JAC Advance Access originally published online on September 1, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 695-698
© 2003 The British Society for Antimicrobial Chemotherapy
High levels of multiple antibiotic resistance among 938 Haemophilus influenzae type b meningitis isolates from Cuba (1990–2002)
1 Laboratorio Nacional de Referencia de Haemophilus, Instituto de Medicina Tropical ‘Pedro Kouri’, La Habana, Cuba; 2 Centro Nacional de Microbiología, Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Carretera Pozuelo a Majadahonda, 28220. Majadahonda, Madrid, Spain
Received 31 October 2002; returned 2 April 2003; revised 3 April 2003; accepted 29 June 2003
Objectives: A national surveillance study to determine antimicrobial susceptibility in Haemophilus influenzae type b isolated from cerebrospinal fluid was carried out in Cuba from 1990 to 2002.
Methods: Susceptibility to ampicillin, co-amoxiclav, cefotaxime, ceftriaxone, co-trimoxazole, tetracycline, chloramphenicol and rifampicin was tested by the microdilution method according to the NCCLS guidelines.
Results: The 34 participating laboratories recovered 938 consecutive, non-identical isolates. All the isolates were retrieved from children aged <5 years. The mean number of isolates collected by year in the pre-vaccination era (1990–1998) was 93; after vaccination, 57 isolates were reported in 1999, 31 in 2000, four in 2001 and five in 2002. Resistance to ampicillin, co-trimoxazole, tetracycline and chloramphenicol was 46.3% (all ß-lactamase-positive), 51.3%, 33.2% and 44.0%, respectively. Ampicillin-resistant ß-lactamase-negative strains were not detected. All strains were susceptible to co-amoxiclav, cefotaxime, ceftriaxone and rifampicin. Ampicillin resistance was strongly associated with resistance to tetracycline, co-trimoxazole and chloramphenicol (P < 0.001). Multidrug resistance was present in 43.8% of isolates. The most prevalent phenotype was resistance to ampicillin/chloramphenicol/tetracycline/co-trimoxazole, which was detected in 29.2% of strains overall. An increase in the prevalence of resistance to these antibiotics was observed from 1990 to 2000 in the range 40.7%–54.8% for ampicillin, 40.1%–51.6% for chloramphenicol, 45.4%–58.1% for co-trimoxazole and 23%–45.2% for tetracycline.
Conclusions: In Cuba, the widespread vaccination against Haemophilus influenzae type b prevented a large number of meningitis cases in children caused by strains resistant to multiple antibiotics.
Keywords: Haemophilus influenzae type b, antimicrobial resistance, meningitis, conjugate vaccines
* Corresponding author. Tel: +34-91-509-79-01; Fax: +34-91-509-79-66; E-mail: jcampos{at}isciii.es
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