Antimicrobial Susceptibility of Causative Agents of Fatal Community-Acquired Pneumonia in Adult Patients

Clinical Microbiology and Antimicrobial Chemotherapy. 2008; 10(4):368-380

​ Ivanchik N.V., Kozlov S.N., Rachina S.A., Krechikova O.I., Sinyatnikova T.M.
community-acquired pneumonia adults autopsy sample etiology antimicrobial resistance
Section
Personal Experience
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2008; 10(4):368-380

Abstract

The aim of the study was to determinate the structure of bacterial pathogens and their antimicrobial resistance in adult patients with community-acquired pneumonia (CAP). A total of 57 adult patients from Smolensk and Yartsevo hospitals with severe CAP were included in the study. Immediate autopsy samples (blood, lung, liver and spleen tissues) were obtained for histological examination and quantitative cultures. Clinically significant bacterial pathogens were isolated in 52 patients; among them single microorganism were found in 39 patients, ≥2 – in 13. K. pneumoniae, S. aureus, S. pneumoniae and H. influenzae were the most frequent isolates (31.4%, 28.6%, 12.9 and 11.4% of all strains, respectively). The best in vitro activity against K. pneumoniae show amoxicillin/clavulanate, III–IV generation cephalosporins, fluoroquinolones and carbapenems, against E. coli – III– IV generation cephalosporins and carbapenems. Among 20 strains of S. aureus 2 were resistance to oxacillin; the best activity against S. aureus show vancomycin, linezolid, trimethoprim/sulfamethoxazole, fuzidic acid and clindamycin. All S. pneumoniae strains were susceptible to all antimicrobials tested. III–IV generation cephalosporins and fluoroquinolones were the most active against H. influenzae. III-IV generation cephalosporins and carbapenems can be considered as the drugs for empiric therapy of severe CAP in Smolensk, amoxicillin/clavulanate, carbapenems and fluoroquinolones – in Yartsevo.

