Clinical Microbiology and Antimicrobial Chemotherapy. 2002; 4(3):267-277
To determine the structure of antimicrobial resistance of clinical isolates of pneumococci in different regions of Russia.
A total of 210 Streptococcus pneumoniae strains isolated in 15 centres of Central (Moscow – 5 centers, Kazan, Nizniy Novgorod, Ryzan), North-Western (Smolensk, Saint-Petersburg), Southern (Krasnodar) regions, Urals (Ekaterinburg) and Siberia (Novosibirsk, Tomsk) were included in this study. Susceptibility to 19 antimicrobials – penicillin G, amoxicillin, amoxicillin/clavulanate, cefotaxime, cefepime, erythromycin, azithromycin, clarithromycin, midecamycin, midecamycin acetate, spiramycin, clindamycin, tetracycline, ciprofloxacin, levolfloxacin, chloramphenicol, co-trimoxazole, rifampicin and vancomycin – was determined by broth microdilution in accordance with NCCLS recommendations.
β-Lactams sustain high in vitro activity against studied population of pneumococci: nonsusceptibility (percentage of both intermediate and fully resistant isolates) to amoxicillin and amoxicillin/clavulanate was 0,5%, to cefotaxime and cefepime – 2%, to penicillin G – 9%. Resistance to studied macrolides/azalide (erythromycin, azithromycin, clarithromycin, midecamycin, midecamycin acetate, spiramycin) varied from 2 to 6%. Chloramphenicol, clindamycin and rifampicin also sustained high activity (proportion of non-susceptible strains was 5, 2 and 1% respectively). No resistance to levofloxacin and vancomycin was found. The highest percentage of non-susceptible isolates (27 and 33% respectively) was determined to tetracycline and co-trimoxazole. Multi-resistance (defined as resistance to 3 and more classes of antimicrobials) was found in 8% of strains.
β-Lactams and macrolides might be recommended as drugs of choice for the therapy of pneumococcal infections. Respiratory fluoroquinolones (levofloxacin) are highly active against pneumococci. High resistance to co-trimoxazole and tetracycline dictates the necessity to limit use of these antimicrobials for the therapy of the above infections.