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Antimicrobial Agents and Chemotherapy, June 2004, p. 2101-2107, Vol. 48, No. 6
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.6.2101-2107.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

High Prevalence of Antimicrobial Resistance among Clinical Streptococcus pneumoniae Isolates in Asia (an ANSORP Study)

Division of Infectious Diseases,¹ Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine,⁵ Asian-Pacific Research Foundation for Infectious Diseases,² Kyungbook National University, Seoul,⁴ Chonnam National University Hospital, Gwangju, Korea,³ Beijing Children's Hospital, Beijing,⁶ Shanghai Children's Hospital, Shanghai,⁷ Princess Margaret Hospital, Hong Kong, China,¹⁷ Chulalongkorn University, Bangkok, Thailand,⁸ Chang Gung Children's Hospital, Taipei, Taiwan,⁹ Christian Medical College, Vellore, India,¹⁰ University of Colombo, Colombo, Sri Lanka,¹¹ National University of Singapore, Singapore,¹² Universiti Putra Malaysia,¹³ University Malaya, Kuala Lumpur, Malaysia,¹⁴ University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam,¹⁵ Research Institute for Tropical Medicine, Manila, Philippines,¹⁶ King Saud University, Riyadh, Saudi Arabia,¹⁸

Received 3 November 2003/ Returned for modification 21 January 2004/ Accepted 5 February 2004

A total of 685 clinical Streptococcus pneumoniae isolates from patients with pneumococcal diseases were collected from 14 centers in 11 Asian countries from January 2000 to June 2001. The in vitro susceptibilities of the isolates to 14 antimicrobial agents were determined by the broth microdilution test. Among the isolates tested, 483 (52.4%) were not susceptible to penicillin, 23% were intermediate, and 29.4% were penicillin resistant (MICs 2 mg/liter). Isolates from Vietnam showed the highest prevalence of penicillin resistance (71.4%), followed by those from Korea (54.8%), Hong Kong (43.2%), and Taiwan (38.6%). The penicillin MICs at which 90% of isolates are inhibited (MIC₉₀s) were 4 mg/liter among isolates from Vietnam, Hong Kong, Korea, and Taiwan. The prevalence of erythromycin resistance was also very high in Vietnam (92.1%), Taiwan (86%), Korea (80.6%), Hong Kong (76.8%), and China (73.9%). The MIC₉₀s of erythromycin were >32 mg/liter among isolates from Korea, Vietnam, China, Taiwan, Singapore, Malaysia, and Hong Kong. Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan^19F clone and the Spain^23F clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.

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