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Sir,
We thank Dr.Goel and Dr.Wattal for showing such a keen interest in our study. The reasons for the unusually high percentage of penicillin resistance seen in our study could be two fold. One is the methodology followed, as pointed out by Dr.Goel. We agree that disc diffusion test using oxacillin 1 μg discs is not the ideal method of detecting penicillin resistance in Streptococcus pneumoniae but performing MIC for all the isolates was beyond the scope of the study as it was an ICMR short term student project carried out by an M.B.B.S student for 2 months. So, it is likely that some of the resistant isolates would have been ultimately identified as susceptible if test for determining MIC had been performed. The second reason for this undoubtedly high resistance could be the type of study population included i.e. inpatients in contrast to most similar studies where a community based subject enrolment is done with consequent lower rates of resistance.MIC for penicillin in Streptococcus pneumoniae is regularly being carried out in our department for the past 2 years and we have come across several penicillin resistant isolates with MIC of 2 μg/ml, mostly from sputum specimens from cases of pneumonia. Recently, CLSI has modified the interpretative criteria for penicillin resistance in Streptococcus pneumoniae, with different MIC values based on clinical condition and route of penicillin therapy. In pneumonia cases treated with IV penicillin, MIC of > = 8 μg/ml is considered resistant, drastically bringing down the reported cases of penicillin resistance. The MIC value in patients with meningitis remain the same [1].
The reason for including cephalexin in our study was to give clinicians information on the susceptibility to available oral 1st generation cephalosporins. This drug has since been discontinued from our panel of antibiotics. No ceftriaxone resistance has been encountered in any of our isolates so far.
Reference
1. CDC. Effects of new penicillin susceptibility breakpoints for Streptococcus pneumoniae, United States, 2006–2007. MMWR, December 19th, 2008;57:1353–1355.
Rupak Dhakal (Final Yr MBBS)
Osler House – 419, JIPMER Puducherry -605006,Pondicherry India. E-mail : 2rupak@gmail.com
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Goel, N., Wattal, C. Asymptomatic Colonization of Upper Respiratory Tract by Potential Bacterial Pathogens. Indian J Pediatr 78, 118–119 (2011). https://doi.org/10.1007/s12098-010-0261-4
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DOI: https://doi.org/10.1007/s12098-010-0261-4