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
