The Alexander Project 1998-2000:: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents
The Alexander Project 1998-2000:: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents
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DOI：
10.1093/jac/dkg321
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发表时间：
2003-08-01
影响因子：
5.2
通讯作者：
Grüneberg, RN
中科院分区：
文献类型：
--
作者：
Jacobs, MR;Felmingham, D;Grüneberg, RN
目的：该亚历山大项目是一个持续的监测研究，开始于1992年，研究的敏感性病原体参与成人社区获得性呼吸道感染（CARTI）的范围内的抗菌agents.Materials和方法：本研究测试的敏感性分离的肺炎链球菌，流感嗜血杆菌和卡他莫拉菌收集在1998年和2000年之间的23种抗菌药物。采用微量肉汤稀释法测定药物的最低抑菌浓度，并根据NCCLS和药代动力学/药效学（PK/PD）折点进行解释。pneumoniae，8523株H. 874株M. 1998-2000年期间从26个国家的中心收集了卡他病病例。世界范围内流行的青霉素耐药性（青霉素MIC大于或等于2 mg/L）的分离株的S。在研究期间，肺炎链球菌的耐药率为18.2%，该病原体的大环内酯类耐药率（红霉素MIC大于或等于1 mg/L）为24.6%。在研究期间，在研究所包括的26个国家中，有19个国家的大环内酯类耐药性超过了青霉素耐药性。在非氟喹诺酮类药物中，90%以上的S.在NCCLS和PK/PD折点处，对阿莫西林（95.1%）和复方阿莫西林（95.5-97.9%）敏感的肺炎分离株。氟喹诺酮类耐药的S.肺炎克雷伯菌（氧氟沙星MIC ≥ 8 mg/L）为1.1%。吉美氟沙星是对沙门氏菌最有效的氟喹诺酮类药物。肺炎（99.9%敏感）。在H.流感病毒中，β-内酰胺酶的产生率为16.9%，而β-内酰胺酶阴性、对青霉素耐药的菌株的患病率较低（0.2%）。产β-内酰胺酶M.在研究期间，全球卡他病仍然很高（92.1%）。使用PK/PD折点，对H.敏感率为100%，头孢克肟99.8%，阿莫西林98.1-99.6%。复方阿莫西林、头孢地尼和头孢克肟（100%）是对M.粘膜炎。两个都是H. influenzae和M.结论：这些数据表明，在细菌耐药性的持续演变和地理变异，并强调需要适当的处方抗菌药物在CARTI，使用具有足够的活性的代理商，根据当地的敏感性和PK/PD参数。
Objectives: The Alexander Project is a continuing surveillance study, begun in 1992, examining the susceptibility of pathogens involved in adult community-acquired respiratory tract infections (CARTI) to a range of antimicrobial agents.Materials and methods: This study tested the susceptibility of isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis collected between 1998 and 2000 to 23 antimicrobials. Minimum inhibitory concentrations of agents were determined using the broth microdilution method and interpreted according to NCCLS and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.Results: In total, 8882 isolates of S. pneumoniae, 8523 isolates of H. influenzae and 874 isolates of M. catarrhalis were collected during 1998-2000 from centres in 26 countries. The world-wide prevalence of penicillin resistance (penicillin MICs greater than or equal to 2 mg/L) in isolates of S. pneumoniae was 18.2% over the study period, and the prevalence of macrolide resistance (erythromycin MICs greater than or equal to 1 mg/L) in this pathogen was 24.6%. Over the study period, macrolide resistance exceeded penicillin resistance in 19 of the 26 countries included in the study. Of the non-fluoroquinolone agents, the only oral agents to which over 90% of S. pneumoniae isolates were susceptible at both NCCLS and PK/PD breakpoints were amoxicillin (95.1%) and co-amoxiclav (95.5-97.9%). The prevalence of fluoroquinolone-resistant S. pneumoniae (ofloxacin MICs greater than or equal to 8 mg/L) was 1.1%. Gemifloxacin was the most potent fluoroquinolone tested against S. pneumoniae (99.9% susceptible). In isolates of H. influenzae, beta-lactamase production was 16.9%, whereas the prevalence of beta-lactamase-negative, ampicillin-resistant strains was low (0.2%). beta-Lactamase production in M. catarrhalis world-wide remained high over the period studied (92.1%). Using PK/PD breakpoints, the most active non-fluoroquinolone agents against H. influenzae were ceftriaxone (100% susceptible), cefixime (99.8%) and co-amoxiclav (98.1-99.6%). Co-amoxiclav, cefdinir and cefixime (100%) were the most active beta-lactams against M. catarrhalis. Both H. influenzae and M. catarrhalis were highly susceptible to the fluoroquinolones.Conclusions: These data demonstrate the continued evolution of and geographical variation in bacterial resistance and highlight the need for appropriate prescribing of antimicrobials in CARTI, using agents with adequate activity, based on local susceptibility profiles and PK/PD parameters.