The Alexander project 1998-2000: Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents

Michael R. Jacobs, David Felmingham, Peter C. Appelbaum, Reuben N. Grüneberg, S. Kariuki, K. Klugman, P. Urbášková, W. Hryniewicz, S. V. Sidorenko, H. Upková, U. Theuretzbacher, J. Verhaegen, J. Lemozy, H. Dabernat, F. Goldstein, M. Weber, M. Roussel-Delvallez, F. Jehl, H. Grimm, M. SeewaldH. Mauch, H. Giamarellou, G. C. Schito, E. E. Stobberingh, J. M. Cristino, E. Smyth, A. Gilleece, L. Fenelon, J. Liñares, J. Bille, D. Felmingham, S. Wing Hong, K. Yamaguchi, S. Kono, M. Inoue, M. Kaku, M. Yeo, R. Lin, N. Keller, A. M. Shibl, C. Mendes, J. Sifuentes-Osornio, F. Quiñones, L. E. Espinosa, G. Alvarez, R. Ma.Hinojosa, J. C. Tinoco, F. Ojeda, B. Grover, S. Gamble, M. Bay, D. Lamb, S. Munroe, G. Teskie, P. Wong, S. Cyprian, T. Cleary, M. Rivera, C. Watkins, H. Phillips, D. Prince, S. Walker, M. Beard, R. Carey, B. Droege, J. Tjhio, G. Denys, R. Cheek, G. Munier, B. Cato, W. Eppling, D. Cosmidis, D. DeMarco, L. McDermott, D. Schwartz, M. Welty, R. VanEnk, J. Loomis, L. McClure, L. Temme, S. Matthey, M. Hostetter, L. Buck, G. Overturf, R. Cammarata, S. Jenkins, L. Rosenstein, J. R. DiPersio, M. Jacobs, C. Hogan, B. Rourke, L. Kaufmann, J. Griffin, B. Smith, L. Brown, B. Cavagnolo, N. Lee, L. Mann, K. Korgenski

Research output: Contribution to journalArticle

440 Citations (Scopus)

Abstract

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 ≥ 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, β-lactamase production was 16.9%, whereas the prevalence of β-lactamase-negative, ampicillin-resistant strains was low (0.2%). β-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 β-lactams against M. catarrhalis. Both H. influenzae and M. catarrhalis were highly susceptible to the fluoroquinolones. 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.

Original languageEnglish (US)
Pages (from-to)229-246
Number of pages18
JournalJournal of Antimicrobial Chemotherapy
Volume52
Issue number2
DOIs
StatePublished - Aug 1 2003

Fingerprint

Community-Acquired Infections
Moraxella (Branhamella) catarrhalis
Anti-Infective Agents
Streptococcus pneumoniae
Respiratory Tract Infections
Haemophilus influenzae
Amoxicillin-Potassium Clavulanate Combination
Fluoroquinolones
Pharmacokinetics
Cefixime
Penicillin Resistance
cefdinir
Macrolides
Lactams
Ofloxacin
Ceftriaxone
Amoxicillin
Microbial Sensitivity Tests
Erythromycin
Ampicillin

Keywords

  • Antimicrobial resistance
  • Community-acquired respiratory tract infection
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Streptococcus pneumoniae
  • Surveillance

