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JAC Advance Access published online on November 5, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh458
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received June 3, 2004
Revised September 7, 2004
Accepted September 12, 2004

Original article

Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe

Nienke Bruinsma 1*, Karl G. Kristinsson 2, Stef Bronzwaer 3, Paul Schrijnemakers 1, John Degener 4, Edine Tiemersma 1, Waleria Hryniewicz 5, Jos Monen 1, Hajo Grundmann 1, and on behalf of EARSS participants

1 Centre for Infectious Disease Epidemiology (CIE--Pb. 75), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
2 Department of Microbiology, Landspitali University Hospital, Reykjavik, Iceland
3 Directorate Public Health, European Commission, Luxembourg
4 Department of Medical Microbiology, University Hospital Groningen, Groningen, The Netherlands
5 National Institute of Public Health, Warsaw, Poland

* To whom correspondence should be addressed.
Nienke Bruinsma, E-mail: nienke.bruinsma{at}rivm.nl


  Abstract

Objectives: To forecast trends in resistance to penicillin and erythromycin among Streptococcus pneumoniae in Europe.

Methods: Since 1999, the European Antimicrobial Resistance Surveillance System (EARSS) has collected routine antimicrobial susceptibility test results of S. pneumoniae. To observe and predict changes of reduced susceptibility over time, we used a multinomial logistic regression model.

Results: Large variations in penicillin and erythromycin non-susceptibility were observed between countries, and reduced susceptibility to erythromycin (17%) has become more frequent than reduced susceptibility to penicillin (10%) in Europe overall. An overall decrease in single penicillin non-susceptibility, but an increase in dual non-susceptibility was observed, indicating a shift of single penicillin to combined non-susceptibility with erythromycin. By 2006, the proportion of single erythromycin and dual non-susceptibility could increase to as much as 20.4% and 8.9%, respectively.

Conclusions: Our results indicate that appropriately dosed {beta}-lactams for empirical therapy are still the treatment of choice, and that macrolides should be used with prudence.

Keywords: public health; antimicrobial resistance; antimicrobial use.
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