
    • 2
  • M. Ferech
    • 3
  • H. Goosens
    • 3
  • G. V. Doern
    • 1
  1. 1.Division of Microbiology, Department of PathologyUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  2. 2.Department of MicrobiologyUniversity Clinical HospitalValenciaSpain
  3. 3.Laboratory of MicrobiologyUniversity of AntwerpAntwerpBelgium

Personalised recommendations