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

The Alexander project 1998-2000 : Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. / Jacobs, Michael R.; Felmingham, David; Appelbaum, Peter C.; Grüneberg, Reuben N.; Kariuki, S.; Klugman, K.; Urbášková, P.; Hryniewicz, W.; Sidorenko, S. V.; Upková, H.; Theuretzbacher, U.; Verhaegen, J.; Lemozy, J.; Dabernat, H.; Goldstein, F.; Weber, M.; Roussel-Delvallez, M.; Jehl, F.; Grimm, H.; Seewald, M.; Mauch, H.; Giamarellou, H.; Schito, G. C.; Stobberingh, E. E.; Cristino, J. M.; Smyth, E.; Gilleece, A.; Fenelon, L.; Liñares, J.; Bille, J.; Felmingham, D.; Wing Hong, S.; Yamaguchi, K.; Kono, S.; Inoue, M.; Kaku, M.; Yeo, M.; Lin, R.; Keller, N.; Shibl, A. M.; Mendes, C.; Sifuentes-Osornio, J.; Quiñones, F.; Espinosa, L. E.; Alvarez, G.; Ma.Hinojosa, R.; Tinoco, J. C.; Ojeda, F.; Grover, B.; Gamble, S.; Bay, M.; Lamb, D.; Munroe, S.; Teskie, G.; Wong, P.; Cyprian, S.; Cleary, T.; Rivera, M.; Watkins, C.; Phillips, H.; Prince, D.; Walker, S.; Beard, M.; Carey, R.; Droege, B.; Tjhio, J.; Denys, G.; Cheek, R.; Munier, G.; Cato, B.; Eppling, W.; Cosmidis, D.; DeMarco, D.; McDermott, L.; Schwartz, D.; Welty, M.; VanEnk, R.; Loomis, J.; McClure, L.; Temme, L.; Matthey, S.; Hostetter, M.; Buck, L.; Overturf, G.; Cammarata, R.; Jenkins, S.; Rosenstein, L.; DiPersio, J. R.; Jacobs, M.; Hogan, C.; Rourke, B.; Kaufmann, L.; Griffin, J.; Smith, B.; Brown, L.; Cavagnolo, B.; Lee, N.; Mann, L.; Korgenski, K.

In: Journal of Antimicrobial Chemotherapy, Vol. 52, No. 2, 01.08.2003, p. 229-246.

