Infect Chemother.  2003 Oct;35(5):298-305.

Clinical Impact of Antimicrobial Resistance among Invasive Pneumococcal Pathogens in Asian Countries:Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study

• Jung SI
• Ki HK
• Son JS
• Ko KS
• Kim NY
• Chang HH
• Oh WS
• Peck KR
• Lee NY
• Kim SW
• Lee H
• Kim YS
• Song JH

Abstract

BACKGROUND: Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries.
METHODS
In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality.
RESULTS
A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIC90s for penicillin ranged from 0.03 (India) to 4.0 microgram/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains.
CONCLUSION
Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.

Keyword

Pneumococcal disease; In vitro resistance; Clinical impact; Mortality

MeSH Terms

Anti-Infective Agents
Asian Continental Ancestry Group*
Bacteremia
Humans
Macrolides
Meningitis
Meningitis, Pneumococcal
Mortality
Otitis Media
Penicillins
Pneumococcal Infections
Pneumonia
Pneumonia, Pneumococcal
Prevalence
Prospective Studies
Risk Factors
Taiwan
Vietnam
Anti-Infective Agents
Macrolides
Penicillins