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Antimicrobial Agents and Chemotherapy, July 2005, p. 2903-2913, Vol. 49, No. 7
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.7.2903-2913.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Antimicrobial Susceptibility of Streptococcus pneumoniae in Eight European Countries from 2001 to 2003

Ralf René Reinert,1* Susanne Reinert,2 Mark van der Linden,1 Murat Y. Cil,1 Adnan Al-Lahham,1 and Peter Appelbaum3

Institute of Medical Microbiology, National Reference Centre for Streptococci, University of Aachen (RWTH-Aachen), Aachen, Germany,1 SR Medical Communications GmbH, Frechen, Germany,2 Hershey Medical Center, Hershey, Pennsylvania3

Received 17 January 2005/ Returned for modification 11 February 2005/ Accepted 15 March 2005

Susceptibility testing results for Streptococcus pneumoniae isolates (n = 2,279) from eight European countries, examined in the PneumoWorld Study from 2001 to 2003, are presented. Overall, 24.6% of S. pneumoniae isolates were nonsusceptible to penicillin G and 28.0% were resistant to macrolides. The prevalence of resistance varied widely between European countries, with the highest rates of penicillin G and macrolide resistance reported from Spain and France. Serotype 14 was the leading serotype among penicillin G- and macrolide-resistant S. pneumoniae isolates. One strain (PW 158) showed a combination of an efflux type of resistance with a 23S rRNA mutation (A2061G, pneumococcal numbering; A2059G, Escherichia coli numbering). Six strains which showed negative results for mef(A) and erm(B) in repeated PCR assays had mutations in 23S rRNA or alterations in the L4 ribosomal protein (two strains). Fluoroquinolone resistance rates (levofloxacin MIC ≥ 4 µg/ml) were low (Austria, 0%; Belgium, 0.7%; France, 0.9%; Germany, 0.4%; Italy, 1.3%; Portugal, 1.2%; Spain, 1.0%; and Switzerland, 0%). Analysis of quinolone resistance-determining regions showed eight strains with a Ser81 alteration in gyrA; 13 of 18 strains showed a Ser79 alteration in parC. The clonal profile, as analyzed by multilocus sequence typing (MLST), showed that the 18 fluoroquinolone-resistant strains were genetically heterogeneous. Seven of the 18 strains belonged to new sequence types not hitherto described in the MLST database. Europe-wide surveillance for monitoring of the further spread of these antibiotic-resistant S. pneumoniae clones is warranted.

* Corresponding author. Mailing address: Institute of Medical Microbiology, National Reference Centre for Streptococci, University of Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany. Phone: 49 241 8089787. Fax: 49 241 808248. E-mail: Reinert{at}rwth-aachen.de.

Antimicrobial Agents and Chemotherapy, July 2005, p. 2903-2913, Vol. 49, No. 7
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.7.2903-2913.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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