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Antimicrobial Agents and Chemotherapy, November 2006, p. 3646-3650, Vol. 50, No. 11
0066-4804/06/$08.00+0     doi:10.1128/AAC.00234-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Macrolide and Azithromycin Use Are Linked to Increased Macrolide Resistance in Streptococcus pneumoniae{triangledown}

Miika Bergman,1* Solja Huikko,1,2 Pentti Huovinen,1 Pirkko Paakkari,3 Helena Seppälä,1,4 and Finnish Study Group for Antimicrobial Resistance (FiRe Network){dagger}

Antimicrobial Research Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute, Turku, Finland,1 School of Public Health, University of Tampere, Tampere, Finland,2 National Agency of Medicines, Helsinki, Finland,3 Department of Ophthalmology, Turku City Hospital, Turku, Finland4

Received 23 February 2006/ Returned for modification 2 June 2006/ Accepted 15 August 2006

The connection between regional rates of antimicrobial resistance in Streptococcus pneumoniae and regional antimicrobial use in Finland was investigated. During the 6-year study period of 1997 to 2002, a total of 31,609 S. pneumoniae isolates were tested for penicillin resistance and a total of 23,769 isolates were tested for macrolide resistance in 18 central hospital districts in Finland. The regional macrolide resistance rates were compared with the local use of (i) all macrolides pooled and (ii) azithromycin. The penicillin resistance levels were compared with the consumption data for (i) penicillins, (ii) cephalosporins, (iii) all beta-lactams pooled, and (iv) all macrolides pooled. A statistically significant association between macrolide resistance and total use of macrolides and the use of azithromycin was found. Moreover, total use of beta-lactams and total use of cephalosporins were significantly connected to low-level penicillin resistance. A statistically significant association between penicillin-nonsusceptible isolates and penicillin or total macrolide consumption was not found. In conclusion, total macrolide use and azithromycin use are associated with increased macrolide resistance, and beta-lactam use and cephalosporin use are connected to increased low-level penicillin resistance in S. pneumoniae. Unnecessary prescribing of macrolides and cephalosporins should be avoided.

* Corresponding author. Mailing address: Antimicrobial Research Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute, Kiinamyllynkatu 13, FI-20520 Turku, Finland. Phone: 358-2-3316631. Fax: 358-2-3316699. E-mail: miika.bergman{at}ktl.fi.

{triangledown} Published ahead of print on 28 August 2006.

{dagger} Members of the Finnish Study Group for Antimicrobial Resistance in 2002 are as follows: Anja Kostiala Thompson and Merja Rautio (Jorvi Hospital, Espoo); Risto Renkonen and Anna Muotiala (MedixDiacor Laboratory Service, Espoo); Martti Vaara and Petteri Carlson (Helsinki University Central Hospital, Helsinki); Hannele Somer (Mehiläinen Hospital, Helsinki); Anni Virolainen-Julkunen (Yhtyneet Laboratoriot Oy, Helsinki); Jukka Korpela and Ritva Heikkilä (Central Hospital of Kanta-Häme, Hämeenlinna); Suvi-Sirkku Kaukoranta and Heikki Kaukoranta (Central Hospital of North-Karelia, Joensuu); Antti Nissinen (Central Hospital of Keski-Suomi, Jyväskylä); Pekka Ruuska (Central Hospital of Kainuu, Kajaani); Henrik Jägerroos (Central Hospital of Lapland, Rovaniemi); Martti Larikka (Central Hospital of Länsi-Pohja, Kemi); Simo Räisänen (Central Ostrobothnian Hospital District, Kokkola); Ulla Larinkari (Central Hospital of Kymenlaakso, Kotka); Marja-Leena Katila and Ulla Kärkkäinen (Kuopio University Hospital, Kuopio); Hannu Sarkkinen and Pauliina Kärpänoja (Central Hospital of Päijät-Häme, Lahti); Maritta Kauppinen and Seppo Paltemaa (Central Hospital of South-Karelia, Lappeenranta); Päivi Kärkkäinen (Mikkeli Central Hospital, Mikkeli, and Savonlinna Central Hospital, Savonlinna); Ilmo Pietarinen (Deaconess Institution in Oulu, Oulu); Markku Koskela (Oulu University Hospital, Oulu); Sini Pajarre (Central Hospital of Satakunta, Pori); Sinikka Oinonen and Virpi Ratia (Central Hospital of Seinäjoki, Seinäjoki); Paul Grönroos (Koskiklinikka, Tampere); Risto Vuento and Oili Liimatainen (Tampere University Hospital, Tampere); Maj-Rita Siro (Health Center Pulssi, Turku); Erkki Eerola and Raija Manninen (University of Turku, Turku); Olli Meurman (Turku University Central Hospital, Turku); Marko Luhtala (Central Hospital of Vaasa, Vaasa); and Pentti Huovinen and Katrina Lager (National Public Health Institute, Turku).

Antimicrobial Agents and Chemotherapy, November 2006, p. 3646-3650, Vol. 50, No. 11
0066-4804/06/$08.00+0     doi:10.1128/AAC.00234-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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