  • 1. National Center for Health Statistics. Health, United States, 2006, with chartbook on trends in the health of Americans. Available at: www.cdc.gov/nchs/data/hus/hus06/pdf.
  • 2. Woodhead M., Blasi F., Ewig S., et al. Guidelelines for management of adult lower respiratory tract infections. Eur Respir J 2005; 26:1138-30.
  • 3. Mandell L.A., Wunderink R.G., Anzueto A., et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of CommunityAcquired pneumoniae in Adults. Clin Infect Dis 2007; 44: S27-S72.
  • 4. Centers for Disease Control and Prevention. Premature deaths, monthly mortality and monthly physician contacts: United States. Morb Mortl Wkly Rep 1997;46: 556.
  • 5. Medicare and Medicaid statistical supplement, 1995. Health Care Financ Rev 1995;16.
  • 6. Ewig S. Community-acquired pneumonia. Epidemiology, risk and prognosis. Eur Respir Mon 1997; 3: 13-35.
  • 7. Чучалин А.Г., Синопальников А.И., Страчунский Л.С. и соавт.. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. Клин микробиол антимикроб химиотер 2006; 8(1):54-86.
  • 8. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low risk patients with community-acquired pneumonia. N Engl J Med 1997; 336:243-50.
  • 9. Синопальников А.И., Козлов Р.С. Внебольничные инфекции дыхательных путей. Руководство для врачей. М.: Премьер МТ, Наш Город, 2007. 352 с.
  • 10. Marston B., Plouffe J., File T. et al. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance study in Ohio. The Community-Acquired Pneumonia Study Group. Arch Intern Med 1997; 157:1709-18.
  • 11. Premature death, monthly mortality and monthly physician contacts – United States. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1997; 46:556-61.
  • 12. Hoogewerf M., Oosterheert J.J, Hak E., et al. Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia. Clin Microbiol Infect 2006; 12: 1097-104.
  • 13. Gutierrez F., Masia M., Rodriguez J.C., et al. Epidemiology of community-acquired pneumonia in adult patients at the dawn of the 21st century: a prospective study on the Mediterranean coast of Spain. Clin Microbiol Infect 2005; 11:788-800.
  • 14. Marrie T.J. Epidemiology of community-acquired pneumonia in the elderly. Semin Respir Inf 1990; 5:260-8.
  • 15. Козлов Р.С., Сивая О.В, Шпынев К.В. и др. Антибиотико­резистентность Streptococcus pneumoniae в России в 1999-2005 гг.: результаты многоцентровых проспективных исследований ПеГАС-I и ПеГАС-II. Клин микробиол антимикроб химиотер 2006; 8(1):33-47.
  • 16. Bandak S.I., Turnak M.R., Allen B.S., et al. Antibiotic susceptibolities among recent clinical isolates of Haemophilus influenzae and Moraxella catarrhalis from fifteen countries. Eur J Clin Microbilol Infect Dis 2001; 20:55-60.
  • 17. Jacobs M.R., Felmingham D., Appelbaum P.C., Gruneberg R.N.; The Alexander Project Group. The Alexander Project 1998-2000: susceptibility of pathogens isolated from community-acquired respiratory tract infections to commonly used antimicrobial agents J Antimicrob Chemother 2003; 52:229-46.
  • 18. Mera R.M., Miller L.A., Daniels J.J., Weil J.G., White A.R. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States over a 10- year period: Alexander Project. Diagn Microbiol Infect Dis 2005; 51:195-200.
  • 19. Thomsberry C., Sahm D.F., Kelly L.J., et al. Regional trends in antimicrobial resistance among clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella caiarrhalis in the United States: results from the TRUST surveillance program, 1999-2000. Clin Infect Dis 2002; 34 (Suppl 1): S4-S16.
  • 20. Naimi T.S., LeDell K.H., Como-Sabetti K., et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003; 290: 2976-84.
  • 21. Francis J.S., Doherty M.C., Lopatin U., et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis. 2005; 40:100-7.
  • 22. Johnston B.L. Methicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia - a critical review. Semin Respir Infect 1994; 9:199-206.
  • 23. Hageman J.C., Uyeki T.M., Francis J.S., et al. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis 2006; 12: 894-9.
  • 24. Fridkin S.K., Hageman J.C., Morrison M., et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352:1436-44.
  • 25. Tenover F.C., McDougal L.K., Goering R.V., et al. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol 2006; 44:108-18.
  • 26. Rodrıguez-Ban˜o J., Ngugro M.D. Extended-spectrum β-lactamases in ambulatory care: a clinical perspective. Clin Microbiol Infect 2008; 14 (Suppl. 1): 104–10.
  • 27. Rodríguez-Baño J., Navarro M.D., Romero L., et al. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004, 42, 3:1089-94.
