Streptococcus pneumoniae with High-Level Resistance Worldwide: Results from the ATLAS (Antimicrobial Testing Leadership and Surveillance) Database (2004–2015)

Abstract

Background. Evidence for a relationship between resistance and treatment failures may be higher for pneumococcal infections caused by strains with elevated resistance to antibiotics. The purpose of this study was to determine the prevalence of high-level of antibiotic-resistant (HLAR) Streptococcus pneumoniae in the world by analyzing the ATLAS (Antimicrobial Testing Leadership and Surveillance) database. Methods. Six hundred and thirty-two hospital sites in 66 countries worldwide collected 15,501 clinically significant isolates of Streptococcus pneumoniae were identified by each participating site and confirmed by the central laboratory from 2004 to 2015 (6532 [40%] invasive pneumococcal disease [IPD]). Minimum inhibitory concentrations (MICs) were determined using broth microdilution panels and interpreted according to CLSI guidelines (penicillin [PEN] [meningeal and non-meningeal breakpoints], ampicillin [AMP], amoxicillin/clavulanate [AMXCLAV], ceftriaxone [CRO], levofloxacin [LEV], clarithromycin [CLAR], and azithromycin [AZT]). Results. Conclusion. Considering the agents most commonly used, HLAR pneumococci prevalence remains at <10% worldwide for IPD isolates with exception of macrolides (∼20% to 50%). HLAR to PEN using meningeal breakpoints is almost 16% in Africa and 18% in Asia. Local and global surveillance studies of common respiratory pathogens such as S. pneumoniae remain instrumental to guide clinicians in appropriate empirical treatments and to emphasize the need for prudent antimicrobial use. (Figure Presented) .