Research output: Contribution to journalArticle

Jacobs, MR, Felmingham, D, Appelbaum, PC, Grüneberg, RN, Kariuki, S, Klugman, K, Urbášková, P, Hryniewicz, W, Sidorenko, SV, Upková, H, Theuretzbacher, U, Verhaegen, J, Lemozy, J, Dabernat, H, Goldstein, F, Weber, M, Roussel-Delvallez, M, Jehl, F, Grimm, H, Seewald, M, Mauch, H, Giamarellou, H, Schito, GC, Stobberingh, EE, Cristino, JM, Smyth, E, Gilleece, A, Fenelon, L, Liñares, J, Bille, J, Felmingham, D, Wing Hong, S, Yamaguchi, K, Kono, S, Inoue, M, Kaku, M, Yeo, M, Lin, R, Keller, N, Shibl, AM, Mendes, C, Sifuentes-Osornio, J, Quiñones, F, Espinosa, LE, Alvarez, G, Ma.Hinojosa, R, Tinoco, JC, Ojeda, F, Grover, B, Gamble, S, Bay, M, Lamb, D, Munroe, S, Teskie, G, Wong, P, Cyprian, S, Cleary, T, Rivera, M, Watkins, C, Phillips, H, Prince, D, Walker, S, Beard, M, Carey, R, Droege, B, Tjhio, J, Denys, G, Cheek, R, Munier, G, Cato, B, Eppling, W, Cosmidis, D, DeMarco, D, McDermott, L, Schwartz, D, Welty, M, VanEnk, R, Loomis, J, McClure, L, Temme, L, Matthey, S, Hostetter, M, Buck, L, Overturf, G, Cammarata, R, Jenkins, S, Rosenstein, L, DiPersio, JR, Jacobs, M, Hogan, C, Rourke, B, Kaufmann, L, Griffin, J, Smith, B, Brown, L, Cavagnolo, B, Lee, N, Mann, L & Korgenski, K 2003, 'The Alexander project 1998-2000: Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents', Journal of Antimicrobial Chemotherapy, vol. 52, no. 2, pp. 229-246. https://doi.org/10.1093/jac/dkg321
Jacobs, Michael R. ; Felmingham, David ; Appelbaum, Peter C. ; Grüneberg, Reuben N. ; Kariuki, S. ; Klugman, K. ; Urbášková, P. ; Hryniewicz, W. ; Sidorenko, S. V. ; Upková, H. ; Theuretzbacher, U. ; Verhaegen, J. ; Lemozy, J. ; Dabernat, H. ; Goldstein, F. ; Weber, M. ; Roussel-Delvallez, M. ; Jehl, F. ; Grimm, H. ; Seewald, M. ; Mauch, H. ; Giamarellou, H. ; Schito, G. C. ; Stobberingh, E. E. ; Cristino, J. M. ; Smyth, E. ; Gilleece, A. ; Fenelon, L. ; Liñares, J. ; Bille, J. ; Felmingham, D. ; Wing Hong, S. ; Yamaguchi, K. ; Kono, S. ; Inoue, M. ; Kaku, M. ; Yeo, M. ; Lin, R. ; Keller, N. ; Shibl, A. M. ; Mendes, C. ; Sifuentes-Osornio, J. ; Quiñones, F. ; Espinosa, L. E. ; Alvarez, G. ; Ma.Hinojosa, R. ; Tinoco, J. C. ; Ojeda, F. ; Grover, B. ; Gamble, S. ; Bay, M. ; Lamb, D. ; Munroe, S. ; Teskie, G. ; Wong, P. ; Cyprian, S. ; Cleary, T. ; Rivera, M. ; Watkins, C. ; Phillips, H. ; Prince, D. ; Walker, S. ; Beard, M. ; Carey, R. ; Droege, B. ; Tjhio, J. ; Denys, G. ; Cheek, R. ; Munier, G. ; Cato, B. ; Eppling, W. ; Cosmidis, D. ; DeMarco, D. ; McDermott, L. ; Schwartz, D. ; Welty, M. ; VanEnk, R. ; Loomis, J. ; McClure, L. ; Temme, L. ; Matthey, S. ; Hostetter, M. ; Buck, L. ; Overturf, G. ; Cammarata, R. ; Jenkins, S. ; Rosenstein, L. ; DiPersio, J. R. ; Jacobs, M. ; Hogan, C. ; Rourke, B. ; Kaufmann, L. ; Griffin, J. ; Smith, B. ; Brown, L. ; Cavagnolo, B. ; Lee, N. ; Mann, L. ; Korgenski, K. / The Alexander project 1998-2000 : Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. In: Journal of Antimicrobial Chemotherapy. 2003 ; Vol. 52, No. 2. pp. 229-246.
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title = "The Alexander project 1998-2000: Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents",
abstract = "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 ≥ 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, β-lactamase production was 16.9{\%}, whereas the prevalence of β-lactamase-negative, ampicillin-resistant strains was low (0.2{\%}). β-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 β-lactams against M. catarrhalis. Both H. influenzae and M. catarrhalis were highly susceptible to the fluoroquinolones. 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 = "Antimicrobial resistance, Community-acquired respiratory tract infection, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Surveillance",
author = "Jacobs, {Michael R.} and David Felmingham and Appelbaum, {Peter C.} and Gr{\"u}neberg, {Reuben N.} and S. Kariuki and K. Klugman and P. Urb{\'a}škov{\'a} and W. Hryniewicz and Sidorenko, {S. V.} and H. Upkov{\'a} and U. Theuretzbacher and J. Verhaegen and J. Lemozy and H. Dabernat and F. Goldstein and M. Weber and M. Roussel-Delvallez and F. Jehl and H. Grimm and M. Seewald and H. Mauch and H. Giamarellou and Schito, {G. C.} and Stobberingh, {E. E.} and Cristino, {J. M.} and E. Smyth and A. Gilleece and L. Fenelon and J. Li{\~n}ares and J. Bille and D. Felmingham and {Wing Hong}, S. and K. Yamaguchi and S. Kono and M. Inoue and M. Kaku and M. Yeo and R. Lin and N. Keller and Shibl, {A. M.} and C. Mendes and J. Sifuentes-Osornio and F. Qui{\~n}ones and Espinosa, {L. E.} and G. Alvarez and R. Ma.Hinojosa and Tinoco, {J. C.} and F. Ojeda and B. Grover and S. Gamble and M. Bay and D. Lamb and S. Munroe and G. Teskie and P. Wong and S. Cyprian and T. Cleary and M. Rivera and C. Watkins and H. Phillips and D. Prince and S. Walker and M. Beard and R. Carey and B. Droege and J. Tjhio and G. Denys and R. Cheek and G. Munier and B. Cato and W. Eppling and D. Cosmidis and D. DeMarco and L. McDermott and D. Schwartz and M. Welty and R. VanEnk and J. Loomis and L. McClure and L. Temme and S. Matthey and M. Hostetter and L. Buck and G. Overturf and R. Cammarata and S. Jenkins and L. Rosenstein and DiPersio, {J. R.} and M. Jacobs and C. Hogan and B. Rourke and L. Kaufmann and J. Griffin and B. Smith and L. Brown and B. Cavagnolo and N. Lee and L. Mann and K. Korgenski",
year = "2003",
month = "8",
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doi = "10.1093/jac/dkg321",
language = "English (US)",
volume = "52",
pages = "229--246",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
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}

TY - JOUR

T1 - The Alexander project 1998-2000

T2 - Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents

AU - Jacobs, Michael R.

