Journal of Antimicrobial Chemotherapy, Vol 40, 11-18, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
CE Goldsmith, JE Moore and PG Murphy
The first case reports of infection with penicillin-resistant pneumococci
(PRP, MIC > 0.1 mg/L) and multidrug-resistant pneumococci were made in
Australia in 1967 and South Africa in 1977, respectively. Since this time
these organisms have spread to become a worldwide problem. In Europe PRP
prevalence rates of up to 40% have been reported from Spain and 58% from
Hungary, although there has been considerable national, regional and local
variation in these figures. Until recently the UK was considered to have
low prevalence of PRP. As recently as 1990, 100% of 7255 strains of
pneumococci from 61 centres across the UK were found to be penicillin
sensitive. However, there have now been several reports of significant and
rising levels of resistance nationwide. Erythromycin resistance has also
risen from 2.8% to 8.6% between 1990 and 1995 in England and Wales. At the
Northern Ireland Public Health Laboratory (NIPHL) 3171 strains of
pneumococci were examined using the oxacillin screening test between 1988
and 1995, during which time the annual rate of penicillin resistance was
found to increase from <1% to 10.6%. The proportion of PRP with
high-level resistance (MIC > 1 mg/L) increased from 0% to 36% and levels
of PRP cross-resistance to cephalosporins and ciprofloxacin were 89% and
78%, respectively, which are amongst the highest in the UK. Similar rates
of penicillin resistance have now been reported from several geographically
disparate regions in the UK including Liverpool, Manchester and London. The
number of laboratories in England and Wales reporting the isolation of PRPs
to the Central Public Health Laboratory increased from 23 (3%) in 1987 to
72 (21%) in 1991 and a recent study from this reference laboratory showed
that the prevalence of pneumococcal resistance to penicillin had increased
2.5-fold between 1990 and 1995. Clearly both PRP and multidrug-resistant
pneumococci are increasing in prevalence in the UK, and this increase is
likely to continue. A recent model of the evolution of national PRP
prevalence rates describes a slow emergence phase, followed by an
exponential growth phase of around 10 years reaching a stationary phase
when the proportion of PRP reaches 50%. It is possible that the UK is
currently at the beginning of the exponential growth phase of PRP. This has
implications for the future treatment of pneumococcal infections in this
country and emphasizes the need for new anti-pneumococcal agents. The new
quinolone grepafloxacin, which has an MIC90 of 0.25 mg/L for pneumococci,
may represent a future alternative oral treatment for multidrug-resistant
strains. The activity of this antibiotic against 70 PRPs is compared with
that of two other quinolones and macrolides.
ORIGINAL ARTICLES
Pneumococcal resistance in the UK
Bacteriology Department and Northern Ireland Public Health Laboratory, Belfast City Hospital, UK.
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