JAC Advance Access published online on July 15, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg321
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Pathology,
Case Western Reserve University and University Hospitals of Cleveland,
11100 Euclid Ave, Cleveland, OH 44106
* Corresponding author. E-mail: mrj6{at}po.cwru.edu.
Received 24 May 2002
; revised 30 April 2002
; accepted 7 May 2003
Objectives: The Alexander Project
is a continuing surveillance study, begun in 1992, examining the
susceptibility of pathogens involved in adult community-acquired
respiratory tract infections (CARTI) to a range of antimicrobial
agents. Materials and methods: This study tested the
susceptibility of isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella
catarrhalis collected between 1998 and 2000 to 23 antimicrobials. Minimum
inhibitory concentrations of agents were determined using the broth
microdilution method and interpreted according to NCCLS and pharmacokinetic/pharmacodynamic
(PK/PD) breakpoints. Results: In total, 8882 isolates of S.
pneumoniae, 8523 isolates of H. influenzae and
874 isolates of M. catarrhalis were collected during
1998-2000 from centres in 26 countries. The world-wide
prevalence of penicillin resistance (penicillin MICs Conclusions: These data demonstrate the continued
evolution of and geographical variation in bacterial resistance
and highlight the need for appropriate prescribing of antimicrobials
in CARTI, using agents with adequate activity, based on local susceptibility
profiles and PK/PD parameters.
Keywords: surveillance, antimicrobial resistance, community-acquired
respiratory tract infection, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
The Alexander Project 1998-2000: susceptibility
of pathogens isolated from community-acquired respiratory tract
infection to commonly used antimicrobial agents
2 GR Micro, London, UK
3 Hershey Medical Center, Hershey, PA, USA
2
mg/L) in isolates of S. pneumoniae was 18.2% over
the study period, and the prevalence of macrolide resistance (erythromycin
MICs 1 mg/L) in this pathogen was
24.6%. Over the study period, macrolide resistance exceeded
penicillin resistance in 19 of the 26 countries included in the
study. Of the non-fluoroquinolone agents, the only oral agents to
which over 90% of S. pneumoniae isolates
were susceptible at both NCCLS and PK/PD breakpoints were amoxicillin
(95.1%) and co-amoxiclav (95.5-97.9%). The
prevalence of fluoroquinolone-resistant S. pneumoniae (ofloxacin
MICs 8 mg/L) was 1.1%. Gemifloxacin
was the most potent fluoroquinolone tested against S.
pneumoniae (99.9% susceptible). In isolates of H.
influenzae, 
-lactamase production
was 16.9%, whereas the prevalence of -lactamase-negative, ampicillin-resistant
strains was low (0.2%). -Lactamase
production in M. catarrhalis world-wide remained high
over the period studied (92.1%). Using PK/PD breakpoints,
the most active non-fluoroquinolone agents against H.
influenzae were ceftriaxone (100% susceptible), cefixime
(99.8%) and co-amoxiclav (98.1-99.6%). Co-amoxiclav,
cefdinir and cefixime (100%) were the most active -lactams
against M. catarrhalis. Both H.
influenzae and M. catarrhalis were highly
susceptible to the fluoroquinolones.
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