Background Fluoroquinolones are now recommended for the treatmentof respiratory tract infections due to Streptococcus pneumoniae,particularly when the isolates are resistant to ß-lactamantibiotics. Although pneumococci with reduced susceptibilityto fluoroquinolones have been identified, their prevalence hasnot been determined in a defined population.
Methods We performed susceptibility testing on 7551 isolatesof S. pneumoniae obtained from surveillance in Canada in 1988and from 1993 to 1998. Pneumococci with reduced susceptibilityto fluoroquinolones (defined as a minimal inhibitory concentrationof ciprofloxacin of at least 4 µg per milliliter) werefurther characterized. We also examined antibiotic prescriptionsdispensed in Canadian retail pharmacies.
Results Between 1988 and 1997, fluoroquinolone prescriptionsincreased from 0.8 to 5.5 per 100 persons per year. The prevalenceof pneumococci with reduced susceptibility to fluoroquinolonesincreased from 0 percent in 1993 to 1.7 percent in 1997 and1998 (P=0.01). Among adults, the prevalence increased from 1.5percent in 1993 and 1994 combined to 2.9 percent in 1997 and1998 combined. The prevalence was higher in isolates from olderpatients (2.6 percent among those 65 years of age or older vs.1.0 percent among those 15 to 64 years of age, P<0.001) andamong those from Ontario (1.5 percent, vs. 0.4 percent amongthose from the rest of Canada; P< 0.001). Fluoroquinoloneuse was greatest among the elderly and in Ontario. The 75 isolates(17 serotypes) of pneumococci with reduced susceptibility tofluoroquinolones were submitted by 40 laboratories in eightprovinces. Reduced susceptibility to fluoroquinolones was associatedwith resistance to penicillin.
Conclusions The prevalence of pneumococci with reduced susceptibilityto fluoroquinolones is increasing in Canada, probably as a resultof selective pressure from the increased use of fluoroquinolones.
Source Information
From the Departments of Medicine (D.K.C., A.M., D.E.L.) and Laboratory Medicine and Pathobiology (A.M., J.C.A., D.E.L.), University of Toronto; and the Departments of Microbiology, Mount Sinai Hospital and Toronto Hospital (A.M., J.C.A., D.E.L.) — all in Toronto.
Address reprint requests to Dr. Low at the Department of Microbiology, Mount Sinai Hospital, 600 University Ave., Toronto, ON M5G 1X5, Canada, or at dlow{at}mtsinai.on.ca.
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Chaitram, J. M., Jevitt, L. A., Lary, S., Tenover, F. C.
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Johnson, C. N., Benjamin, W. H. Jr., Moser, S. A., Hollingshead, S. K., Zheng, X., Crain, M. J., Nahm, M. H., Waites, K. B.
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Gonzales, R.
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Brown, R. B., Iannini, P., Gross, P., Kunkel, M.
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47: 1257-1261
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de la Campa, A. G., Ferrandiz, M.-J., Tubau, F., Pallares, R., Manresa, F., Linares, J.
(2003). Genetic Characterization of Fluoroquinolone-Resistant Streptococcus pneumoniae Strains Isolated during Ciprofloxacin Therapy from a Patient with Bronchiectasis. Antimicrob. Agents Chemother.
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Fogarty, C. M., Kohno, S., Buchanan, P., Aubier, M., Baz, M.
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Steinman, M. A., Gonzales, R., Linder, J. A., Landefeld, C. S.
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Yang, S., Clayton, S. R., Zechiedrich, E. L.
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El Kholy, A., Baseem, H., Hall, G. S., Procop, G. W., Longworth, D. L.
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