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SENTRY Programme Detects Decreasing Susceptibility to Levofloxacin and Macrolides in European Countries: Presented at ECCMID-ICC

By Chris Berrie

MUNICH, GERMANY -- April 2, 2007 -- Pathogens associated with community-acquired respiratory tract infections (CA-RTIs) -- Haemophilus influenzae and Moraxella catarrhalis -- show relatively stable, but variable, antimicrobial resistance patterns across 13 European countries that are being monitored in the SENTRY Antimicrobial Surveillance Programme.

However, Streptococcus pneumoniae resistance rates for penicillin, macrolides and to a lesser extent fluoroquinolones continue to evolve with varying velocities.

These data from 10 years of monitoring in the SENTRY Programme were presented here by Ronald M. Jones, MD, principal investigator, president and chief executive officer, JMI Laboratories, North Liberty, Iowa, United States, here at the 17^th European Congress of Clinical Microbiology and Infectious Diseases and 25^th International Congress of Chemotherapy (ECCMID-ICC).

"The programme itself is actually the most comprehensive antimicrobial surveillance programme in the World," with more than 100 participating medical centres worldwide, 25 to 30 of which are in Europe, he said during his presentation on March 31^st.

The isolates were collected according to site of infection, including for CA-RTIs, bacteraemia, pneumonia in hospitalised patients, skin/ wound infections and urinary tract infections.

The objective of this analysis was to determine the antimicrobial susceptibility patterns and beta-lactamase occurrence for S. pneumoniae, M. catarrhalis and H. influenzae from CA-RTI samples collected from these 13 European countries between 1997 and 2006.

These samples were forwarded annually to a central reference laboratory where the susceptibility tests were performed and where the organism's identity was confirmed. A panel of 55 antimicrobials have been monitored according to Clinical and Laboratory Standards Institute methods, providing the trends in the susceptibility rates by country through a total of 6,280 samples of H. influenzae, 1,908 M. catarrhalis and 6,753 S. pneumoniae.

For H. influenzae, the resistance to ampicillin, as beta-lactamase positive (BL+) rate, varied from 3.6% to 30.8%, with beta lactamase-negative ampicillin-resistant H. influenzae strains found in 6 countries (13-country mean, 0.3%; 0.5%-1.7%). Among the BL+ strains, resistance to amoxicillin with or without clavulanate was rare and seen in only 2 countries (13-country mean, 0.03%; 2.5%-5.5%). Dr. Jones also indicated that the susceptibility rates for H. influenzae were generally greater than 90% for the range of key antimicrobials.

M. catarrhalis showed susceptibility to nearly all classes of antimicrobials, although while the macrolides, tetracyclines, and enzyme-stable beta-lactams remained very potent, there was a rare high-level resistance to fluoroquinolones. These isolates also had a uniform beta-lactam production rate and associated penicillin resistance (mean, 95.5%; range, 92%-100%) across the full 13 countries.

Relatively high susceptibilities were generally seen for S. pneumoniae across a range of selected antimicrobials (range, 67%-98%). For penicillin and erythromycin, the 13-country, 10-year mean rates of susceptibility were 70.1% and 71.5%, respectively, although Dr. Jones did stress the potential for increased susceptibility for penicillin (~97%) should the new, proposed breakpoint for CA-RTI of less than or equal to 2 mg/L be applied.

In comparing these penicillin and erythromycin susceptibilities directly, over the 3 most recent years of sampling, 7 countries showed equal rates, while Germany, Belgium and Italy showed higher penicillin rates, and Ireland, Turkey and Israel, higher erythromycin rates. "This will be related to what the usage patterns of these drugs are in those nations," Dr. Jones said.

Thus, consistent monitoring of these European CA-RTI pathogens through the SENTRY Programme showed that susceptibilities towards penicillin have been variable across these European countries. However, macrolide susceptibility has predominantly decreased, and, of note, levofloxacin susceptibility has decreased, with the detection of resistant strains seen.

While Dr. Jones indicated the disturbing resistances seen in beta lactamase-negative ampicillin-resistant with H. influenzae and for fluoroquinolones with M. catarrhalis, he stressed that local surveillance of these RTI pathogens continues to be required to provide the best selections of empiric treatments, "Although they should probably be done more often and on a country basis," he added.

The SENTRY Programme has been supported collectively by Elan, Schering-Plough, Pfizer, Wyeth, Cubist, Johnson & Johnson, Abbott, GlaxoSmithKline, and AstraZeneca.


[Presentation title: Community-Acquired Respiratory Tract Infections in Europe Caused by S. Pneumoniae, H. Influenzae and M. Catarrhalis: Report From 10 Years of Monitoring by the SENTRY Programme. Abstract O29]

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