Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013)
- 387 Downloads
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.
KeywordsMeningitis Invasive Pneumococcal Disease Pneumococcal Conjugate Vaccine EUCAST Meningitis Case
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.
- 2.Clinical Laboratory Standards Institute (CLSI) (2006) Performance standards for antimicrobial susceptibility testing; 16th informational supplement. CLSI document M100-S16. CLSI, Wayne, PAGoogle Scholar
- 3.Clinical Laboratory Standards Institute (CLSI) (2008) Performance standards for antimicrobial susceptibility testing; 18th informational supplement. CLSI document M100-S18. CLSI, Wayne, PAGoogle Scholar
- 4.Clinical Laboratory Standards Institute (CLSI) (2014) Performance standards for antimicrobial susceptibility testing; 24th informational supplement. CLSI document M100-S24. CLSI, Wayne, PAGoogle Scholar
- 5.Centers for Disease Control and Prevention (CDC) (2008) Effects of new penicillin susceptibility breakpoints for Streptococcus pneumoniae—United States, 2006–2007. MMWR Morb Mortal Wkly Rep 57(50):1353–1355Google Scholar
- 7.European Committee for Antimicrobial Susceptibility Testing (EUCAST) (2009) Breakpoint tables for interpretation of MICs and zone diameters, version 1.0, December 2009. European Society of Clinical Microbiology and Infectious Diseases (ESCMID). http://www.eucast.org
- 8.European Committee for Antimicrobial Susceptibility Testing (EUCAST) (2014) Breakpoint tables for interpretation of MICs and zone diameters, version 4.0, January 2014. European Society of Clinical Microbiology and Infectious Diseases (ESCMID). http://www.eucast.org
- 13.Pérez-Trallero E, Martín-Herrero JE, Mazón A, García-Delafuente C, Robles P, Iriarte V, Dal-Ré R, García-de-Lomas J; Spanish Surveillance Group for Respiratory Pathogens (2010) Antimicrobial resistance among respiratory pathogens in Spain: latest data and changes over 11 years (1996–1997 to 2006–2007). Antimicrob Agents Chemother 54(7):2953–2959PubMedCrossRefPubMedCentralGoogle Scholar
- 14.Fenoll A, Granizo JJ, Aguilar L, Giménez MJ, Aragoneses-Fenoll L, Hanquet G, Casal J, Tarragó D (2009) Temporal trends of invasive Streptococcus pneumoniae serotypes and antimicrobial resistance patterns in Spain from 1979 to 2007. J Clin Microbiol 47(4):1012–1020PubMedCrossRefPubMedCentralGoogle Scholar
- 16.Oteo J, Lázaro E, de Abajo FJ, Baquero F, Campos J; Spanish Members of the European Antimicrobial Resistance Surveillance System (2004) Trends in antimicrobial resistance in 1,968 invasive Streptococcus pneumoniae strains isolated in Spanish hospitals (2001 to 2003): decreasing penicillin resistance in children’s isolates. J Clin Microbiol 42(12):5571–5577PubMedCrossRefPubMedCentralGoogle Scholar
- 20.Wolkers PC, Mantese OC, Paula A, Almeida VV, Aguiar PA, Alvares JR, Almeida SC, Brandileone MC (2009) New susceptibility breakpoints in antimicrobial resistance rates of invasive pneumococcal strains. J Pediatr (Rio J) 85(5):421–425Google Scholar
- 24.Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, Thomas AR, Harrison LH, Bennett NM, Farley MM, Facklam RR, Jorgensen JH, Besser J, Zell ER, Schuchat A, Whitney CG; Active Bacterial Core Surveillance of the Emerging Infections Program Network (2006) Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 354(14):1455–1463PubMedCrossRefGoogle Scholar