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Antimicrobial Agents and Chemotherapy, June 2001, p. 1721-1729, Vol. 45, No. 6
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.6.1721-1729.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Antimicrobial Resistance among Clinical Isolates of Streptococcus pneumoniae in the United States during 1999-2000, Including a Comparison of Resistance Rates since 1994-1995

Gary V. Doern,* Kristopher P. Heilmann, Holly K. Huynh, Paul R. Rhomberg, Stacy L. Coffman, and Angela B. Brueggemann

Medical Microbiology Division, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa 52242

Received 20 December 2000/Returned for modification 14 February 2001/Accepted 19 March 2001

A total of 1,531 recent clinical isolates of Streptococcus pneumoniae were collected from 33 medical centers nationwide during the winter of 1999-2000 and characterized at a central laboratory. Of these isolates, 34.2% were penicillin nonsusceptible (MIC >=  0.12 µg/ml) and 21.5% were high-level resistant (MIC >=  2 µg/ml). MICs to all beta-lactam antimicrobials increased as penicillin MICs increased. Resistance rates among non-beta-lactam agents were the following: macrolides, 25.2 to 25.7%; clindamycin, 8.9%; tetracycline, 16.3%; chloramphenicol, 8.3%; and trimethoprim-sulfamethoxazole (TMP-SMX), 30.3%. Resistance to non-beta-lactam agents was higher among penicillin-resistant strains than penicillin-susceptible strains; 22.4% of S. pneumoniae were multiresistant. Resistance to vancomycin and quinupristin-dalfopristin was not detected. Resistance to rifampin was 0.1%. Testing of seven fluoroquinolones resulted in the following rank order of in vitro activity: gemifloxacin > sitafloxacin > moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin > ofloxacin. For 1.4% of strains, ciprofloxacin MICs were >= 4 µg/ml. The MIC90s (MICs at which 90% of isolates were inhibited) of two ketolides were 0.06 µg/ml (ABT773) and 0.12 µg/ml (telithromycin). The MIC90 of linezolid was 2 µg/ml. Overall, antimicrobial resistance was highest among middle ear fluid and sinus isolates of S. pneumoniae; lowest resistance rates were noted with isolates from cerebrospinal fluid and blood. Resistant isolates were most often recovered from children 0 to 5 years of age and from patients in the southeastern United States. This study represents a continuation of two previous national studies, one in 1994-1995 and the other in 1997-1998. Resistance rates with S. pneumoniae have increased markedly in the United States during the past 5 years. Increases in resistance from 1994-1995 to 1999-2000 for selected antimicrobial agents were as follows: penicillin, 10.6%; erythromycin, 16.1%; tetracycline, 9.0%; TMP-SMX, 9.1%; and chloramphenicol, 4.0%, the increase in multiresistance was 13.3%. Despite awareness and prevention efforts, antimicrobial resistance with S. pneumoniae continues to increase in the United States.

* Corresponding author. Mailing address: Medical Microbiology Division, C606 GH, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 356-8616. Fax: (319) 356-4916. E-mail: gary-doern{at}uiowa.edu.

Antimicrobial Agents and Chemotherapy, June 2001, p. 1721-1729, Vol. 45, No. 6
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.6.1721-1729.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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