AU - Felmingham, David

AU - Appelbaum, Peter C.

AU - Grüneberg, Reuben N.

AU - Kariuki, S.

AU - Klugman, K.

AU - Urbášková, P.

AU - Hryniewicz, W.

AU - Sidorenko, S. V.

AU - Upková, H.

AU - Theuretzbacher, U.

AU - Verhaegen, J.

AU - Lemozy, J.

AU - Dabernat, H.

AU - Goldstein, F.

AU - Weber, M.

AU - Roussel-Delvallez, M.

AU - Jehl, F.

AU - Grimm, H.

AU - Seewald, M.

AU - Mauch, H.

AU - Giamarellou, H.

AU - Schito, G. C.

AU - Stobberingh, E. E.

AU - Cristino, J. M.

AU - Smyth, E.

AU - Gilleece, A.

AU - Fenelon, L.

AU - Liñares, J.

AU - Bille, J.

AU - Felmingham, D.

AU - Wing Hong, S.

AU - Yamaguchi, K.

AU - Kono, S.

AU - Inoue, M.

AU - Kaku, M.

AU - Yeo, M.

AU - Lin, R.

AU - Keller, N.

AU - Shibl, A. M.

AU - Mendes, C.

AU - Sifuentes-Osornio, J.

AU - Quiñones, F.

AU - Espinosa, L. E.

AU - Alvarez, G.

AU - Ma.Hinojosa, R.

AU - Tinoco, J. C.

AU - Ojeda, F.

AU - Grover, B.

AU - Gamble, S.

AU - Bay, M.

AU - Lamb, D.

AU - Munroe, S.

AU - Teskie, G.

AU - Wong, P.

AU - Cyprian, S.

AU - Cleary, T.

AU - Rivera, M.

AU - Watkins, C.

AU - Phillips, H.

AU - Prince, D.

AU - Walker, S.

AU - Beard, M.

AU - Carey, R.

AU - Droege, B.

AU - Tjhio, J.

AU - Denys, G.

AU - Cheek, R.

AU - Munier, G.

AU - Cato, B.

AU - Eppling, W.

AU - Cosmidis, D.

AU - DeMarco, D.

AU - McDermott, L.

AU - Schwartz, D.

AU - Welty, M.

AU - VanEnk, R.

AU - Loomis, J.

AU - McClure, L.

AU - Temme, L.

AU - Matthey, S.

AU - Hostetter, M.

AU - Buck, L.

AU - Overturf, G.

AU - Cammarata, R.

AU - Jenkins, S.

AU - Rosenstein, L.

AU - DiPersio, J. R.

AU - Jacobs, M.

AU - Hogan, C.

AU - Rourke, B.

AU - Kaufmann, L.

AU - Griffin, J.

AU - Smith, B.

AU - Brown, L.

AU - Cavagnolo, B.

AU - Lee, N.

AU - Mann, L.

AU - Korgenski, K.

PY - 2003/8/1

Y1 - 2003/8/1

N2 - 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 ≥ 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, β-lactamase production was 16.9%, whereas the prevalence of β-lactamase-negative, ampicillin-resistant strains was low (0.2%). β-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 β-lactams against M. catarrhalis. Both H. influenzae and M. catarrhalis were highly susceptible to the fluoroquinolones. 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.

AB - 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 ≥ 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, β-lactamase production was 16.9%, whereas the prevalence of β-lactamase-negative, ampicillin-resistant strains was low (0.2%). β-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 β-lactams against M. catarrhalis. Both H. influenzae and M. catarrhalis were highly susceptible to the fluoroquinolones. 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.

KW - Antimicrobial resistance

KW - Community-acquired respiratory tract infection

KW - Haemophilus influenzae

KW - Moraxella catarrhalis

KW - Streptococcus pneumoniae

KW - Surveillance

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U2 - 10.1093/jac/dkg321

DO - 10.1093/jac/dkg321

M3 - Article

C2 - 12865398

AN - SCOPUS:0043156138

VL - 52

SP - 229

EP - 246

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

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ER -