  • 28. Pitout J.D.D., Nordmann P., Laupland K.B., Poirel L. Emergence of Enterobacteriaceae producing extendedspectrum β-lactamases (ESBLs) in the community. J antimicrob Chemother 2005; 56: 52-9.
  • 29. Paganin F., Lilienthal F., Bourdin A., et al. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur Respir J 2004; 24:779- 85.
  • 30. Методические указания МУК 4.2.1890-04. Определение чувствительности микроорганизмов к антимикробным препаратам. М.: Федеральный центр Госсанэпиднадзора Минздрава России, 2004. – 91 с.
  • 31. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Sixteenth Informational Supplement // CLSI. – 2006. - M100-S16., Vol.26 №.3.
  • 32. Lim W.S., Macfarlane J.T., Boswell T.C., et al. Study of community-acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax 2001; 56:296-301.
  • 33. Bartlett J.G., Dowell S.F., Mandell L.A., et al. Guidelines from the Infectious Diseases Society of America. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 2000; 31: 347-82.
  • 34. Luna C.M., Famiglietti A., Absi R., et al. Communityacquired pneumonia: etiology, epidemiology and outcome at a teaching hospital in Argentina. Chest 2000; 118: 1344-54.
  • 35. El-Solh A.A., Sikka P., Ramadan F., et al. Etiology of severe pneumonia in the very elderly. Am J Respire Crit Care Med 2001; 163:645-51.
  • 36. Чучалин А.Г., Синопальников А.И., Чернеховская Н.Е. Пневмония. М.: Экономика и информатика, 2002. 480 с.
  • 37. Wu C.L., Chan M.C., Chang G.C., et al. Eliology and cytokine expression in patients requiring mechanical ventilation due to severe community-acquired pneumonia. J Formos Med Assoc 2006; 105: 49-55.
  • 38. Kang C.-I., Song J.-H., Oh W.S., et al. Clinical outcomes and risk factors of community-acquired pneumonia caused by gram-negative bacilli. Eur J Clin Micribiol Infect Dis 2008; 27:657-61.
  • 39. Практическое руководство по антиинфекционной химиотерапии. Под ред. Страчунского Л.С., Белоусова Ю.Б., Козлова С.Н. Смоленск: МАКМАХ, 2007. 464 с.
  • 40. Palmer S.M., Kang S.L., Cappelletty D., Rybak M.J. Bactericidal killing activities of cefepime, ceftazidime, cefotaxime, and ceftriaxone Against Staphylococcus aureus and β-lactamase-producing strains of Enterobacter aerogenes and Klebsiella pneumoniae in an in vitro infection model. Antimicrob Agents and Chemother.1995; 39: 8: 1764–71.
  • 41. Vandenesch F., Naimi T., Enright M.C., et al. Communityacquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003; 9:978–84.
  • 42. Labandeira-Rey M., Couzon F., Boisset S., et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science 2007; 315: 1130-3.
  • 43. Roberts J.C., Gulino S.P., Kealy Peak K., Luna V.A., Sanderson R. Fatal necrotizing pneumonia due to a Panton-Valentine leukocidin positive community-associated methicillin-sensitive Staphylococcus aureus and Influenza co-infection: a case report. Ann Clin Microbiol Antimicrob 2008; 7: 5.
  • 44. Doern G.V., Richter S.S., Miller A., et al. Antimicrobial resistance among Streptococcus pneumoniae in the United States: have we begun to turn the corner on resistance to certain antimicrobial classes? Clin Infect Dis 2005; 41:139-48.
  • 45. Drugeon H.B., Juvin M., Janus C., et al. Antimicrobial resistance among Streptococcus pneumoniae isolated in Europe, Turkey, Middle East, Africa and Asia (eBASKET2). Proceeding of the 44th ICAAC, 2004. Abstr C2- 832.
  • 46. Bozdogan B., Apelbaum P.C., Kelly L.M., et al. Activity of telitromycin and seven other agents against 1034 pediatric Streptococcus pneumoniae isolates from ten central and eastern European centers. Clin Microbiol Infect 2003; 9:653-61.
  • 47. Reinert R.R., Reinet S., van der Linden M., et al. Antimicrobial susceptibility of Streptococcus pneumoniae in eight European countries from 2001 to 2003. Antimicrob Agents Chemother 2005; 49:2903-13.
  • 48. Страчунский Л.С., Тарасов А.А., Крюков А.И. и др. Возбудители острого бактериального синусита. Результаты многоцентрового микробиологического исследования SSSR. Клин микробиол антимикроб химиотер 2005; 7(4): 337-49.
  • 49. Kelley M., Weber D., Gilligan P., Cohen M. Breakthrough pneumococcal bacteremia in patients being treated with azithromycin and clarithromycin. Clin Infect Dis 2000; 31:1008-11.
  • 50. Hoban D., Felmingham D. The PROTEKT surveillance study antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections. J Antimicrob Chemother 2002; 50 (Suppl S1):49-59.
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