susceptibility patterns over 3 years in community-acquired lower respiratory infection in the uk and...
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Susceptibility Patterns over 3 years in Community-acquired Lower Respiratory Infection in
the UK and Ireland
R. Reynolds, D. Felmingham
BSAC Working Party on Respiratory Resistance Surveillance
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Question: Are resistance rates rising in community-acquired lower respiratory infection?
Question: Are resistance rates rising in community-acquired lower respiratory infection?
BSAC Respiratory Resistance Surveillance Programme
• ~ 20 laboratories over UK and Ireland
• winter seasons (October-April)
• community-acquired infection (patients in hospital > 48 hours excluded)
• duplicate isolates within 2 weeks excluded
• cystic fibrosis excluded
• central testing, BSAC agar dilution MIC
Acknowledgements
COLLECTING LABORATORIES
CENTRAL LAB - GR Micro Ltd., London
SPONSORS during 1999 - 2002
• Abbott
• Aventis
• Bayer
• GSK
S. pneumoniae H. influenzae
1999 - 2000 661 936
2000 - 2001 667 958
2001 - 2002 699 916
Numbers of isolates
S. pneumoniae, beta-lactams
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Penicillin Amoxicillin Cefuroxime Cefotaxime
99-00
00-01
01-02
%
% above breakpoint
0.12 2 2 2
S. pneumoniae/beta-lactams:There are no significant differences between 99-00 and 01-02.
S. pneumoniae/beta-lactams:There are no significant differences between 99-00 and 01-02.
S. pneumoniae, beta-lactams
0.0
20.0
40.0
60.0
80.0
100.0
Penicillin Amoxicillin Cefuroxime Cefotaxime
99-00
00-01
01-02
%
0.12 2 2 2
% above breakpointShown on a full 100% scale, the low level of resistance is clear, and the apparent downward trend seen on the previous slide is seen as a very small effect.
Shown on a full 100% scale, the low level of resistance is clear, and the apparent downward trend seen on the previous slide is seen as a very small effect.
S. pneumoniae, beta-lactams
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Penicillin Amoxicillin Cefuroxime Cefotaxime
99-00
00-01
01-02
%
0.12 2 2 2
% above breakpointThe addition of 95% confidence intervals emphasises the uncertainty involved in measuring low levels of resistance.
The addition of 95% confidence intervals emphasises the uncertainty involved in measuring low levels of resistance.
S. pneumoniae, beta-lactams
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Penicillin Amoxicillin Cefuroxime Cefotaxime
99-00
00-01
01-02
%
0.12 2 2 2
% above breakpointAll the same, the impression is of falling resistance to penicillin and cefuroxime. We are fairly confident that, at the least, these resistance levels are not rising.
All the same, the impression is of falling resistance to penicillin and cefuroxime. We are fairly confident that, at the least, these resistance levels are not rising.
S. pneumoniae, penicillin: MIC distribution
1999-2000
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0.0
04
0.0
08
0.0
15
0.0
3
0.0
6
0.1
2
0.2
5
0.5 1 2 4
pen, SP
2001-02
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0.0
04
0.0
08
0.0
15
0.0
3
0.0
6
0.1
2
0.2
5
0.5 1 2 4
pen, SP
%
%
S. pneumoniae, other classes
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Tetracycline Erythromycin Ciprofloxacin Moxifloxacin
99-00
00-01
01-02
%
2 1 4 2
% above breakpoint
1999-2000
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0.03 0.06 0.12 0.25 0.5 1 2 4 8 16 32 64 128
tet, SP
2001-2002
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0.03 0.06 0.12 0.25 0.5 1 2 4 8 16 32 64 128
tet, SP
S. pneumoniae, tetracycline: MIC distribution
%
%
In tetracycline also, the breakpoint is well clear of the main population and the measured %R is not subject to fluctuations resulting from minor technical shifts in MIC measurement.
In tetracycline also, the breakpoint is well clear of the main population and the measured %R is not subject to fluctuations resulting from minor technical shifts in MIC measurement.
1999-2000
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0.12 0.25 0.5 1 2 4 8 16 32 64
cip, SP
2001-2002
0.0
10.0
20.0
30.0
40.0
50.0
60.0
0.12 0.25 0.5 1 2 4 8 16 32 64
cip, SP
S. pneumoniae, ciprofloxacin: MIC distribution
%
%
However, for ciprofloxacin, the breakpoint falls in the peak of the distribution, so measurement of %R is less reliable. Therefore, the apparent rise in ciprofloxacin resistance in 2001-02 may be an artefact and is not a cause for alarm.
However, for ciprofloxacin, the breakpoint falls in the peak of the distribution, so measurement of %R is less reliable. Therefore, the apparent rise in ciprofloxacin resistance in 2001-02 may be an artefact and is not a cause for alarm.
H. influenzae
0.0
5.0
10.0
15.0
20.0
25.0
Amoxicillin Amox-clav Cefuroxime Cefotaxime
99-00
00-01
01-02
2 2 2 2
% above breakpoint
%
No striking differences in H. influenzae with beta-lactams.
No striking differences in H. influenzae with beta-lactams.
H. influenzae
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Tetracycline Erythromycin Ciprofloxacin Trimethoprim
99-00
00-01
01-02
2 16 2 1
% above breakpoint
%
Trimethoprim resistance in H. influenzae appears to have risen (statistically significant).
Trimethoprim resistance in H. influenzae appears to have risen (statistically significant).
1999-2000
0.0
10.0
20.0
30.0
40.0
0.0
04
0.0
08
0.0
15
0.0
3
0.0
6
0.1
2
0.2
5
0.5 1 2 4 8
16
32
64
tmp, HI
H. influenzae, trimethoprim: MIC distribution
2001-2002
0.0
10.0
20.0
30.0
40.0
0.0
04
0.0
08
0.0
15
0.0
3
0.0
6
0.1
2
0.2
5
0.5 1 2 4 8
16
32
64
tmp, HI
%
%
Some of the increase is contributed by isolates with MICs near the breakpoint, but some is well clear at 32 mg/L. Overall significance uncertain.
Some of the increase is contributed by isolates with MICs near the breakpoint, but some is well clear at 32 mg/L. Overall significance uncertain.
Conclusions
• Resistance rates in community-acquired LRTI in the UK and Eire are not rising generally.
• In S. pneumoniae for -lactams and tetracycline they may be falling.
• Data for 2002-2003 will clarify the picture.
• Results will be on www.bsacsurv.org
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