Vol.13, No 1, 2006 pp. 25 - 31
UC 579.86:615.33(497.11)"1999/2003"

EPIDEMIOLOGY AND ANTIMICROBIAL RESISTANCE
OF STREPTOCOCCUS PNEUMONIAE STRAINS
ISOLATED IN NIŠ DISTRICT DURING 1999-2003
Snežana Mladenović-Antić, Branislava Kocić, Gordana Ranđelović, Slavica Ivić, Predrag Stojanović
Institute of Public Health, Niš
Faculty of Medicine, University of Niš

Summary. Streptococcus pneumoniae, a frequent cause of infections of the respiratory tract, the middle ear and the central nervous system has shown an increase in resistance to antimicrobial drugs, which significantly hinders therapy. The aim of the study was to determine the frequency of occurrence of S.pneumoniae and to determine the level of resistance to the most frequently used antimicrobial drugs and to study it in relation to resistance in other European countries. In a five-year period 2,185 isolates of S.pneumoniae of various origins were studied, identified by means of morphological, cultural and antigen characteristics, and tested by disc diffusion method for recommended antimicrobial drugs. These isolates were viewed from the aspect of sex, patient's age, type of the sample, and their seasonal character. The experimental group consisted of 320 isolates tested by means of the disc diffusion and agar dilution method, to indicate their susceptibility to penicillin, cephtriaxon, erythromycin, and trimetoprim-sulphametoxasol, according to the recommendation of the American National Committee for Clinical Laboratory Standards (NCCLS), now called Clinical and Laboratory Standards Institute (CLSI). From 2,185 S. pneumoniae obtained from various clinical materials, the highest percentage was found in the population under the age of 15 (84.07%). The nose swab (81.4%) and the transtracheal aspirate (7.51%) were the most frequent positive. The isolates which were obtained from outpatients were more frequent than those obtained from hospitalized patients. The occurrence of seasonal variation can also be detected (82.05% in the winter period). From the multi-resistant isolates, the most frequent are the phenotypes resistant to penicillin, erythromycin, and trimetoprim-sulphametoxasol (11.85%). Examinations were performed on 320 isolates of S.pneumoniae and gave the following results: 68.2% of the isolates showed a reduced sensitivity to penicillin, 33.7% to erythromycin, 19.4% to cephtriaxon and 66.5% to trimetoprim-sulphametoxasol. The level of resistance and percentage of highly resistant isolates (21.3%) rank us among the European countries with the highest rate of resistance of S.pneumoniae to penicillin. The level of resistance to penicillin, erythromycin, and trimetoprim–sulphametoxasol is the highest among the isolates obtained from carriers (38%, 33.7% and 46%). In the case of cephtriaxon, the level of resistance is highest among the hospital isolates (8%), while the percentage of isolates resistant (10%) and intermediary (9.4%) to cephtriaxon is at the level of the Mediterranean and Eastern European countries. There is a significantly high level of resistance to trimetoprim–sulphametoxasol (59%).
Key words: Streptococcus pneumoniae, antimicrobial resistance, surveillance

EPIDEMIOLOGIJA I ANTIMIKROBNA REZISTENCIJA SOJEVA STREPTOKOKUS PNEUMONIAE IZOLOVANIH U NIŠKOM REGIONU TOKOM 1999-2003.
Kratak sadržaj: S. pneumoniae, čest uzročnik infekcija respiratornog trakta, srednjeg uha i centralnog nervnog sistema poslednjih godina pokazuje porast rezistencije na antimikrobna sredstva što otežava terapijski pristup. Cilj rada bio je utvrđivanje učestalosti pojave S.pneumoniae i određivanje nivoa rezistencije na penicilin, ceftriakson, eritromicin i trimetoprim- sulfametoksazol, kao i njegovo upoređivanje sa rezistencijom u ostalim zemljama Evrope. U petogodišnjem periodu ispitano je 2185 izolata S.pneumoniae različitog porekla, identifikovanih pomoću morfoloških, kulturelnih i antigenih osobina. Ovi izolati sagledani su sa aspekta pola, uzrasta, vrste bolesničkog materijala, porekla izolata i sezonskog karaktera i testirani disk-difuzionom metodom na preporučene antimikrobne lekove. Eksperimentalnu grupu činilo je 320 izolata testiranih disk-difuzionom i agar- dilucionom metodom na penicilin, ceftriakson, eritromicin i trimetoprim-sulfametoksazol, prema preporukama Američkog nacionalnog komiteta za kliničke laboratorijske standarde (NCCLS), sada Instituta za kliničke laboratorijske standarde (CLSI). Od 2185 S.pneumoniae iz različitog kliničkog materijala, najveći procenat bio je u uzrastu do 15 godina (84,07%) i to iz brisa nosa (81,4%) i aspirata (7,51%). Izolati ambulantnog porekla zastupljeniji su od bolničkih (87%). Uočava se pojava sezonskih varijacija (82,05% u zimskom periodu). Od multirezistentnih izolata najčešći su fenotipovi rezistentni na penicilin, eritromicin i sulfametoksazol. Ispitivanje osetljivosti eksperimentalne grupe od 320 izolata S.pneumoniae, dalo je sledeće podatke: 68,2% izolata sa smanjenom osetljivošću prema penicilinu, 33,7% prema eritromicinu, 19,4% prema ceftriaksonu. Rezistencija na trimetoprim-sulfametoksazol je 66,5%. Nivo rezistencije i procenat visoko rezistentnih izolata (21,3%) svrstavaju nas u red zemalja sa najvišom stopom rezistencije na penicilin u Evropi. Nivo rezistencije na penicilin, eritromicin i trimetoprim-sulfametoksazol najviši je kod izolata iz nosilaštva (38%, 33,7% i 46%). Kod ceftriaksona je nivo rezistencije najviši kod bolničkih izolata (8%), a procenat rezistentnih (10%) i intermedijarnih (9,4%) izolata je na nivou mediteranskih i istočnoevropskih zemalja. Postoji značajno visok nivo rezistencije na trimetoprim-sulfametoksazol (59%).
Ključne reči: Streptococcus pneumoniae, antimikrobna rezistencija, pregled