Journal of Antimicrobial Chemotherapy (1999) 44, 749-759
© 1999 The British Society for Antimicrobial Chemotherapy
Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in the United States, 1997–1998
a MRL Pharmaceutical Services, Brentwood, TN, USA b Utrecht, The Netherlands c 13665 Dulles Technology Drive, Suite 200, Herndon, VA 20171-4603 d Ortho-McNeil Pharmaceutical, Raritan, NJ, USA
A national antimicrobial resistance surveillance study was conducted from December
1997 to May 1998 to determine the prevalence of antimicrobial resistance in 6620 clinical
isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In this centralized study, which involved 163 institutions located in
43 states, we determined MICs for representatives of five antimicrobial classes: ß-lactams
(penicillin, co-amoxiclav, cefuroxime, ceftriaxone), macrolides (azithromycin, clarithromycin),
co-trimoxazole, glycopeptides (vancomycin) and fluoroquinolones (levofloxacin). In most S.
pneumoniae isolates, all antimicrobials were to be found active, but amongst
penicillin-resistant isolates (MICs 
2 mg/L), resistance to other ß-lactams, macrolides
and co-trimoxazole was common. For vancomycin and levofloxacin, however, activity was not
associated with penicillin resistance. The prevalence of penicillin-nonsusceptible (intermediate
and resistant) pneumococci was highest in the South Atlantic (44%) and East South Central
(43%) regions and lowest in the Mid-Atlantic (28%) and New England (28%) regions.
Resistance to ß-lactams, macrolides and co-trimoxazole was more commonly found amongst
respiratory isolates than blood isolates and in strains from patients 
12 years old than from
older patients. ß-lactamase, which was detected in 33% of H. influenzae and 92%
of M. catarrhalis strains, did not affect the activity of the ß-lactams under study
other than ampicillin. Certain agents, such as vancomycin and the fluoroquinolones, remain
highly active, and well-designed surveillance systems that monitor MIC distributions would be
needed to detect a potential for reduced susceptibility. In addition, surveillance programmes
should be designed to collect information about associated resistance as well as differences in
prevalence associated with region, specimen source and patient age.
* Corresponding author: Tel: +1-703-480-2500; Fax +1-703-480-2670; E-mail: dsahm{at}thetsn.com
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